From Pakistan to China: A Country in Crisis and the Reemergence of Polio

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In a rather disturbing article on their official website, WHO has come forward with some startling facts. Conventionally, polio has been endemic to four nations for the greater part of the past decade: Pakistan, Afghanistan, Nigeria, and of course, India. The last recorded polio case from China was in 1999. In the article dated 20th September, the WHO has declared that the WPV1, genetically linked to the virus currently circulating in Pakistan (which has already seen 84 cases thus far this year, compared to 48 in the same period last year) has now been isolated from 7 cases in China.

The poor coverage in inaccessible areas of the Khyber and Federally Administered Tribal Areas is to blame, according to the WHO. The lack of security has hampered the coverage of as many as 200,000 susceptible children in these zones.

This brings us face to face with an inconvenient truth. With the conflict zones ever increasing in the politically charged areas of Pakistan, it might serve as a fair warning for India as well. Although India is much safer a place to organize a public health program, than, say some of the African nations like Somalia, for example, still, recent trends are not encouraging.

The fact remains that like the Khyber, Sindh, Baluchistan and FATA areas of Pakistan, North East India is a politically labile place. Widely regarded to be a corridor of passage for illegal arms men and terrorists, who prefer it due to its geographical inaccessibility, the general health status of the more inaccessible parts are not very encouraging.

With globalization and international travel being as rampant as it is nowadays, the real fear is the exportation of the disease to the more developed world, where Polio eradication has moved well into its second/third decade. These countries have since discontinued the regular polio vaccination program, with a subsequent decay in the herd immunity of the population. The possible explosive nature of the resulting outbreak is scary.

While the whole world looks on towards the subcontinent and hopes against hope that some day soon the political tension and internal conflicts in the respective nations shall come to an end and life will go on as usual. But until that happens, there will be more than just financial or socio-political fall outs.

There will be medical impacts as well, like the spread and reemergence of Poliomyelitis. While we have struggled to wipe out its last vestiges thanks to a number of issues like poor coverage, poor compliance, poor monitoring, etc. adding the problem of poor security issues would even worsen the situation. This is one more aspect to add to the ever growing problem of the conflict within and outside the subcontinental countries.

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Update: This post was the first draft for a scholarly submission by me, Parijat Sen and Tamoghna Biswas. You can check out the final publication here.

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

0 Comments

    • The real risk, besides importation is also that of the problem within. With Hajj and other mass pilgrimages scheduled, the WHO is justifiably worried about the spread to the Middle East, but there are ways to check that. However what about places in India and Pakistan, which are literally hotbeds of organized terrorism, that are far flung and are poorly covered by public/preventive health?

      Risks of terrorism come in many form and shape and public health disasters like this one is one of them… these signs are not particularly encouraging I think…

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