The polio surge

The battle against infectious disease requires organization, resources and a plan. Wars and conflict push the other way: They disrupt basic services, create inaccessible areas and expose aid workers to danger. No wonder disease loves a war zone.

In Syria and Pakistan, this is occurring once again, threatening campaigns against the polio virus, a disease that primarily affects young children. Two years ago, in 2012, the global incidence of polio reached an all-time low and hopes were kindled that we might be on the verge of eradicating the disease. This month, India celebrated an important landmark: three years without a polio case; as recently as 2009 there were 741 confirmed cases there. Both Afghanistan and Nigeria, where the disease is endemic, also saw lower levels last year than in 2012.

But polio leapt forward in Pakistan, where it is also endemic, and there were new outbreaks in the Horn of Africa and Syria. In all these locations, a critical challenge is to vaccinate children, and that means health care workers must reach where they live. Unfortunately, war and violence are blocking their way.

In Pakistan, which recorded 85 cases last year compared with 58 in 2012, militants continue to kill health care workers who are attempting to vaccinate children. The World Health Organization warned recently that the city of Peshawar, in Pakistan’s northwest, is the world’s “largest reservoir” of polio virus. On Jan. 22 in Charsadda, 15 miles outside of Peshawar, six policeman providing protection for a polio vaccination team were killed when a bomb struck their vehicle; a boy nearby also died. On Jan. 20, gunmen on motorbikes opened fire on health workers carrying out vaccination campaigns in the southern city of Karachi, killing three.

The militants carrying out these attacks appear to be attempting to pressure the Pakistani government; they claim (wrongly) that the health care workers are spreading nefarious Western influences. In fact, the attackers are showing their own ignorance — the spread of polio in Pakistan can just as easily threaten their children, too.

In Syria, engulfed in civil war, slow and gradual progress is being made in efforts to vaccinate against polio after an outbreak last year, but there are still tens of thousands of children trapped in conflict zones who are receiving no humanitarian aid at all, much less vaccinations. Again, access is the key. The Syrian Arab Red Crescent, which like all such groups is backed by the government, is at the forefront of the vaccination campaigns. But in a forthcoming article in the New York Review of Books, Annie Sparrow points out that in the civil war, polio is emerging in areas beyond government-controlled territory, and the needs are great. Both rebels and government forces must realize that polio does not take sides. More than 1 million Syrian children are refugees. Much needs to be done, and soon, to deny polio the opportunity to take a larger toll.