On 24th July, the same day that marked two years since the last case of polio on the continent of Africa, news arrived of two children not only contracting polio and becoming paralysed in Borno state, Nigeria. It was a huge disappointment, but one that can serve as something of a reality check for global health. It’s not through lack of funding or attention that the world has missed various polio eradication targets since the programme started out in 1988. It’s a genuinely difficult mission. Here are some reasons why:
- Eradication may not be a goal that everyone shares
Global health programmes are costly, require high level political commitment and typically operate through massive bodies such as the World Health Organization and UNICEF. By their nature, these initiatives to follow global political priorities, rather than national or local ones, which can generate tension between global financing and local needs. This has already been seen in Nigeria, where recent research revealed that communities had knowingly refused polio vaccines en masse in order to bargain with government authorities for other – in their view more vital – services such as usable roads, electricity and schools.
- As long as people fight, disease will thrive
Polio eradication presents a key challenge: to vaccinate every single children at risk, across the whole world, including those in vulnerable areas. For obvious reasons this is not always possible, and over the past 10 years the polio eradication project has been disrupted multiple times by conflicts in Pakistan, Afghanistan, and now by Boko Haram in Nigeria. Occasionally, when combatants hope to become an officially recognised government, polio vaccination can be negotiated. But with the rise of extremists like Daesh and others, this possibility seems less and less likely. Instead vaccinators must use “hit and run” tactics or work in secret, which puts their lives at risk and often prohibits vaccinating all children in need.
- Often eradication is not just a people problem
Polio can live in feces for many weeks, and doesn’t produce symptoms in 95% of cases, allowing it to spread “silently” from person to person through infected sewage. This means that the environment is an important and complex component of eradication, especially in areas where sanitation is inadequate. To make sure a country is really polio free, testing samples from the environment and waiting for long periods are necessary and – as we saw recently in Nigeria – may still not be able to capture the real picture.
The environment can play a larger role in obstructing eradication of other kinds of diseases. For example, hopes for the eradication of Guinea orm disease have recently been adjusted after the discovery of the presence of the worm in wild dogs. Sadly, canines aren’t great performers when it comes to the main method of Guinea worm prevention – drinking water through a filter.
Many were disappointed and confused by this recent blow to aspirations for polio eradication, which seemed much closer at hand than it really was. Of course we should continue working for a world free from polio, Guinea worm and other preventable diseases, but this development is a reminder that we must be realistic. Disease eradication is a multi-layered challenge, and only by understanding and accepting this can we set expectations at the right level to maintain funding, detect new cases and learn from mistakes before they turn into substantial setbacks.
Featured image © CDC Global
Emily Loud is co-founder and communications manager at The Diagonal, and has a master’s in Global Health and Development from UCL. She is particularly interested in the “demand-side” of health interventions and global health security. Emily is currently based in London, doing communications for two global health and development organisations, shoehorning in research when she can find a moment. You can find her on Twitter @eloudness