Since the development of the vaccine, perhaps the most effective public health measure we have yet devised, only one human disease has been completely eradicated from the world – smallpox. The last case was reported in Somalia in 1977. Eradication was the result of a deliberate and intense campaign, requiring almost complete vaccination of the population, especially in certain population dense areas. Countries such as India and Nigeria were among the last to achieve eradication. Some of the lessons learned were that very high compliance rates were needed and that even small communities could harbor the virus and prevent eradication.

Several decades later, at the beginning of the 21st century, we are on the verge of eradicating a second major human infectious disease, polio. Like smallpox, polio is a virus that has no major non-human host, so eradication is possible. The polio virus enters the anterior horn cells of the spinal cord, the lower motor neuron – cells that connect the brain to muscles. When those cells die muscles lose their connection causing weakness and atrophy. Vaccine campaigns have successfully eliminated polio from most countries, but the wild type of the virus remains endemic in Nigeria, India, Pakistan, and Afghanistan.

We have the potential, with one final push (which is being spearheaded by the World Health Organization – WHO) to eradicate wild type polio from the world, but these efforts are being hampered by politics and ideology.

In 2002 the WHO had hoped to eradicate polio from Nigeria by the end of that year, and the rest of the world by 2005. Now seven years later that goal has still not been reached. The problem is not lack of funding, will, or scientific knowledge, but rumor and ignorance. Certain Muslim clerics began preaching to their people not to take the polio vaccine. The reasons varied, but were all based in fear of the West. For example, a BBC article from 2002 reported:

I am sceptical and apprehensive about the polio campaign given the desperation and the rush of the sponsors, who are all from the West,” a young scholar, Muhammad bin Uthman, told the French news agency AFP.

Clerics spread fears that the AIDS virus was being spread (some even claimed deliberately) in the vaccine. Others cited the Pfizer drug scandal from 1996  when an untested drug (an antibiotic called Trovan) was used to treat bacterial meningitis and resulted in a reported 11 deaths and others injured. The WHO was eventually able to get past many of these rumors, but the opportunity for eradication was lost and now the WHO is playing catch up.

Once again, however, politics and ideology are getting in the way of world-wide eradication of polio, this time in Pakistan and Afghanistan. Several factors are at work to frustrate eradication plans. Pakistan recently abolished its health ministry, so the WHO has to work directly with local leaders who may be less receptive to foreigners. The Taliban has long opposed vaccines. Time World reports:

In 2007, a doctor who spoke out against anti-vaccine propaganda was killed in Bajaur agency. The same year, he notes, Taliban fighters kidnapped a public health worker and held him captive until he promised to stop vaccinating children. Last August, Taliban gunmen captured and killed ten aid workers in Afghanistan, claiming they were spies. Such incidents keep health workers out of high-need conflict zones, often the very areas that are in need of care.

This distrust was greatly exacerbated in 2011 when the CIA used a vaccine clinic and its health staff to gather DNA from Osama bin Laden’s children and help locate Osama. This action confirmed the worst fears and rumors of the Taliban – that health workers are really spies working for the US government.

The Taliban has also announced recently that they will not allow the polio vaccine campaign in North Waziristan until the US stops its drone campaign. Estimates range from 280,000 to 350,000 affected children, who will not receive the oral polio vaccine because of the Taliban ban. They are essentially holding the public health, and world health, hostage as a political maneuver.

The CIA using health workers as spies has been universally condemned as reckless. Health workers in general and the vaccine program specifically must be kept apolitical and civilian. The Taliban is also committing a crime against humanity by using an essential health campaign as a political bargaining chip.

We have the ability to eradicate polio from the world and spare countless children from a crippling illness. Since 1988 polio cases have been reduce 99.8% by the WHOs eradication campaign, but endemic polio remains in the four countries named. The polio virus is highly contagious, and because of the potential of world travel if the world wide polio vaccine program is not kept up the virus can rapidly re-establish itself. We have the ability to eradicate this disease, to confine the polio virus to secured laboratories. We have the knowledge and resources – only ignorance and politics now stands in the way. Perhaps we need severe world wide pressure on the four remaining countries to stop their resistance and cooperate with the vaccine campaign. This is an issue of world health that should not be held hostage to any one group’s immediate desires or ideology.


Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.