Another wild polio case in Mozambique shows eradication's fragility

Another incidence of wild polio in Mozambique demonstrates the fragility of eradication efforts.

Last Monday, WHO member countries agreed on a new polio eradication plan for the years 2022-2026, with the goal of eliminating both wild poliovirus and vaccine-derived infections forever.

According to WHO Director-General Dr. Tedros Adhanom Ghebreyesus, the discovery of a second wild poliovirus case in Africa, verified on May 18 in Mozambique, was "not surprising."

Tedros stated that member states can eliminate polio in the coming years if they "get every child" virus-free and build strong health systems.

On Saturday, Tedros addressed the World Health Assembly's concluding session on poliovirus eradication.

The poliovirus outbreak in Mozambique raises questions regarding the WHO African Region's status as "wild poliovirus free."

The wild virus is only found in Afghanistan and Pakistan.

However, two new wild poliovirus cases in southern Africa and six in Pakistan in April and May, following a 15-month period without an occurrence, illustrate the fragility of past gains.

Because these illnesses are tied to the Pakistani virus, a WHO spokesperson told Health Policy Watch that Africa's wild poliovirus eradication status is unaffected.

"We've seen this previously in other regions when poliovirus was imported, but it wouldn't affect certification because it's not endemic to the region," a WHO official said.

"The epidemic is a public health concern, particularly for children and their families." Mozambique proclaimed the disease a national public health emergency and continues to work with Malawi and other border countries in the multi-country outbreak response."

Vaccine-related epidemics have become more common.

About 20 additional countries, including Israel and Ukraine, continue to report Type II vaccine-derived polio infections, with the first case in nearly 30 years discovered in an ultra-Orthodox Jewish community with low childhood vaccination rates.

According to a WHO report, vaccine-derived poliovirus outbreaks increased dramatically between 2018 and 2021, with "vastly inadequate inactivated polio vaccine and oral polio vaccination coverage rates across numerous polio transition priority countries."

"Compared to 2020, the epidemiological picture improved in 2021, with a 96 percent decline in poliomyelitis infections attributed to wild poliovirus type 1 and a 47 percent reduction in vaccine-derived poliovirus infections globally," according to the most recent WHO research.

In endemic regions in 2021, five wild poliovirus type 1 cases were reported. This optimistic situation should not be taken for granted; it is a once-in-a-lifetime opportunity that civil society partners and the general public should seize," the study states.

Uncertainty and vaccine scepticism

"The polio eradication scheme still faces emerging and ongoing difficulties," according to the report, "such as the ongoing COVID-19 pandemic, which affects polio surveillance and campaigns; the persistence of conflict in some endemic reservoir areas, such as Afghanistan; and a fragile financial position affecting international effort."

Members of the UN expressed particular concern about the resurgence in southern Africa, where wild poliovirus infections were identified in Malawi and Mozambique, prompting a massive five-country vaccine campaign aiming at 23 million children.

Members thought Mozambique's wild polio virus strain, like Malawi's, originated in Pakistan. Because neither of the afflicted children had traveled, the two occurrences indicate that the virus is presently spreading locally.

The United States backs WHO's polio eradication efforts and recommends field projects in Mozambique, Malawi, Afghanistan, and Pakistan. It also raised concern about polio infections being smuggled into southern Africa.

Improve the ability of countries to produce vaccines.

Benin, speaking on behalf of 47 African countries, called for more health-care capability, including local polio vaccinations, to eradicate the disease.

Member nations have pledged to eradicate polio by 2023, but progress is shaky. To maintain development, governments must develop solid policies and long-term financial projects.

WHO Africa Regional Director Dr. Matshidiso Moeti stated that member countries must prioritize eliminating polio with political commitment and more domestic funding.

To prevent vaccine-derived and wild polio, she proposed a better surveillance system.

The case in Mozambique, according to Moeti, is "genetically linked to Pakistan" and "does not risk the WHO African region wild polio-free classification just yet."

"The governments of Mozambique and Malawi are taking strong and quick action with the assistance of GPEI partners, as well as the efforts of their neighbors to confront a setback that threatens decades of hard work and the region's accreditation," she said, acknowledging that the continued appearance of cases would jeopardize Africa's polio-free status.

Wild poliovirus has a possibility to thrive in Afghanistan and Pakistan, according to Dr. Ahmed Ali Mandhari, regional director of WHO's Eastern Mediterranean Region. In fatal areas, however, health facilities and polio workers continue to perform a fantastic job.

Additional money for polio eradication projects, he added, might help wipe out vaccine-derived illnesses in war zones like Sudan, Yemen, and Somalia, Yemen.

In order to fully implement the eradication strategy for 2022-2026, 1.71 million additional unvaccinated children must be reached, mostly in AFRO and EMRO.

COVID-19, according to Gavi, disrupted global immunization efforts and widened vaccine equity gaps.

Wild poliovirus re-emerges as a result of shaky anti-polio efforts.

Despite the lowest polio rates ever in 2021, the virus reappeared in 2022 owing to frail anti-polio efforts, according to Rotary International, a GAVI and WHO partner.

"The fragility of anti-polio campaigns in 2022 led to cases in Mozambique and Malawi," according to the Rotary delegate to the World Health Assembly. He asked countries to fix gaps in vaccine coverage.

Rotary members were asked to help close polio vaccination gaps.

Pakistan has made a commitment to eradicate polio. The country has announced a $10 million, five-year plan to eradicate polio in the country.

Malawi, which has 2.9 million children, has submitted a financial plan to combat the resurgence of polio.

Malawi's Emergency Operations Center and polio response program are operational, and the country's objective is to have zero instances of the disease.

Ten proposals were made, including the integration of polio into global health systems.

Another WHO report on the success of poliomyelitis eradication efforts included eleven recommendations for boosting eradication efforts.

Creating a worldwide strategy for polio eradication and immunization integration into national health systems.

Previously, polio eradication was sponsored separately by a donor-driven initiative known as the Global Polio Eradication Initiative (GPEI) and handled vertically, with national health systems using better-resourced polio units to deliver other vaccinations at the same time.

The WHO strategy aims to better integrate polio efforts with primary health care, vaccine-preventable illnesses, emergency preparedness, and global polio and transition programs.

GPEI assists 50 countries, each of which has challenges in eliminating polio by 2023.

"Those that are infected with the virus must reach out to every child, while countries that aren't infected must build strong health systems," Dr. Tedros added.