Ebola Outbreak Disrupts Polio Eradication Efforts, Highlighting the Need for Greater Investment in Weak Health Systems
By Mark Rosenberg, MD, MPP, President and Chief Executive Officer, The Task Force for Global Health
In 2014, the most devastating Ebola outbreak in history struck West Africa. Guinea, Liberia, and Sierra Leone, which had already been struggling to meet the basic health needs of their populations, were forced to direct their focus and resources to containing the outbreak. Hospitals and clinics closed and healthcare workers went on strike, resulting in the suspension of basic health services including vaccinations for children.
With fewer healthcare workers and resources, Ebola-stricken countries in West Africa suspended or severely limited their polio vaccination campaigns. During this time, an estimated half million children did not receive vaccinations against polio in Guinea, Liberia, and Sierra Leone, leaving these children susceptible to contracting the disease. Although polio is no longer endemic in these countries, the risk for outbreaks increased as a result of the interruption in vaccination campaigns and gaps in vaccination coverage.
Immunization programs have resumed in West Africa in recent months and polio is still on track to be eradicated worldwide. As of Sept. 2, only 37 cases of polio have been reported worldwide in 2015. The Decatur-based Task Force for Global Health has been involved in the polio eradication effort on a number of fronts. In collaboration with the World Health Organization, Ministries of Health, and other global health partners, The Task Force has been supporting the introduction of inactivated polio vaccine, the two-step process for global withdrawal of oral polio vaccine, and strengthening routine immunization systems. These activities are all crucial to polio eradication.
The biggest threat to polio eradication is gaps in immunization coverage that continue to occur due to under-resourced health systems and resistance to receiving vaccines. In 2009, gaps in immunization resulted in a polio outbreak in West Africa. Unvaccinated children in eight countries in the region were exposed to the virus after it was exported from Nigeria, one of three countries where the disease remains endemic. Although Nigeria is on the brink of eliminating wild poliovirus and no wild polio virus cases have been detected this year, West Africa still has not been declared completely free of the disease.
The consequences of immunization gaps were also seen earlier this month when three rare cases of vaccine-derived polio were reported in two previously polio-free countries–Mali and Ukraine. These cases likely occurred because a mutated form of the virus resulting from the vaccine itself was able to circulate within under-immunized populations in these countries.
The global health system is deeply interconnected. Weakness in one part ripples through the entire system. Although the Ebola threat has abated in West Africa, another outbreak could once again disrupt basic health services, including immunization programs, and threaten polio eradication. We must continue to help those countries with weak health systems build their capacity and resources to respond to the next Ebola outbreak while being able, at the same time, to maintain basic health services, including immunizations. Strong immunization programs in these countries ensure all people everywhere are protected against Ebola, polio, and other public health threats.