07/07/2013 18:12 BST | Updated 06/09/2013 06:12 BST

Polio: We've Started, So We'll Finish


We are within spitting distance of wiping polio off the face of the planet for all time. This is the last stage of one of the grand medical crusades of the 20th Century, which in 1988 was given focus, credibility and an apparently workable schedule by the World Health Organisation and its partners. Back then, the WHO was flushed by its success in having eradicated the much greater scourge of smallpox, a feat accomplished in just 11 years. Polio had already been pushed out of two-thirds of the world's countries by vaccination; polio seemed an easier target and a deadline of the year 2000 entirely reasonable.

Now, 25 years and several missed deadlines later, there are just three last-ditch enclaves of endemic polio: Northern Nigeria, Afghanistan and Pakistan. One of the three types of poliovirus has already been beaten into extinction, and 2012 saw only two hundred cases of paralytic polio worldwide - a reduction of over 99.9% compared with the 350,000 cases in 1988. But this is an exercise that cannot be left nearly finished, and a happy ending is by no means guaranteed. Polio vaccination will have to continue until after the last boltholes had been cleared of the virus. Without that safeguard, a huge susceptible population would soon build up around the world; if allowed to smoulder on, the infection could then flare up and ignite the biggest real pandemic ever.

So what is preventing us from going those last few inches? The poliovirus is resilient, the vaccines are not perfect, and the remaining battlegrounds are riven with geographical and logistical barriers. But the major obstacle is something much more intractable: people.

All three polio strongholds are under the control of hard-line Islamists, who are implacably opposed to polio vaccination. Religious and government leaders have proclaimed that the vaccine has been deliberately contaminated by Western anti-Islam forces, and contains toxic hormones and even HIV, designed to sterilise and kill young Muslims. This is blatantly rubbish, as has been demonstrated by an independent (and Muslim-run) laboratory. Moreover, a senior Islamic cleric and scholar has taken pains to point out that there is nothing in the Koran against the concept or practice of polio vaccination (which in fact is mandatory for all pilgrims setting out on the Hajj to Mecca). However, the hard-liners hold sway, thanks to their backing by tame doctors, an intensive campaign of intimidation, and the high-profile murders of officials and volunteers involved in the vaccination initiative. The murders, mostly of women vaccination workers and including a 16-year-old schoolgirl, have done the trick. The parents of several million children in these regions are now keeping them away from vaccination.

These are crimes against humanity. However, the Taliban and their Nigerian counterparts are not alone in being focused on their own agenda and showing cruel disregard for vulnerable people and the bigger picture. The current wave of anti-western anger was triggered by the murder of Osama bin Laden in 2011. Especially inflammatory was the revelation that bin Laden had been located by a covert CIA operation involving a tame Pakistani doctor (genuine) and a vaccination campaign (bogus), which exploited the bond of trust that gives doctors extraordinary privileges of access. A brain the size of a planet is not required to predict how the Taliban would react to this Trojan horse operation, or to see that the polio vaccination campaign, which has 'America' stamped all over it, was an obvious soft target for retribution. There is savage irony here, in that the polio vaccines were the product of funds raised in the USA during the 1930s-1950s by the 'March of Dimes', a massive pyramidal enterprise whose apex lay in the White House with President (and polio survivor) Franklin D Roosevelt.

So where do we go from here? The Global Polio Eradication Initiative cannot be allowed to fail. If it does, the $11billion already tipped into it will make this one of the costliest public-health flops ever. The reputations of those committed to the GPEI, including Bill Gates, Rotary International, WHO and UNICEF, will be diminished. The credibility of the WHO, which desperately needs a big hit to demonstrate its ability to deliver, will be called into doubt. A noble cause which has its roots over 60 years ago will have been derailed on the brink of victory. And a miserably cruel disease, whose legacy still afflicts tens of millions of people around the world today, could come back to hit us harder than ever before.

It is now acknowledged that the long-term solution in those three troubled regions will hinge on bringing former enemies to the table, burying differences and finding a common way forward. A good first step, and potentially an easy hit both symbolically and practically, would be for both sides to work together to restart the polio vaccination campaign. Let's hope that all those around the table will agree.

Gareth Williams is Professor of Medicine at the University of Bristol and author of Paralysed With Fear: The Story of Polio. He is ambassador for British Polio Month 2013 in association with the British Polio Fellowship.