The dramatic return of polio to Kazakhstan, the Russian Federation, Tajikistan and Turkmenistan last year – countries which had been polio-free for almost a decade – came at a time when the number of new cases actually fell in India and Nigeria.
Globally, there were almost 1,300 wild poliovirus cases in 2010 which represents a significant fall on the global number reported the previous year. However, progress in some countries was offset by outbreaks in Pakistan, Chad and the Democratic Republic of Congo.
Above all, it’s the widening geographic spread of the disease which is furrowing the brows of health officials in Europe.
US authorities are also growing increasingly concerned that polio eradication targets will not be met. In a report by the Centre for Disease Control, US officials offer a pessimistic assessment: “The goal set in 2009 of interrupting all wild poliovirus transmission globally by the end of 2012 is in jeopardy based on current trends.”
A moving target
The global polio eradication programme began in 1998 and originally set the year 2000 as a target for worldwide elimination of the disease. Despite this, the disease remains a major problem in parts of South Asia and sub-Saharan Africa.
The WHO renewed its commitment to worldwide eradication in 2009 and international campaigners have sought to add political momentum to this effort by linking polio eradication with Millennium Development Goal No. 4 – the reduction of child mortality.
The 2010 outbreak in Eastern Europe and Central Asia was a major setback, undoing a decade of progress in the European region.
A global problem
The polio outbreak is believed to have been carried to Central Asia from the Indian subcontinent and its spread was facilitated by international travel. This is part of the reason that Europe is watching health reforms in Pakistan nervously.
Pakistan is considering the abolition of its national health ministry and devolving all power to regional authorities, something critics in Pakistan fear will hamper the national effort to control polio – a disease which remains endemic across the country.
This, and the recent measles spike in Europe which have seen outbreaks on the east coast of the US, reinforce the complexity of wiping out infectious diseases in an age of international travel.
Steve Allen, regional UNICEF Director for Central and Eastern Europe and the CIS, said the recent outbreaks of polio in Central Asia highlight the consequences of the failure of routine immunisation systems.
Speaking at the launch of the European Immunization Week, he pinned the blame primarily on declining public trust in vaccination, something which he said is a major concern, along with increased global travel.
The surge in polio in Central Asia had originated in India, according to Mr Allen. “Infectious diseases do not recognise borders. Outbreaks in one place can rapidly affect people in another due to increased mobility and migration,” he said.
Setback breeds frustration
The resurgence of polio is causing considerable angst about health campaigners and aid workers who are frustrated that the disease continues to destroy lives despite the long-standing availability of an effective vaccine.
Billionaire philanthropist Bill Gates – – has made polio eradication a priority and pledged $10 billion to vaccine programmes. He is also using his high profile to lean on EU leaders, encouraging them to stick with to developing countries, in the face of tightening public spending in Europe.
While the 2010 epidemic has served to concentrate the minds of public and private sector health advocates, an air of pessimism prevails.
Speaking last month at the opening of European Immunization Week, Zsuzsanna Jakab, Regional Director, WHO Europe, called for a redoubling of efforts to get infectious diseases under control.
“In 2010, we witnessed explosive measles outbreaks continuing in the western part of the region and the re-emergence of poliomyelitis at a time when we would have been preparing to celebrate 10 years of polio-free status in 2012,” she said.
To date, – a breakthrough on a par with any scientific advance of the modern age. Achieving the same feat with polio is going to take a similarly concerted effort.
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See the WHO’s latest bulletin on measles and polio in Europe