Polio outbreaks in Africa and Pakistan alarm health officials
Health experts are increasingly alarmed by new outbreaks, which threaten an ambitious plan to eradicate the disease
The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on two continents.
The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off-limits to vaccinators 14 months ago.
The African outbreak began in May with two cases of polio paralysis: one in Mogadishu, Somalia's capital, and another in the huge Dadaab refugee camp in Kenya, where thousands of Somalis have fled fighting between Islamic militants, clan militias, government troops and African peacekeepers.
Now there are 121 cases in the region; last year, there were only 223 in the world.
The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the CIA had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until US drone strikes ended.
Although only three North Waziristan children have suffered polio paralysis since then, even one case means the virus could spread.
The new outbreaks may delay a recently announced US$5.5 billion plan to eradicate polio by 2018. Nonetheless, public health officials still believe that, with enough local political will and donor money, they can prevail by using techniques that have worked before.
To prevent the disease from reaching Mecca during next month's haj, Saudi Arabia has tightened its rules. Pilgrims from any country with polio cases must be vaccinated at home and again on arrival. Last year, nearly 500,000 pilgrims were vaccinated on arrival, the Saudi health authorities have said.
The Pakistan outbreak is particularly frustrating, because eradication had been going steadily forward despite the killings in December of nine vaccinators for which some blamed on the Taliban.
Public health officials had counted themselves lucky that despite vaccination bans in North and South Waziristan, no polio virus was known to be circulating among 250,000 children in those areas. Vaccination posts were set up on nearby highways and on buses and trains. Urban hospitals packed the vaccine on ice for families willing to smuggle it back to neighbours, but it was not enough.
"The equation is simple," said Dr Elias Durry, World Health Organisation emergency co-ordinator for polio eradication in Pakistan. "Where you can immunise, the virus goes away. Where you can't, the virus gets in, and it will paralyse these poor kids."
Durry said he hoped that parents whose children were paralysed would speak up at local councils, called shuras, that are common in tribal areas, and possibly put pressure on warlords to rescind the ban.
The Taliban warlord in South Waziristan, Maulvi Nazir, was killed by a drone strike in January.
Before the Waziristan outbreak, Pakistan had seen only 24 cases this year, about as many as it had at the same point last year. Most were around Karachi and Peshawar, where last year's killings of the vaccinators took place and where resistance to vaccines is highest.
The Somali outbreak is different. There is little opposition to the vaccine itself, said Dr Bruce Aylward, the WHO assistant director general for polio. In several Muslim countries, including Pakistan, the drive has been hurt by rumours that the vaccine sterilises girls or contains the virus that causes Aids - or even pork products.
However, he said, many cases are in areas south of Mogadishu where Shabab, a militant group, operates. The group opposes mass campaigns because it believes the sight of thousands of vaccinators going house-to-house would undercut its claim to rule those areas.