Source: New York Times
5th May, 2014
PARIS — Alarmed by the spread of polio to fragile countries in three continents riven by conflict, the World Health Organization declared an international health emergency on Monday in an effort to contain the paralyzing virus, which officials thought two years ago had been nearly eradicated.
An emergency committee convened by the organization announced in Geneva that three countries — Pakistan, Syria and Cameroon — had allowed the virus to spread, and should take extraordinary measures to combat it, including making sure that all children in those countries are inoculated or reinoculated. Dr. Bruce Aylward, the W.H.O. official in charge of polio eradication, said during a telephone news conference that citizens and long-term residents of those countries who travel abroad should be vaccinated before they leave and should carry an internationally recognized certificate as proof.
Though the disease primarily strikes children under 6, the committee said there was “increasing evidence that adult travelers contributed” to the recent spread of polio from Pakistan to Afghanistan, from Syria to Iraq, and from Cameroon to Equatorial Guinea during what health officials said was the low season for polio transmission, between January and April.
Ten countries are now affected by the new wild polio virus, Dr. Aylward said, including those six as well as Ethiopia, Israel, Nigeria and Somalia. In Israel, he said, there were no confirmed human cases of the disease, but that a Pakistan strain of the virus had been detected in the country’s sewage.
According to the health organization, there were 417 known new cases of polio around the world in 2013, compared with 223 in 2012, the lowest on record. Three-fifths of the new cases in 2013 were in regions that had previously been free of polio, a consequence of conflict and the interruption of vaccination campaigns, the organization said.
“It can become endemic in the entire world if we do not complete the eradication of this disease,” Dr. Aylward said.
Polio, short for poliomyelitis, is a highly contagious viral infection that can lead to partial and sometimes fatal paralysis. It is preventable through immunization, but there is no cure. Because some people can carry the virus without displaying symptoms, and can unwittingly infect hundreds of others, the World Health Organization considers even a single symptomatic polio case to constitute an epidemic.
Despite a concerted inoculation effort in the Middle East, which began following the discovery of a cluster of polio cases in eastern Syria more than seven months ago, global health officials warned in April that polio had spread from Syria to Iraq, as refugees fleeing Syria’s war strained Iraq’s already fragile health care system.
“The consequences of further international spread are particularly acute today given the large number of polio-free but conflict-torn and fragile states which have severely compromised routine immunization services and are at high risk of re-infection,” the World Health Organization said in a statement on its website announcing the emergency.
Polio eradication advocates welcomed the step, but some criticized what they called the World Health Organization’s belated realization that polio’s resurgence was more virulent than had been foreseen last September, when the disease suddenly reappeared in Syria for the first time since 1999.
Dr. Annie Sparrow, a pediatrician and deputy director of the human rights program at the Icahn School of Medicine at Mount Sinai in New York, who has frequently asserted that World Health Organization officials have understated the polio problem, said they should be far more aggressive, particularly concerning Syria, where the government has not yet allowed vaccinations to all areas requiring them.
“Now they’re saying, “Oh my God, danger, danger, Will Robinson,’ ” Dr. Sparrow, who recently returned from a trip to the Syrian-Turkish border, said in a telephone interview. “Now they’re finally seeing the gravity and irresponsibility.”
She said pressure should be intensified on President Bashar al-Assad of Syria, whose forces are “bombing Aleppo every single day, killing the very schoolchildren who are supposed to be vaccinated.”
It was unclear precisely how Cameroon became a polio transmitter, but the country shares an extensive border with Nigeria, Africa’s most populous country, where polio has been a problem for years. Cameroon shares borders with five other countries — Equatorial Guinea, Gabon, the Republic of Congo, Central African Republic and Chad, increasing the risk of spread through cross-border travel.
Dr. Aylward said Pakistan was a notable exporter of the virus. Eradication efforts there have been hampered by the hostility of local leaders in the conservative tribal areas of the country and the conflict with Taliban militants, who have repeatedly attacked health workers administering vaccines. The violence grew worse after American forces located and killed Osama bin Laden in 2011 using information gathered in part by a doctor under the guise of a vaccination campaign. The doctor was later convicted of treason.
Dr. Aylward said Pakistan had made some progress by improving security in vulnerable areas, and had installed vaccination booths at land borders with Afghanistan, China, and Iran. But it still has not begun vaccination in some parts of the country. The number of cases recorded in Pakistan rose to 93 last year from 58 in 2012.
Pakistani officials said on Monday that they would step up efforts to fight the spread of the disease. Saira Afzal Tarar, the state minister of health, was quoted by Pakistani news outlets as saying that the government would announce its strategy on Wednesday after meetings with provincial officials. The World Health Organization and other agencies will be asked to provide more vaccine, she said, and special counters may be set up at airports.
“The best way is that there should be vaccination at the airport and a card issued before departure,” Ms. Tarar said.
Some countries have made major gains in combating the disease. As recently as 2009, India had more new cases of polio than any other country, but after an immunization program, within three years it was detecting no new cases.