New York Times
http://www.nytimes.com/
Accessed 10 May 2014
The Global Polio Threat, Back Again
By THE EDITORIAL BOARD
[Full text]

Just when it looked as if polio was headed toward eradication around the world, the disease is once again on the march.

The World Health Organization declared on Monday that the spread of polio virus to new countries in 2014 had become “a public health emergency of international concern” that warranted aggressive measures to control transmission. It was timely advice on the eve of what is typically the onset of the high season for transmitting the virus.

Only two infectious diseases have ever been eradicated — smallpox and rinderpest, a viral cattle disease — but there were expectations that polio would soon join them. That hope dimmed this year when three countries where the polio virus was thought to be bottled up allowed the virus to be carried beyond their borders.

Pakistan, which has the largest number of domestic cases largely because Taliban factions have forbidden vaccinations in conservative tribal areas and attacked health care workers elsewhere, has spread the virus to neighboring Afghanistan. Syria, rived by civil conflict, has spread cases to neighboring Iraq, and Cameroon has spread cases to neighboring Equatorial Guinea.

The W.H.O. said that residents of these three countries should be vaccinated before traveling abroad and be provided with internationally recognized certificates as proof. The agency has no enforcement powers, but under a 2007 global treaty all three countries are supposedly required to ensure that the recommended steps are taken.

The W.H.O. also named seven other nations as infected with the polio virus but not yet exporting it. These included Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria. It said these nations should “encourage” their citizens to follow the same procedures. And it urged all nations infected with polio to carry out more vigorous immunization campaigns.

The total number of cases in 2014 is small — 68 as of April 30, up from 24 by that date in 2013. This is far less than the hundreds of thousands of people who were crippled or killed by the disease every year even three decades ago. But experts are concerned that the virus could now spread to a large number of polio-free nations that are torn by conflicts or have very fragile public health systems. In the meantime, vigorous vaccination efforts, backed by public and private donors, are clearly required in any nation with polio cases.

Washington Post
http://www.washingtonpost.com/
Accessed 10 May 2014
The Post’s View
What’s behind the WHO’s emergency declaration on the spread of wild polio
By Editorial Board, Published: May 8
[Full text]

THE WORD “emergency” was emphasized in the headlines about the World Health Organization’s May 5 declaration on the spread of wild poliovirus, and rightly so. The high season for the spread of the virus is approaching, and the WHO emergency measures are aimed at deterring transmission of the virus and protecting the hard-won gains of recent years.

Actually, the polio situation this year has been promising in some places. In Nigeria, where the virus has been endemic, only two cases have been reported this year, following declines last year; in Afghanistan there has been some spillover from Pakistan but only one case of the endemic virus in more than a year. Dr. Bruce Aylward, assistant director-general of WHO for polio, said that in both countries “we’re at a level of control there that we’ve never seen” before. In Syria, where a civil war has raised concerns about the difficulty of carrying out vaccination campaigns, the last case was in January.

The dark heart of the polio scourge lies in Pakistan. According to Dr. Aylward, of the 74 cases of polio due to the wild poliovirus this year, 59 have been reported from Pakistan and within Pakistan; 46 of those 59 were from the Federally Administered Tribal Areas; and 40 of those from just one agency or semi-autonomous administrative unit. By contrast, no other country this year has reported more than Afghanistan’s four cases, and three of those came from Pakistan.

What caused the WHO to sound the alarm — this is only the second such emergency declared; the first was for the H1N1 influenza pandemic in 2011 — is the fear that travelers are spreading the wild poliovirus, threatening to export it to nations where it does not now exist. Many populations are at high risk of infection due to fragile states, war and broken immunization systems. The WHO estimates that about 60 percent of the cases last year were due to international travel. Although the virus mainly strikes young people, there was evidence that adult travelers were contributing to the spread.

The target of the global polio eradication program has been to stop transmission by this year, but Dr. Aylward said Pakistan is the one country that is really “off track.” Attacks on polio vaccination workers there have stymied vaccination campaigns, opening a door to the highly contagious disease. The government has made some efforts in Peshawar to beef up security and resume vaccination campaigns, but it is not enough.

The WHO has called for travel restrictions in Pakistan, Syria, Cameroon and elsewhere to stop the spread by those who fly or travel by land. It may be tempting for the affected nations to shrug and take half-steps, but the threat of polio spreading is very real and poses a danger not only for their own populations but also for peoples far beyond.