The return of poliomyelitis | scientific medicine
The first case of polio since 2013 has been reported in the United States in Rockland County, NY. So far, no other cases have been reported. Hopefully this is just an isolated case, but it highlights the fact that polio still exists around the world.
Poliomyelitis is an infection caused by the poliomyelitis virus, which infects cells in the anterior horn of the spinal cord. This causes severe paralysis. Before vaccination, the disease paralyzed hundreds of thousands of children around the world each year. After the introduction of vaccines in the 1950s and 1960s, cases plummeted, reduced by more than 99%.
The CDC says that the United States has been polio-free since 1979. This is considered “elimination” – the disease is no longer endemic in the United States. Since then, there have only been a few isolated cases reported imported from outside the United States, the last in 2013, and now another case.
In 2002, the WHO predicted that it would be able to eradicate poliomyelitis from the world by 2005. It is possible to eradicate poliomyelitis because there is no non-human reservoir. This was accomplished through a robust vaccination campaign. However, as close as they got, their efforts were thwarted by conspiracy theories spreading in Nigeria, one of the last three infected countries. An anti-vaccine campaign allowed poliomyelitis to spread.
It took 15 years to return to the same point, being on the verge of eradication. In 2020, wild-type poliomyelitis was eliminated from Africa and existed only in Pakistan and Afghanistan. Although there had been an increase since 2016 in the latter two countries, once again the WHO could see the finish line and was making a last ditch effort to vaccinate enough people to complete eradication. Then the COVID pandemic hit.
COVID has caused a major setback in WHO’s efforts to eradicate polio. Poor countries, especially in Africa, have had to suspend their vaccination programs. The WHO also had to divert resources to the pandemic, and the United States was threatening to cut funding to the WHO, including for its immunization program. Now, two years later, polio cases have been reported in eight African countries and continue in Pakistan and Afghanistan.
Since 2022, polio cases have been increasing in Africa and remain in Pakistan and Afghanistan. We may have missed another chance to eradicate polio and will have to spend years trying to get back to the brink of eradication.
It should be noted that there are basically two sources of poliomyelitis: wild-type poliomyelitis virus that spreads in populations and vaccine-derived poliomyelitis. The latter occurs when people are vaccinated with the live attenuated vaccine (which is not used in the United States, where the inactivated virus vaccine is used). Weakened live virus can be spread through feces, and unvaccinated children can catch vaccine-derived virus. Thus, the best way to prevent vaccine-induced cases is still vaccination (to eliminate susceptible hosts).
The NY case is a vaccine-derived virus, and the man who contracted it was unvaccinated. The strain of the virus has been linked to a strain in Israel, but this strain has also been found in the UK, so it is unclear where the subject contracted the virus from.
One way to track viral infections is to look for viral DNA in sewage. In fact, the poliomyelitis virus has been found in sewage in New York, but also in London. No other cases have been reported, but that means there are likely people spreading the virus through litter. This is very concerning and is something that needs to be monitored further.
And that’s the problem – poliomyelitis is highly contagious. The only proven way to prevent infection is vaccination. The dramatic reduction in polio cases over the past 70 years has been entirely due to polio vaccination programs, and the only way to eradicate polio is to make these programs as comprehensive as possible.
The recent case in New York also highlights the fact that we still need to vaccinate children against polio, even in countries where polio has been eliminated. Otherwise, we risk new epidemics in these countries, and eradication becomes an endless losing game of molesting. Essentially, we need to vaccinate the world against poliomyelitis until it is completely eradicated.
The recent rapid rise in polio and its spread in previously polio-free countries shows how quickly the virus can rebound. It also highlights the absurdity of the anti-vaccine movement, which has pushed back against the polio vaccine by asking why Americans need to be vaccinated against polio when it is not spreading in the United States. That is why.
The recent resurgence of poliomyelitis also highlights the importance of WHO leading the polio eradication effort. Even if there are legitimate criticisms of the WHO, this does not mean that it does not provide certain essential services. Reducing or cutting WHO funding would be a disaster and would abandon any hope of eradicating poliomyelitis.
The time has come to intensify our efforts to implement a comprehensive vaccination program against poliomyelitis and finally eradicate this serious infection. We are still relatively close to this goal (historically speaking). All politics must be set aside and this must be a global priority. We can only achieve this together, because even a single refusal can mean failure.