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Guest Host: Marc Fisher
Once nearly eradicated, increased concern over the spread of polio has prompted the World Health Organization to declare a global health emergency. The rare move comes as cases of the paralyzing virus, which can be fatal, spread outside the border of three nations – Pakistan, Syria and Cameroon – where it persists. We consider what the declaration means, what it will take to contain the virus and which regions are most at risk.
- Steve Wassilak, MD Medical Epidemiologist, Centers for Disease Control and Prevention
MR. MARC FISHERFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. I'm Marc Fisher of The Washington Post, sitting in for Kojo. A little later in this hour, we'll be talking about the revolution in leafy greens and microgreens, changes in the way we eat. But first, in 1988, there were 350,000 recorded cases of polio worldwide. Since then, a global campaign has vaccinated billions of children, and two years ago, the disease was nearly eradicated. Now, though, the World Health Organization has issued an unusual global health emergency declaration warning that the virus may be spreading again, with the number of known cases so far this year at 68, that's more than double what it was last year.
MR. MARC FISHERThat may seem like a small number, but there's growing concern that countries like Pakistan, Syria and Cameroon, where the virus persists, are allowing it to spread outside their borders. Here to help us understand the nature of the illness and what the WHO warning means, is Dr. Steve Wassilak. He's a medical epidemiologist with the Centers for Disease Control and Prevention in Atlanta. And that agency has provided funding and expertise for the polio eradication campaign since it began in the 1980s. And Dr. Wassilak, thanks very much for joining us. What -- some Americans for generations, really -- or the older generations may be more familiar with polio than others. So maybe we can start by telling us what we're talking about in terms of symptoms of this virus and how readily it spreads, why it became so feared?
DR. STEVE WASSILAKGood afternoon, Marc, thank you. Anyone who was born in the '40s or '50s remembers when polio was rampant in the U.S., and it's a virus that spreads easily person to person, infects in the intestinal tract, and is spread that way, but rarely, and unfortunately not rarely enough, it causes paralysis by infecting the cells of the spinal cord. And it's that paralysis that we know as polio is what is a feared event, and is something that is permanent.
DR. STEVE WASSILAKAnd because of that, when the vaccines were derived or developed by Salk and Sabin, we got into a period of -- when we have gotten rid of the polio in the U.S. by the '70s, and now we've been posed in a position to get rid of it in the world, over the last few years. And we're almost there.
FISHERAnd so, there you were on the cusp of total success, and now we're seeing that polio is rearing its ugly head in some places, particularly some places that experience all sorts of difficulties, war in Syria, and all kinds of unrest in Pakistan. And so why is this popping up in those particular places, and what do the difficulties that those countries have in other regards -- what impact does that have on their ability to control the spread of this virus?
WASSILAKWell the virus is easily -- the infection is easily prevented by vaccination. And the critical part that's missing in these countries is having every child have access to enough of the doses of the vaccine to be protected against illness. Let's take Syria. With their civil war, a very good vaccination program (unintelligible) down, and became particularly weak in the areas that are opposition-held, but also weak in the other areas.
WASSILAKAnd when that happens, the virus, which does travel around, unfortunately too well, can find susceptible in children, and cause the paralysis. So the basic problem is a health system that can't deliver enough vaccines, and that's the situation in some of the other countries as well.
FISHERSo you can join our conversation by calling us at 1-800-433-8850, or email us at firstname.lastname@example.org. Let us know if you've lived, worked or traveled to a country where polio remains an problem. What role do you think that privately run organizations should play in eradicating these diseases? Dr. Wassilak, the World Health Organization this week took this unusual step of declaring a global health emergency, based on just a few dozen cases of polio. What tools, what weapons does the WHO have, or do governments have, to try to get this under control in these countries that are having a tough time controlling themselves?
WASSILAKThe whole point of the director general of WHO declaring this a public health event of international concern is that international collaboration is more important now than ever before. So this -- the recommendations that are made are trying to help pull everyone together, and to point out that with increased vaccination of travelers, we can try to avoid spreading the virus elsewhere.
WASSILAKAnd having documentation of that vaccination will be helpful. And it's not only children, it's also adults who actually may be protected against the disease, but can be infected by the virus, can spread it as well. So these are the steps that these countries can take to prevent the virus from spreading outside of those three countries, and of the other countries that are listed in this declaration that still have polio circulating as well, most important of which is Nigeria, which has shared its virus pretty vigorously in years past, but not over the last year.
FISHERYou mentioned earlier that obviously the way of getting at this problem is through vaccination, and yet there are cultural norms and political realities in some of these countries that make people reluctant to get the vaccine. What are those obstacles, and what's the best way to overcome them?
WASSILAKThere are, of course, at times been rumors about the vaccine being not good. And usually these are situations where it's manipulated by local, powerful individuals who may put a religious bent on it, but it's often a political issue, and that was the case in the mid-2000s with Nigeria in particular. Resistance to the vaccine is not as big of an issue as simply having an efficient system to bring the vaccine around, but because health systems are not always strong everywhere, in order to really protect all children, you have to basically take it to their door.
WASSILAKAnd to do that efficiently and effectively has been a problem in some places because of just logistics, and in other places budvase of security. In Pakistan and northern Nigeria and Borno are examples where security are issues.
FISHERThere were reports about two years ago about CIA efforts to get DNA samples from the bin Ladens -- head of the raid on the compound in Pakistan, where Osama bin Laden was eventually found. And there were reports that these CIA efforts were responsible for increased skepticism about vaccinations in that country. Did that story end up having any credence?
WASSILAKWell there are certain individuals within the country who feel fairly strongly that that story has increased resistance among factions against immunization, polio vaccination in particular. And it cannot be denied, but it's not the only issue. And really, it's unfortunate that political instability is the foundation of the problem in Pakistan to begin with. It's just another -- how can I say, excuse on top of the situations that are already existing in there that have compounded it.
FISHERSo there has been some success and you've spent some years on polio eradication in Europe and of course in India -- India's been held up quite regularly as a case study for eradicating the disease. What best practices have been exported from the areas where you've worked in and from India that have been helpful?
WASSILAKWell the critical thing that happened in India more than a decade ago was that it became a program that was advocated by outside parties, and international organizations. It was something that the government themselves progressively became more involved in, and actually started buying the vaccine and becoming responsible for the execution or the implementation of these mass campaigns.
WASSILAKWhen that happened, and they held the individual politicians and magistrates responsible, the effectiveness of the whole program dramatically improved. And that has also proven to be the case over the last couple of years for Nigeria and Pakistan, as the accountability and responsibility have been taken up by the central and provincial, or state and local governments, things have improved in making sure children get immunized. That's one big thing.
WASSILAKThe other big that can be taken from the experience with India is that -- monitoring how effective the campaigns are has been a value, not just assuming that everybody gets a dose of vaccine. They actually began using what they called ballot box ink, or, you know, the ink that they mark fingers with for when (unintelligible) adults voted, they started using that on children to show that a child has received a dose during the (word?) campaign, to kind of avoid the complications of knowing who and who wasn't vaccinated in the last few days, to make it much more efficient.
WASSILAKThose kind of things have -- those innovations have been taken from India as well as the example of the political commitment to really get us where we are, great progress over the last couple years, but we still have the virus getting outside the borders of these countries that have never stopped the transmission, and that's where we want to stop that entirely, and then also continue to make progress within Nigeria, within Afghanistan, and particularly within Pakistan where there's been -- most of the increase in cases this year is due to the increase in Pakistan.
FISHERWell, we certainly hope that that progress continues, and we want to thank Dr. Steve Wassilak from the Centers for Disease Control and Prevention for updating us on the situation with polio around the world. Thanks very much. When we come back after a short break, we will change gears and talk about the revolution in leafy greens and microgreens. We've got a whole array of greens spread out across the table here. We're gonna learn about them from a farmer and from an agricultural specialist and from someone who operates farmers' markets. That's all coming up after a short break. Please stay tuned.
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