Already struggling with a surging Covid-19 pandemic, United Nations health agencies must now face the possible abdication of the United States’ leading role in fighting polio — just as the world gets tantalizingly close to eradicating it for good.
Polio-free since 1979, the US has historically made combating the infectious disease its top funding priority at the World Health Organization, investing more than $158 million in voluntary funding over the last two years alone. The effort has broad public support dating to the 1950s, when Jonas Salk, with the help of the March of Dimes, created the first vaccine.
Older Americans still have “horrific” memories of polio sufferers in iron lungs, notes Dr. Hamid Jafari, director of the WHO’s polio eradication program in the eastern Mediterranean region, and the US has an “emotional investment” in polio eradication.
After Nigeria was declared free of wild poliovirus in 2016, Pakistan and Afghanistan became the globe’s only countries with recorded wild polio cases, with 12 and 49 cases, respectively. (Wild polio is different from the rare, more easily controlled “circulating vaccine-derived poliovirus,” of which there 134 cases worldwide. Communitywide vaccinations prevent the spread of both types of polio.)
But despite the success of polio vaccination efforts, the WHO is warning that failure to eradicate it from these last remaining areas could produce a resurgence worldwide, with as many as 200,000 new cases annually over 10 years. A mutated strain of poliovirus has been reported in more than 30 countries, and the cumulative effect has been particularly dire for polio eradication — around 85,000 Congolese children have not received that vaccine.
President Trump’s withdrawal from the WHO on May 29 now threatens polio-control efforts already complicated by the Covid-19 pandemic.
“Polio vaccination campaigns have been put on hold,” the WHO director-general, Tedros Adhanom Ghebreyesus, said at a media briefing in April, during World Immunization Week. Poor countries are reporting shortages of vaccines due to border closures to contain the spread of Covid-19 — and children, while at relatively low risk for severe illness and death from the virus, remain at high risk for life-threatening infectious diseases like measles and polio, Ghebreyesus said.
Efforts to control polio overlap with other public health campaigns, including the containment of Covid-19. As of June 15, Afghanistan had 25,527 confirmed cases of Covid-19 and 476 deaths, though numbers are certainly much higher given the country’s limited health services. (Its population is approximately 35 million.)
US Secretary of State Michael Pompeo recommended in April that funding for seven countries continue despite Trump’s actions against the WHO: Afghanistan, Egypt, Libya, Pakistan, Sudan, Syria and Turkey. Pompeo argued that the UN agency is critical in those countries to fighting Covid-19 and polio.
A March 27 State Department fact sheet, titled “The United States Is Leading the Humanitarian and Health Assistance Response to COVID-19,” says the US has redirected $10 million in resources to support the UN’s emergency response to Covid-19 through the WHO. “This support will include surveillance, lab improvements, case management, infection prevention and control, community engagement, and technical assistance to Government of Afghanistan.”
The State Department, however, declined to clarify the status of Pompeo’s recommendation, one employee told PassBlue anonymously, adding, “We do not comment on deliberative interagency matters.”
[UPDATE: The State Department held a media briefing on June 19 that discussed the US withdrawal from the WHO, and a US official said of the polio program: “We still have a hard time finding implementing partners for polio, for instance, and so we’re still working through an interagency process to come to resolution on that issue and see how we want to proceed as the government in those unique cases.”]
Meanwhile, volunteers with the polio program in Afghanistan encourage hand-washing; staff members in the field check for and report potential cases of Covid-19; and program staffers strive to improve health workers’ ability to respond to the virus.
Unicef is using its Immunization Communication Network to disseminate information on personal hygiene, and the WHO’s Afghanistan polio team is coordinating with the government to combat Covid-19.
Primary health care faces its own challenges.
“WHO is concerned that fragile and hard-fought achievements in health will erode if Essential Health Services are compromised,” Dr. Rik Peeperkorn, a WHO representative in Afghanistan, said in an email, adding, “It is of paramount importance that primary health care . . . continue and resume” — focusing on reproductive, maternal, newborn, child and adolescent health and family planning, noncommunicable diseases, routine immunization and polio eradication.
Speaking from Amman, Jordan, Dr. Jafari of the WHO told PassBlue that the agency remains committed to polio detection even as vaccination efforts are curtailed to protect both Afghan populations and international health care workers from the spread of Covid-19. Dr. Jafari noted that the pandemic has increased the agency’s mandate, and this will increase its budget needs. “We can’t go back just with polio vaccine in these communities that have been devastated by Covid-19.”
Dr. Jafari expressed concern for the populations that are “most vulnerable” to both Covid and polio, including refugees and displaced people from places like Somalia, Afghanistan, Syria and Yemen, where the UN is trying to maintain polio surveillance. He also said that UN staff are “running toward danger” as they do their jobs. “There is a human component to what we are discussing,” he said. “We need to recognize the morale issues.”
Dr. Jafari declined to speculate about how the US withdrawal of money would affect the agency’s polio work. Calling the US “an important partner for WHO and the overall health sector in Afghanistan,” he said the agency is “fortunate to have many other international and national health sector partners in Afghanistan.”
(Earlier this month, numerous world leaders, led by Boris Johnson of Britain, pledged an additional $8.8 billion for Gavi, the Vaccine Alliance, to help immunize 300 million more children in the world’s poorest countries against polio, measles and diphtheria by the end of 2025.)
Work on wiping out polio is primarily funded through the Global Polio Eradication Initiative, a public-private partnership whose core partners include the WHO, Rotary International, the US Centers for Disease Con-trol and Prevention (CDC), Unicef, the Bill & Melinda Gates Foundation and Gavi. “We’ve come too far to let this program fail,” Dr. Jafari said.
A former principal deputy director at the CDC’s Center for Global Health, in Atlanta, Dr. Jafari said the Global Polio Eradication Initiative relies on the CDC primarily for lab virology and on the WHO for strategy, monitoring and evaluation.
The main implementers are the WHO and Unicef, which leads on vaccination and logistics work. This international cooperation has benefits, Dr. Jafari said, noting that it sustains public health opera-tions in areas where the US cannot.
PassBlue spoke with Mohammed Mohammedi, a polio vaccine expert, during his recent trip to Lashkar Gar, in Afghanistan’s Taliban-heavy Helmand Province. Based in Kabul, he is Unicef’s section chief for polio eradication and had traveled to the unstable region to help prevent the spread of both Covid-19 and polio through education and distribution of basics like soap.
While vaccination efforts have been temporarily suspended, he said, “we’re continuing to lay the groundwork for future continued vaccination programming, education and logistics.”
It would be “a great shame,” Mohammedi added, that with billions of dollars invested and great success achieved, the fight against polio was lost because the job could not be finished in just two countries: Afghanistan and Pakistan.
“Polio is the easiest disease to get rid of,” Mohammedi said in a WhatsApp chat. “Anybody can give a vaccine to any child. It’s drops in the mouth. It doesn’t require any qualifications. The vaccine is very stable and it’s very cheap.”
Arguing that decreased funding could “force the programs at country level to really assess who is needed and who is not,” Mohammedi said political commitment was more important than money.
“If we get serious, we can eradicate polio from Afghanistan in one year,” he said. “There are only two people who can decide this. One is Gates and the other is Trump. And Trump will never do it.”
The Gates Foundation has made eradicating polio a top priority. But Bill Gates himself has said that polio is not likely to be eradicated without the WHO.
This article was updated to include the comments from the US State Department.
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