The final hurdle in a race is often the toughest hurdle to clear, and the last mile is often the longest mile, and so it is with the campaign to eradicate one of the world’s most destructive diseases.
Millions of children have been saved from death and crippling disabilities over a 30-year campaign to eliminate polio.
But the disease remains a threat in Pakistan and Afghanistan, despite the resources being poured into vaccination and health education campaigns.
The number of polio cases in both countries has reached 22 so far this year. That compares to 12 cases by this time last year.
Until this year, the number of infections had nearly halved annually since 2015.
The increase is numerically small, but is a reminder of the huge challenge health officials face in tackling the last pockets of a disease that only three decades ago could be found in more than 120 countries.
Dr Tarek Foul of the World Health Organisation, said the current picture is “not a good indication”, but reflects the difficulties health workers faced in reaching the communities where polio still occurs.
“Some of these challenges are really tough,” Dr Foul said.
“We simply can’t reach these areas for security reasons.”
“They believe it contains pig fat, which is forbidden to Muslims, or think it will cause infertility,” Dr Foul said of mistaken believes surrounding the vaccination.
In these deeply conservative societies, some believe if their children are crippled by polio or even die, then it is the will of God, he said.
The UAE has been particularly active in Pakistan, administering 347 million vaccines to 57 million children since 2014 and providing $120 million (Dh440.7m) in funding to the Global Polio Eradication Initiative.
Vaccine-derived poliovirus has meant that children often need to be inoculated repeatedly. VDPV occurs where there is poor sanitation and low levels of vaccination coverage.
When a child is vaccinated the vaccine-virus replicates in the gut, generating an immune response. The vaccine is then excreted and on very rare occasions can mutate and spread to other children.
In addition to Pakistan and Afghanistan, Nigeria is the only other country still to be declared polio free.
Although the last case was registered in 2016, health officials say Nigeria’s weak monitoring system means it cannot be absolutely certain there has been no case since then.
The global campaign to eradicate polio was launched in 1988, with international support. The UAE was declared polio free in 1992.
Dr Foul said the persistence of polio in two countries should not overshadow the achievements of the past 30 years.
“There has been great progress,” he said. “In 1988 there were 350,000 cases every year, or over 1,000 a day. The 22 cases from all of last year represent just half an hour from 30 years ago. We have lowered the disease by 99.9 per cent.”
Polio, which occurs in childhood and is caused by poor sanitation and contaminated water, can invade an infected person’s brain and spinal cord, causing paralysis and, in a small number of cases, death.
The WHO estimates that widespread vaccination has prevented about 16 million cases of disability since 1988 and stopped 1.6 million children from dying.
Three types of wild polio have been identified, of which only type 1 remains. Type 2 was officially declared eradicated in 2015 and there have been no new case of type 3 since 2012.
The disease is easily prevented by a simple vaccine first developed in 1955 and has been almost entirely eradicated in the West for more than half a century. Australia was declared polio free in 1972 and the UK by 1982.
The UAE’s programme in Pakistan – known as UAE-PAP – was launched by Sheikh Khalifa bin Zayed, President of the UAE.
Sheikh Mohamed bin Zayed, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, has donated US$167 million since 2011 to support global efforts to eradicate the disease, with a particular focus on Pakistan and Afghanistan.
For a country to be declared polio free there must be no new case for two years. The outbreak in Pakistan and Afghanistan means the earliest theoretical date for global eradication would be 2021.
The original objective was to eliminate polio by 2000.
Dr Foul remains positive that the world can still be free of the disease. “We will not stop. We will reach this,” he said.
“The progress made over the past 30 years tells us that we can do it.”
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