Ready for some good news in 2023? Well, efforts to control the poliovirus and stop its spread have been going well. Like only 11 confirmed cases of wild type 1 poliovirus infections around the world, as of November 14, 2023, well.
Yes, you heard that correctly, just eleven cases—five in Pakistan and six in Afghanistan—of the wild type, meaning the type of poliovirus that originally existed in nature. While that total doesn’t include some mutated versions of the virus that emerged after oral polio vaccination (more on that later), it is still significantly lower than the 176 confirmed cases in 2019 and the 140 in 2020. The past two years have seen six and 30 cases of the wild type poliovirus, suggesting that the 2023 number is not an anomaly. The even bigger picture is that the total number of polio cases worldwide each year has plummeted by more than 99.9% since 1979 when the estimated number of cases was around 350,000. In fact, with the way that global polio eradication efforts have been going, achieving the “e-rad” word may soon be quite possible with eradication meaning completely getting rid of the virus. Yeah, it’s striking what can be accomplished when people follow, you know, science and actually work together for the betterment of humanity.
The need for science-based approaches and cooperation is the why the Global Polio Eradication Initiative (GPEI) initially formed back in 1988. Governments around the world have led the GPEI along with six big-time partners: the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the vaccine alliance. Carol Pandak, Ed.D., the Director of PolioPlus, Rotary International’s global effort to eradicate polio, recounted how far the world has come since the Rotary International first got involved with polio control efforts in 1979 and helped form the GPEI about a decade later: “Rotary did its first oral polio vaccine campaign in the Philippines in 1979 and then piloted similar efforts in six other countries. The year 1985 saw the launch of the Polio Plus program with the goal then to raise $120 million for polio control and eradication.” That original funding number has grown substantially since then with Rotary contributed over $2.6 billion towards polio efforts. Rotary International has also assembled over 1.4 million volunteer members from over 46,000 Rotary and Rotaract clubs in over 200 countries to help with polio eradication efforts.
Polio vaccines have been central to polio control and eradication efforts. The past 35 years have seen close to three billion children get the oral polio vaccine (OPV). That means that over 20 million people who could have ended up paralyzed from polio didn’t actually suffer that fate. So, consider the big time impact that polio vaccines and polio control efforts have had.
One look into the wild shows how far eradication efforts have come in the past several decades. Type 1 is now the only wild type of poliovirus that is still circulating anywhere in the world. The GPEI already declared Type 2 eradicated in September 2015 with the confirmed case in India in 1999 and Type 3 eradicated in October 2019 with the last detection of that type in November 2012. The days of Type 1 appear to be numbered, though, since only Afghanistan and Pakistan have had cases of late. Not only that. The Type 1 wild type has been cornered into two specific geographic areas, Eastern Afghanistan in the Jalabad province and Northwest Pakistan in the Southern Khyber Pakhtunkhwa Province), according to Pandak and Steven Lauwerier, MS, the Global Director of Polio Eradication for UNICEF. That’s left five of the six WHO regions that comprise over 90% of the world’s population completely free of the wild poliovirus. Lauwerier indicated, “We won't make the deadline of end of this year to eradicate all the wild polioviruses. But we will probably make it by the end of next year.”
Now, eradicating all of the wild type polioviruses won’t mean that all polioviruses will be gone from the Earth just yet. The GPEI will still have to contend with the vaccine-derived polioviruses. These are poliovirus that resulted from the mutated from the strain that was part of the original OPVs. OPVs contain live, weakened forms of poliovirus that can reproduce inside your intestines for a short while. These reproducing viruses can then elicit an immune response in your gastrointestinal tract that can result in antibodies there. The problem is that these viruses can sometimes mutate to become strong enough to infect others and cause polio. And when one with such viruses in his or her intestines goes poo, anyone unvaccinated coming into contact with that poop could potentially catch the mutated virus. That’s why once polio has been adequately controlled in an area, control efforts in that area tend to switch from using the OPV to using the inactivated polio vaccine (IPV), which is injected rather than ingested.
Lauwerier explained, “There have been over 350 cases of vaccine-derived polio in four geographies: Northern Nigeria, Eastern Democratic Republic of Congo, Southern Somalia, and northern Yemen [in 2023].” He added, “These are regions that have been forgotten or undergoing conflict and insecurity. The health systems there are not functioning. Vaccination rates are extremely low.” Of course, eradication efforts have not been easy. As Lauwerier described, “There’s been lot of effort on community engagement. We’ve had to work in very fragile environments, complex political environments. This has included working in very difficult situations where front line workers are threatened and killed.”
Those spewing anti-vaccination and anti-science misinformation and disinformation certainly haven’t helped. Pandak gave an example of “Someone making a [fake] video in Northwest Pakistan of people fainting and collapsing after polio drops, causing a panic. It led to a clinic being burned down.” She continued by saying, “Campaigns paused for several months. There were then efforts to find community influencers, who were trusted by communities to counter the negative messages.”
Nevertheless, the progress over the years has been encouraging. Plus, polio eradication efforts haven’t been just about vaccination. They’ve included efforts to improve hygiene, sanitation, and healthcare systems as well as efforts to reduce poverty. Controlling and trying to get rid of any type of infectious disease requires systems approaches, doing things to not only shore up immune protection against the pathogen but also changing the environmental and social systems that may contributing to its spread. Thus, the benefits of polio control efforts may go well beyond their original polio-focused intent. And that’s what tends to happen when you follow science and actually work together for the betterment of humanity.