Polio in Syria and the spread of a
single case to Iraq "signal an absolute failure of the global eradication
effort," according to an expert quoted by the New York Times.
A Guardian headline described the new obstacles as the
"most challenging in history." Even global health bloggers concluded eradication is "further
off than it had been just a year ago." Actually, eradication is closer
than ever.
Outbreaks, while tragic and not to be taken lightly, are a spectacular side show. There are already five in 2014, equaling the total for all of 2013. But 19 outbreaks hammered the eradication project in 2009, clearly short of any breaking point. Polio coverage emphasizing outbreaks has completely missed that two of the three remaining endemic countries, Nigeria and Afghanistan, have seen only a single indigenous case of the disease this year.
Nigeria has been steadily raising vaccination coverage in key high risk areas, accounting for the drop in cases. If coverage continues to climb, transmission might be interrupted and polio eliminated from the country. High season, which generally begins in July and extends through September, will be a major test. Any number of factors might derail progress. Still, today polio teeters closer than ever to extinction in Nigeria.
In Afghanistan, all polio cases this year have been in eastern in provinces near Pakistan, and sequencing shows similarity to strains from from across the border.
Pakistan performs much worse than the
other two endemic nations, but despite even the targeting and killing of polio
vaccinators, Pakistan's case level is not extraordinarily high by historical
standards.
Choking off endemic sources stops outbreaks from occurring to begin with. Outbreaks plummeted after India knocked out polio at the end of 2010. The Global Polio Eradication Initiative has stamped out every single polio outbreak there has ever been; today there are five more that must also be dispatched. In Syria, the 41 cases so far and emergence of a single related case in Iraq is concerning. But a 2013 outbreak hit Somalia with 194 cases and spread a further two dozen cases to Kenya and Ethiopia. Nonetheless, that fire is now out and probably will remain far larger and thus more difficult than reckoning with the smaller (to this point) recrudescence in Syria.
War in Syria undoubtedly complicates vaccination efforts there. But in Somalia, kidnappings and killings forced Médecins Sans Frontières to leave the country in the middle of the polio outbreak after more than two decades in the country.
Polio eradication, in retrospect, is not a good idea. "Vertical," single-disease campaigns are inferior to building health systems, and polio has never been as deadly as say, diarrhea. Eradication is extremely costly.
Regardless, however, polio eradication is succeeding. Local news reporting on fires and gunshots distorts the reality of less crime and fewer fires. Similarly, despite media coverage, eradication of polio has never been so near.