Lagos — Recently, the governor of the state of New York in the United States, declared a state of emergency over polio. This declaration followed the discovery of the poliovirus in sewage samples in four counties.
Because of the New York cases, the U.S. is now on a list of countries with circulating vaccine-derived poliovirus (VDPV). This spread of a preventable virus must end.
A VDPV is a strain related to the weakened live poliovirus contained in oral polio vaccine (OPV). If allowed to circulate in populations with low polio vaccination coverage or to replicate in immunocompromised individuals, the weakened virus can revert to a form that causes illness and paralysis. VDPV is passed in stool. Hence the importance of testing sewage for evidence. According to the Harvard Medical School, sampling of wastewater for genetic material from viruses is a powerful tool used by epidemiologists to track outbreaks of polio and other diseases. It has been used to predict COVID-19 outbreaks in Boston due to the increase in SARS-CoV-2 RNA in Boston wastewater.
The poliovirus causes poliomyelitis, which could lead to paralysis of the limbs and can be fatal if the respiratory muscle of the victim is paralysed. I have seen this devastation firsthand.
In 2002, I began my global health career at Nigeria's National Programme on Immunization. I met children paralysed by polio and witnessed how this changed their lives and that of their families. As the personal assistant to the chief executive officer, I was part of the core national coordination of the Nigeria's polio eradication initiatives. I traveled round Africa's most populous country, conducting advocacy with different partners and training health workers to plan effectively for vaccination. I am proud to have contributed to Nigeria being declared polio-free in 2020.
Polio was nearly eliminated worldwide – but new cases threaten its eradication.
These discoveries of poliovirus in sewage water in the U.S. worries me. Sadly, New York is not the only city in developed economies where this has been discovered. Between February and May this year, traces of the poliovirus were found in sewage water in north and east London, United Kingdom.
It is time to intensify efforts to ensure the global polio initiative is not derailed. These are five ways to achieve this.
First, accelerate the introduction of inactivated poliovirus vaccine (IPV) to all countries that still use the oral polio vaccine. Gavi – the global vaccine alliance – has made tremendous progress. As at April 2019, all Gavi-supported countries had introduced at least one dose of IPV into their routine vaccination schedule. Without a doubt, Gavi requires more funding to complete this transition. If all countries are able to switch to IPV to vaccinate their populations, vaccine-derived polio would no longer lead to a resurgence of polio.
Second, ensure that global vaccine solidarity trumps vaccine nationalism. Vaccine nationalism, with richer nations hoarding vaccines, has slowed availability of Covid-19 vaccines, especially in poorer countries. Global leaders must be more intentional about fostering solidarity and equity. Africa has reported monkeypox for decades, and yet there is still no vaccination against the infection in a continent of 1.2 billion people. This is a lose-lose. Not vaccinating people in Africa is a risk to richer nations.
Third, there should be intensified public education on polio. Globally, Afghanistan and Pakistan are the only two countries that have active polio transmission ongoing. Amid other infectious disease threats globally, polio is not on most people's radar. It is important to keep in mind that to achieve equity in healthcare depends on achieving equity in health education. Media advocacy on polio, especially vaccine derived polio virus, should be intensified via different channels - community structures, social media, radio, TV and others.
Fourth, good sanitation is necessary to prevent polio transmission. The polio virus is passed in stool. Contamination of water and foods by the polio virus leads to transmission of the infection. Therefore, it is imperative to provide sanitation and advocate for proper hygiene, especially in underserved communities in every country. This is even more relevant in countries that still mostly use OPV in vaccinating children. For instance, Nigeria is polio-free but still uses OPV. However, more than a quarter of its estimated 200 million population lack access to toilets. The duo of OPV use and millions stooling in public is a medium for vaccine derived polio virus. Although wastewater is being tested regularly to detect the polio virus, officials across Nigeria must act to increase access to sanitation and to enforce sanitary regulations.
Finally, we must vaccinate every eligible child against polio. According to the New York Health Department, polio vaccination coverage in the four infected counties are as follows: 60 percent in Rockland, 58 percent in Orange, 62 percent in Sullivan and 79 percent in Nassau. However, a coverage of above 90% is desirable to achieve herd immunity.
New York can learn from Nigeria
New York State can learn lessons from Nigeria's polio eradication efforts. House-to-house polio vaccination campaigns in those four counties could ensure that no child is missed. Working with community and religious leaders could increase vaccine acceptance. The use of micro planning would map out communities most at risk and deploy resources efficiently.
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Polio once paralysed more than 1000 children every day.
This is an emergency. There is no time to waste. People are at risk of paralysis and death.
Vaccines work. The global polio eradication initiative is a good example of how effective vaccines are. Prior to its origin in 1988, polio paralysed more than 1000 children daily. Subsequently, more than 2.5 billion children have been immunized against polio. Global incidence of polio cases has decreased by 99 percent.
Let's keep tapping into the power of polio vaccines. It is a matter of life, paralysis and death.
Ifeanyi M. Nsofor, a medical doctor, is the Senior Vice President for Africa at Human Health Education and Research Foundation. He is a Senior New Voices Fellow at the Aspen Institute, a Senior Atlantic Fellow for Health Equity at George Washington University and an Innovation Fellow at PandemicTech. He was named one of the '100 Most Influential Africans' by NewAfrican magazine in 2020. Follow him @ekemma.
