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Wild poliovirus eradication

How polio eradication in Africa can inform the global COVID-19 response

As the global health community celebrates the eradication of wild poliovirus in Africa, there are lessons that can apply to the COVID-19 pandemic.

The global health community recently celebrated the eradication of wild poliovirus from the African continent.

We have come a long way in this worldwide effort. Wild poliovirus -- not to be confused with the exceedingly rare instances of vaccine-derived poliovirus -- was once present throughout the world. Today, it is endemic in only two countries, Pakistan and Afghanistan.

We should reflect on this achievement and on lessons learned from polio eradication that can be applied to the COVID-19 pandemic.

History of polio eradication

Many of us in developed countries may not recall when polio was a pressing concern. Sixty years ago in the United States, there was a "polio season" in the summer months, when parents feared letting their children socialize. Not unlike today, pools and churches closed to prevent the virus from spreading widely.

A young girl receives a polio vaccine at a mobile clinic in the United States in 1963.

Even in the United States, poliovirus took decades to eradicate. After effective vaccines were developed in the 1950s, the United States and other wealthy nations were able to launch nationwide vaccination and communication campaigns. In 1979, the United States was declared polio-free. But low-income countries had major outbreaks of polio into the 1980s, when more than 125 countries continued to struggle with the virus.

This culminated in 1988, with more than 1,000 children paralyzed every day. That year the World Health Assembly took a stance, adopting a resolution to eradicate polio worldwide -- a daunting undertaking. Today, more than 2.5 billion children have been vaccinated in a coordinated global effort involving 200 countries and 20 million volunteers. Since 1988, polio cases have decreased by 99.9%.

What we can learn from efforts in Africa

The eventual eradication of wild poliovirus in Africa was not inevitable. It was the product of critical advancements in vaccination research and technology; unprecedented international coordination among the 47 countries in the WHO African region; large-scale surveillance programs and coordination across borders; and extraordinary individual efforts, in some cases costing the lives of committed health care workers.

Now, an estimated 1.8 million African children have been spared crippling paralysis, and 180,000 lives have been saved. Lessons from this success can inform our global response to COVID-19.

A WHO mobile team provides health care in nomadic settlement in Konduga, Borno state, Nigeria.

For example, polio eradication could have happened more quickly if not for misinformation and pervasive conspiracy theories, a major contributor to cases remaining in the Middle East.

Government agencies must accept responsibility as well -- the CIA orchestrated a fake vaccination program during the hunt for Osama Bin Laden, sowing mistrust in the region. These missteps remind us that any vaccination campaign must not only include strategic public communications, but also effective controls to prevent politicization.

Building expertise and infrastructure

Efforts in Africa also highlight the importance of coordination among government agencies, international agencies, nonprofits, researchers, and local health care entities in unstable regions.

In 2012, for example, Nigeria still had at least 122 polio cases. Combatting polio there was made especially challenging by conflict in the north, where Boko Haram obstructed vaccination campaigns with overt violence towards health care facilities and personnel.

But with immense support from GAVI and the Bill & Melinda Gates Foundation, Nigeria was able to build a vaccination infrastructure that served as a foundation for future unanticipated health emergencies. The National Polio Emergency Operations Center, formed to combat polio, was successfully mobilized in 2014 to address a different public health threat when a feverish 40-year-old man arrived in Lagos airport from Liberia, collapsed, and was diagnosed with Ebola. Using this framework, Nigeria was able to successfully prevent an Ebola catastrophe, suffering only eight confirmed deaths.

As Chris Elias, president of global development at the Bill & Melinda Gates Foundation, told us, "Decades of hard work went into building the expertise and infrastructure that were instrumental in stopping wild polio in the African region. Now these resources -- the emergency operations centers, trained front line health workers and community surveillance networks -- are proving to be critical in the COVID-19 response, and will undoubtedly continue protecting communities for years to come."

Additional positive benefits

It is heartening that the success in Africa will have additional positive benefits in years to come. The regional and global surveillance, communication, and vaccination systems that have been built are not just important for combatting COVID-19 -- they may very well prevent the next pandemic as well.

For some time, all we had to be thankful for during the coronavirus pandemic was that COVID-19 was largely sparing countries in the Southern Hemisphere that are least equipped to handle it. Now, with cases surging in Latin America, India and Africa, it is comforting to know that our polio eradication efforts gave us a strong framework in the continuing fight for global health equity.

Michele Barry, MD, is the Drs. Ben and A. Jess Shenson professor of medicine and the director of the Stanford Center for Innovation in Global Health. Lucas Oliver Oswald is the global health communications manager. 

Top image: A girl receives two drops of oral polio vaccine during market day on the island of Ngorerom on Lake Chad, by Christine McNab/UN Foundation, courtesy of the Global Polio Eradication Initiative.

Middle image: Malen D. Bogue/Courtesy of the CDC. Bottom image: by Andrew Esiebo/WHO/Courtesy of the Global Polio Eradication Initiative

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