What It Will Take to End Polio

TIME magazine online “What it Will Take To End Polio” Oct 2, 2014


What it Will Take to End Polio

Jeffrey Kluger @jeffreykluger

Franklin Roosevelt never knew the Pakistani babies battling polio today, but he knew their pain. The world is fighting to end that suffering forever


President Franklin D. Roosevelt leaves his home at 49 East 65th Street for a short visit to his family estate at Hyde Park, north of New York City on Sept. 27, 1933.

President Franklin D. Roosevelt leaves his home at 49 East 65th Street for a short visit to his family estate at Hyde Park, north of New York City on Sept. 27, 1933.

You can still see the ramps and rails at Franklin Roosevelt’s house on East 65th Street in Manhattan—even though they’ve been gone for decades. They’re easily visible in the pictures that decorate the home. They’re visible, too, in the popular iconography of Roosevelt, who was photographed standing countless times after being paralyzed by polio in 1921, but always with a hand on a railing, an arm on an aide, a cane in his grip—and ramps and rails at the ready.

The six-story Roosevelt house, where the family lived from 1908 until their move to the White House in 1933, is now owned—and was restored—by New York’s Hunter College. These days it’s a place of learning and policy conferences. But it is also a place of historical serendipity.

“When the house was built, it was one of the first private residences in New York that had its own elevators,” Hunter president Jennifer Raab told me as we toured the building this morning. Those became indispensable once FDR became paralyzed, and it was in that house that his kitchen cabinet thus gathered in the four months between his election in 1932 and his inauguration 1933. “The New Deal was born here,” Raab says.

For FDR, there were abundant compensations for polio. As Ken Burns’ documentary The Roosevelts makes clear, the disease deepened and grounded him. It made him a champion of children with polio—an effort that led to the March of Dimes and the later Salk and Sabin vaccines—and for that matter a champion of all people who suffered hardship. It was polio that gave Roosevelt a fuller temperament—and in turn gave the nation a fuller Roosevelt.

There are no such compensations for the handful of children around the world who still contract the crippling disease. On the same morning I was making my visit to the Roosevelt house, word came out of Pakistan that the country is on target to top 200 polio cases in 2014, its biggest caseload since 2000. Pakistan is one of only three countries in the world where polio remains endemic—the other two are Afghanistan and Nigeria, with 10 and six cases respectively so far this year—and it’s the only one in which the caseloads are moving in the wrong direction.

As recently as 2005, Pakistan’s case count was down to just 28, helping to push polio to the brink of eradication. That same year, however, religious leaders in northern Nigeria declared a boycott of the vaccine, claiming that it contained HIV and was intended to sterilize Muslim girls. This led to a wildfire spread of the Nigerian strain that stretched as far southeast as Indonesia.

But Nigeria got its house in order, and the hot zone now—a more challenging one—has shifted to Pakistan, particularly in the tribal areas in the north and in the mega-city of Karachi. Some of the problem is simply the crowded, unhygienic conditions in Karachi. But the bigger piece is the fighting in the tribal regions, which have made vaccinations difficult or impossible. That’s been exacerbated by Taliban gunmen, who have shot and killed 59 polio field workers and police officers trying to protect them since 2012.

“It’s a very sad thing,” Aziz Memon, head of Rotary International’s PolioPlus team, told TIME by phone from Pakistan today. “We’re trying to get vaccinators on the ground and into the field despite the ban. And now rains and flooding that have broken 100-year-old records are creating more problems.”

Rotary, which has been the point-organization for the eradication of polio for more than 25 years, is being assisted by the Gates Foundation, Save the Children and multiple other international groups, all working to push back against the Taliban blockade. Vaccinators routinely wait at bus stops around Pakistan, climbing aboard and looking for kids who have no vaccination records and administering the drops on the spot. Refugee camps in the war torn tribal regions provide another way of standing between the virus and the babies.

“When the virus is contained like this it’s a good opportunity to step in and control it,” says Memon. “We can also take advantage of the low-transmission season, which starts soon.”

The effort to snuff out polio altogether is more than merely the moral thing, it’s also the practical thing. Bill Gates repeatedly stresses that $1 billion spent per year over the next few years can save $50 billion of the next 20 years, money that would otherwise be spent treating polio and constantly fighting the brushfire war of vaccinating against outbreaks. Eliminate the disease for good and those costs go with it. What’s more, the delivery networks that are put in place to do the job can be easily repurposed to fight other diseases.

None of this long-range thinking makes a lick of difference to the 187 Pakistani children—or the 10 Afghanis or six Nigerians—who forever lost the use of their legs this year. They are paralyzed, as they will be for life. For them, there is no offsetting wealth, no townhouse with an elevator, no path to global greatness. There is only the disease—a pain FDR recognized and fought to fix. In Pakistan, that same fight is being waged today.

Karachi’s polio vaccinators in the crosshairs

Link: http://www.aljazeera.com/indepth/features/2014/09/karachi-polio-vaccinators-crosshairs-2014930113016107468.html

Polio remains endemic in Pakistan as health workers battle anti-vaccine prejudice and threat to life by armed groups.


Uzma Islam, right, says she tries to address the concerns of those who refuse the vaccine [Asad Hashim/Al Jazeera]


Karachi, Pakistan - Sitting at his worktable in a ramshackle hut in one of Karachi’s poorest districts, Muhammad Aslam makes clothes for a living. The 17-year-old never went to school, but has been a tailor since he was 12, making about $20 a month from sewing men’s shalwar kurtas - a traditional dress.

“I can walk on it, but it hurts. My leg is wasted away from the knee down,” he says, steadying his left knee with his hand as he leads me through the dusty, labyrinthine streets to his home.

Aslam is one of hundreds of people in Pakistan who suffer from polio, a crippling virus that attacks the body’s central nervous system.

In the last 25 years worldwide polio cases have dropped by 99 percent, but the highly contagious disease, which is passed on through infected water and food contaminated with the faeces of an infected person and thrives in areas with poor sanitation and incomplete vaccination efforts, remains endemic in Pakistan, Afghanistan, and Nigeria.

Of those, it is Pakistan that remains the most at risk, suffering 166 cases already this year, compared to just 10 in Afghanistan and six in Nigeria, according to the World Health Organization (WHO).

It is an alarming uptick from the 93 cases reported in total last year, and the 58 cases in 2012, as Pakistan’s efforts to control the disease appeared to finally be bearing fruit.

While the lack of uniform hygiene standards is one reason for the disease’s spread, health workers told Al Jazeera that the biggest issue in Pakistan is opposition to vaccination by parents – often with the “justification” that the vaccine is part of a conspiracy to sterilise Muslims, as advocated by the Pakistani Taliban – and subsequent attacks on polio vaccination workers.

While the majority of Pakistan’s polio cases are found in the tribal areas, where the government writ is tenuous and the Pakistani Taliban hold sway over large areas, that ideology has been exported to other parts of the country, too, creating reservoirs where the disease can spread across geographical boundaries.

Nowhere is the threat more visible than in Karachi, Pakistan’s largest city, and one where a complex mix of ethnic, political and religious conflicts has resulted in a city where violence itself is endemic.

‘Creating fear by killings’

“[The Taliban] have been living in some areas, engaging in criminal activities and killing polio vaccinators,” says Aziz Memon, chairman of Pakistan’s national Polio Plus committee, referring to the Karachi areas of Sohrab Goth, Baldia, Landhi, and Bin Qasim, where even police officials told Al Jazeera they often feared to tread.

“Now if you start killing people, then [vaccinators] will not be able to go there. When they are not able to go there, it will become a polio reservoir.”

polio victim

Aslam, 17, says that he does not let his disabled leg affect his daily work as a tailor [Asad Hashim/Al Jazeera]


This perception was only strengthened by the CIA’s use of Dr Shakil Afridi during a similar immunisation drive in Abbottabad to ascertain the location of Osama bin Laden, polio workers say, citing arguments made by those who refuse to take the vaccine.The threats from Karachi-based groups allied with the Pakistani Taliban is based on a perception that the polio vaccination drops administered to children are meant to harm them as part of “a foreign conspiracy”.

“No one used to care about the conspiracy theories before Dr Shakil Afridi, but now people have started caring. And they have started creating fear by killing vaccinators,” says Memon.

Since July 2012, 58 people have been killed in attacks on polio vaccination teams in Pakistan, including at least 24 health workers, according to data compiled by UNICEF. In the latest attack, on September 10, in the tribal area of Bajaur, a paramilitary soldier who was providing security to a team was killed by a group of masked gunmen.

“We take our lives in our hands when we work in these areas, the danger is very high,” says Mashook Ali, 20, a polio vaccinator who works in the Quaid-e-Azam Colony area of Karachi. “But we do this for the children, so that they are saved from the virus.”

Vaccination teams in Karachi are often deployed with security cover from the police. On Monday, a four-day polio vaccination drive in Karachi kicked off amid tight security. But vaccinators said that the police protection was often more superficial than meaningful.

“We have seen incidents where vaccinators have been fired upon, especially in Pashtun areas, where we work, so we do feel afraid,” says Saddam Hussain, 18, another vaccinator. “But we do this work for the betterment of Pakistan. We have made an oath to eliminate polio from Pakistan.”

‘Militants are like kings’

Reports of polio cases in Karachi coincide with the areas of influence of the Taliban, according to police officials with whom Al Jazeera spoke. It is in these areas that environmental samples consistently test positive for the virus, too, according to the WHO data.

Karachi is the only Pakistani city, other than Peshawar, where such environmental tests consistently bring up positive results for polio, according to the data.

Sheraz Aslam, a coordinator for polio vaccination efforts in Karachi, says: “There are areas where you cannot go at all. If they want vaccinations there, they have to come outside their area, to us.”

Waqar Gill, 19, an area coordinator for vaccination efforts in an area under threat, said that the vaccinators are more concerned about refusals, however, than the threat of attack.

“Those who refuse say that the vaccine reduces male potency, or that it is a US conspiracy. Some even say it is made from the urine of foreigners,” said Hussain.

Gill added that there were also concerns about short-term ill-effects as a result of the vaccinations, which immunise children by giving them a very small dose of the infection.

Those who refuse say that the vaccine reduces male potency, or that it is a US conspiracy. Some even say it is made from the urine of foreigners.

- Saddam Hussain, 18, a polio vaccinator

“From North Waziristan, when these terrorists went to Syria, they move with their families,” he said, pointing to the detection of a Pakistani strain of polio in Syria last year. “Until you do not achieve total elimination, the whole world is unsafe. Because the virus is just a flight away.”The lack of immunisation coverage, combined with the influence of the Taliban and the constant flow of migrants into the city has turned Karachi into a reservoir for the disease, says Memon, which is of major concern in terms of worldwide polio eradication efforts.

While country-wide coverage rates for Pakistan’s polio immunisation drives are relatively high, they remain far from perfect, with an average of 11 percent of children being missed in vaccination drives, either due to security reasons or refusals, according to the WHO. In Karachi, that number stands at 21 percent.

“If the community is willing to hold a dialogue with you, then you can ask them, and perhaps even convince them [to allow vaccinations],” says Azfar Ali, the country manager for PolioPlus. “But in certain areas of Karachi, like Sohrab Goth, you can’t even talk about it. Militants are like kings there.”

Aslam, the tailor, lives in an area where there are a large number of migrants from the South Waziristan tribal area, and, consequently, a large number of refusals.

“I feel like if I had gotten the drops, then today I would be able to walk, I’d be able to play. I feel like I am less than these other kids,” he says.

“This disease ruins a person’s life. The people who don’t give their children these drops, they must be idiots.”

Follow Asad Hashim on Twitter: @AsadHashim

Forbes hosted a discussion on Rotary Foundation’s efforts to eradicate Polio in Pakistan, Afghanistan and Nigeria. The Interview was held in Evanston, IL, USA on 23rd July, 2014

Dear PolioPlus Committee Members:

Rotary’s National PolioPlus Chairs Aziz Memon, Tunji Funsho and Mohammad Ishaq were interviewed yesterday in a live online video interview on Forbes.com. The three NPPCs were in Evanston for meetings regarding the endemic countries, and had the rare opportunity to share together the current status of polio eradication in their countries, as well as challenges and opportunities. Please share the link below with others.




Make history with Rotary on World Polio Day 2013

Annual Oct. 24 observance highlights progress in the global effort to end polio

EVANSTON, Ill., USA (Oct. 22, 2013) —World Polio Day 2013 (Oct. 24) provides a golden opportunity for Rotary and its partners to build public support for the historic final push now underway to wipe out thisdisabling viral disease once and for all.

In Chicago, where the humanitarian service organization was founded in 1905, Rotary and Northwestern University’s Center for Global Health will convene an international panel of experts to discuss the progress of the Global Polio Eradication Initiative, which Rotary co-launched in 1988. The event, World Polio Day: Making History, will be streamed live to a global online audience at endpolionow.org from Northwestern University’s John Hughes Auditorium, 303 E. Superior St., Chicago, beginning at 5:30 p.m. CST on Oct. 24.

Confirmed panelists include Dr. Bruce Aylward, the world’s leading expert on polio eradication and assistant director-general for polio, emergencies and country collaboration at the World Health Organization; Dr. Robert Murphy, director of Northwestern University’s Center for Global Health; and U.S. ParalympianDennis Ogbe,a polio survivor and ambassador for the United Nations Foundation’s Shot@Life program. An executive with Brown-Forman Co., Ogbe is originally from Nigeria, one of only three countries where the wild poliovirus has never been stopped.

Also invited is Emmy award-winning actress Archie Panjabi, one of Rotary’s End Polio Now celebrity ambassadors. In 2012, Panjabi helped Rotary volunteers immunize children in India, where she spent part of her childhood. Once considered the nation facing the most serious challenges to eradication, India was removed from the polio-endemic list in January 2012. If Panjabi is unable to attend in person, the Chicago program will include exclusive video of her work in India.

This year, World Polio Day fundraisers will have greater impact due to the new fundraising campaign, End Polio Now: Make History Today, recently launched by Rotary and the Bill & Melinda Gates Foundation. The Gates Foundation will match two for one every new dollar Rotary commits to polio eradication up to US$35 million per year through 2018.

“World Polio Day provides an important and timely opportunity for us to let the world know that every dollar contributed to Rotary for polio eradication will work three times as hard,” said Dr. Robert S. Scott, MD, chair of Rotary’s PolioPlus program. “Rotary invites everyone — private citizens, businesses, non-profits – to join us in this historic effort. Only one other human disease – smallpox – has ever been beaten. Now is our best chance ever to make polio the second.”

Rotary clubs in every region are planning an array of activities on or leading up to World Polio Day.

  • Rotary clubs in India plan a nationwide series of outdoor illuminations carrying Rotary’s “End Polio Now” message on World Polio Day. In January, India will celebrate three years of no new polio cases, a huge milestone for a country once considered to harbor the most serious challenges to eradication.
  • Scores of Rotary clubs worldwide are working with local schools to organize Purple Clothes Dayson Oct. 18, the Friday before World Polio Day, encouraging each student to wear a purple item of clothing and make a small donation to Rotary’s polio eradication program. The concept began with Rotary clubs in England, inspired by the purple dye that health workers in polio-affected countries place on children’s pinky fingers to show they have received the oral polio vaccine.Similarly, many Rotary clubs in England, Kenya and elsewhere are selling fabric “purple crocus” lapel pins in support of polio eradication.
  • In Kenya, Rotary clubs will work with partnering agencies and the national government to use World Polio Day to launch the next round of national polio immunization activities in early November, a campaign deemed critical due to the recent outbreak of imported cases throughout the Horn of Africa.
  • Rotary clubs in Lagos, Nigeria, are partnering with the Cycology Riding Club to do a six-hour relay bicycle ride on Oct. 19 to promote World Polio Day and the national immunization rounds set for early November. The event is reportedly Nigeria’s first-ever bike-a-thon.
  • In partnership with UNICEF, Rotary clubsin Pakistan, another polio-endemic country, on World Polio Day will begin distributing 5,000 copies of a 16-page “speaking book” that health workers and parents can use to teach young children the importance of polio vaccinations and basic hygiene. The audio version of the text is in the regional languages of Urdu and Pashto.
  • In Spain and Portugal, Rotary clubs are generating public support for polio eradication via the crowd-speaking platform, Thunderclap, in a campaign that concludes on World Polio Day.

Rotary and polio eradication

In 1988, Rotary helped launch the Global Polio Eradication Initiative with the WHO, UNICEF, and the U.S. Centers for Disease Control and Prevention. Since then, Rotary club members worldwide have contributed more than $1.2 billion and countless volunteer hours to the polio eradication effort.

Overall, the annual number of new polio cases has plummeted by more than 99 percent since the 1980s, when polio infected about 350,000 children a year. Only 223 new cases were recorded for all of 2012. More than two billion children have been immunized in 122 countries, preventing five million cases of paralysis and 250,000 deaths. Polio today remains endemic in only three countries, Afghanistan, Nigeria and Pakistan, although “imported” cases in previously polio-free areas – such as the Horn of Africa — will continue to occur until the virus is finally stopped in the endemic countries.

About Rotary

Rotary is a global network of volunteer leaders dedicated to tackling the world’s most pressing humanitarian challenges. Rotary’s 1.2 million members hail from more than 200 countries and geographical areas. Their work improves lives at both the local and international levels, from helping families in need in their own communities to working toward a polio-free world. For more information, visit rotary.org and endpolionow.org.