Alarmed by the spread of polio to several fragile countries, the World Health Organization
declared a global health emergency on Monday for only the second time
since regulations permitting it to do so were adopted in 2007.
Just
two years ago — after a 25-year campaign that vaccinated billions of
children — the paralyzing virus was near eradication; now health
officials say that goal could evaporate if swift action is not taken.
Pakistan,
Syria and Cameroon have recently allowed the virus to spread — to
Afghanistan, Iraq and Equatorial Guinea, respectively — and should take
extraordinary measures to stop it, the health organization said.
“Things
are going in the wrong direction and have to get back on track before
something terrible happens,” said Gregory Hartl, a W.H.O. spokesman. “So
we’re saying to the Pakistanis, the Syrians and the Cameroonians,
‘You’ve really got to get your acts together.’ ”
The
declaration, which effectively imposes travel restrictions on the three
countries, represented a newly aggressive stance by the health
organization. In the past, it has often bent to pressure from member
states demanding no consequences even as epidemics raged inside their
borders and sometimes slipped over them.
“This
is a fundamental shift in the program,” said Dr. Bruce Aylward, the
organization’s chief of polio eradication. “This is the countries of the
world signaling that they will no longer tolerate the spread of the
virus from the countries that aren’t finished.”
The
emergency was declared though the total number of known cases this year
is still relatively small: 68 as of April 30, compared with 24 by that
date last year.
What
most alarmed experts, Mr. Hartl said, was that the virus was on the
move during what is normally the low transmission season from January to
April.
“What
we don’t want is cases moving into places like the Central African
Republic, South Sudan or the Ukraine,” said Rebecca M. Martin, director
of global immunization for the Centers for Disease Control and Prevention, which has provided money and expertise to the eradication campaign since it began in 1988.
Fighting
the virus normally includes several rounds of vaccination of all young
children in a target country. But, in an unusual step, the agency also
said that all residents of Pakistan, Syria and Cameroon, of all ages,
should be vaccinated before traveling abroad, and that this restriction
should be retained until one year after the last “exported case.”
It
also said another seven countries should “encourage” all their would-be
travelers to get vaccinated. Those are Afghanistan, Equatorial Guinea,
Ethiopia, Iraq, Israel, Nigeria and Somalia.
Israel
has had no confirmed human cases of the disease, but a Pakistan strain
of the virus has been detected in sewage in Tel Aviv and elsewhere.
While
the W.H.O. has no enforcement power, the regulations are part of a 2007
global health treaty saying all parties “should ensure” that steps it
recommends are taken. That applies to Pakistan, Syria and Cameroon. The
other seven only need to “encourage” those steps.
But
countries could use the document to refuse to admit migrants, visitors
or even business travelers who lack vaccination cards.
Polio,
short for poliomyletis, is a highly contagious virus spread in feces;
although only one case in 200 causes symptoms, the hardest-hit victims
can be paralyzed or killed. With so many silent carriers, even one
confirmed case is considered a serious outbreak. There is no cure.
Unlike
influenza or other winter viruses, polio thrives in hot weather. Cases
start rising in the summer and often explode when the monsoon rains
break the summer heat, flooding sewage-choked gutters and bathing the
feet of romping children with virus, which they pick up by touching
their feet or a ball and then putting a finger in a mouth.
Though
the disease primarily strikes children, evidence has mounted that it
also crosses borders in adult carriers, such as traders, smugglers and
migrant workers.
Health officials recommend immunization for people traveling to or from 10 countries affected by polio.
With
54 of this year’s 68 new infections, Pakistan is by far the riskiest
country, Dr. Aylward said. Polio has never been eliminated there,
Taliban factions have forbidden vaccinations in North Waziristan for
years, and those elsewhere have murdered vaccine teams.
Syria has had only one confirmed case of polio this year, but it had 13 cases last October, the first in the country since 1999.
Before
the uprising began in 2011, Syria had a 90 percent vaccination rate,
but it fell rapidly in war-torn areas. About 300,000 children are in
areas blocked off by the government or too dangerous to reach, according
to the United Nations Children’s Fund.
The
Syrian cases from last year were of the Pakistan strain, which was
found in Egypt last year, then moved into Israel, first in a largely
Bedouin desert town, then elsewhere. How it reached Syria is unclear,
but in April it was found in a Syrian refugee camp in Iraq, despite
extensive vaccination campaigns in camps in Lebanon, Jordan, Turkey and
elsewhere.
“Fortunately, it’s pretty easy to do in refugee camps,” Mr. Hartl said.
With Syrians fleeing massacres and bombings, it seems absurd to make them stop and produce vaccination cards, critics said.
Cameroon’s
outbreak is of a strain from Nigeria, which previously had more cases
than any country in the world but which has had only two so far this
year. As in Pakistan, Islamic terrorist groups in Nigeria have killed
vaccinators. Nonetheless, multiple vaccination rounds have reduced the
problem.
Cameroon,
Equatorial Guinea and other African countries are all vulnerable
because their routine immunization rates are so low; in Equatorial
Guinea, only 26 percent of all children are protected, Dr. Martin said
It
is unclear whether the new travel restrictions will hurt the economies
of the affected countries. Pakistan already has vaccination booths where
its highways enter Afghanistan, China and Iran.
Pakistan’s
health minister, Saira Afzal Tarar, said her office had recommended
vaccinating travelers at the country’s five international airports
before they board. (The W.H.O. calls for vaccination at least four weeks
before traveling, except in emergencies.)
She
expressed her disappointment at the restrictions, saying, “We have been
doing whatever we can, but due to the law and order situation in our
country, especially in the two tribal regions, we are facing
extraordinary challenges.”
Until
2012, the world was making enormous progress toward eliminating polio.
India, which once had millions of cases, had its last three years ago.
Monday’s emergency was declared both to alert donors and to pressure the
affected countries to organize vaccination drives, Mr. Hartl said.
That
means recruiting and training hundreds of thousands of vaccinators, and
sending them into the field with millions of doses of vaccine, which
must be kept cold, usually by packing them on ice in a foam plastic box
each vaccinator carries on a shoulder strap.
It
is a huge logistical undertaking. Vaccinators go door to door in
village and cities, approach passengers at railway stations and on
buses, and walk up to cars at toll plazas and in traffic circles. The
ideal is to vaccinate every child in the country several times, with a
month or so between each round.
It
also entails many conflicts. Even when there is no local opposition,
there are struggles over issues including who gets the vaccinator jobs,
which usually pay $2 to $5 a day, and who controls the gas money for
minibuses taking teams to villages.
Reporting was contributed by Anne Barnard, Dan Bilefsky, Rick Gladstone and Salman Masood.
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