Few Americans remember when polio-stricken children relied on seven-foot-long iron cylinders to breathe. At its peak in early 1950s, polio caused more than 15,000 cases of paralysis a year and over 3,000 deaths in the U.S. alone. In the decades that followed, a massive vaccination campaign nearly eradicated the disease from the globe. Now, a perfect storm of factors has made polio a threat once again. Eliminating the virus is still possible, but only if global leaders shake off their complacency.
Polio is a highly contagious, sometimes debilitating disease that primarily affects children under five. It passes from feces to the mouth via unwashed hands or contaminated food or drink. While most cases are asymptomatic or cause symptoms similar to the common flu, permanent paralysis is possible. Polio can be fatal when breathing muscles stop working.
In 1988, 350,000 cases of polio were recorded in 125 countries. Today, polio is endemic in just two — Afghanistan and Pakistan — and cases of wild polio dwindled to 29 so far this year. By many measures, such results qualify as a resounding success. For polio, however, even one case is a serious global threat.
The latest outbreak in the U.S. is a case in point. This summer, a previously healthy, unvaccinated young adult from Rockland County, New York, was paralyzed after getting infected by a mutated strain. The U.S. hasn’t had a case of wild polio since 1979.
While only one case has been recorded so far, 70 positive samples of paralytic or illness-inducing polio have shown up in nearby sewage testing, according to the most recent data. Experts estimate for each case of paralytic polio, hundreds if not thousands of others are infected without symptoms, which means the virus can spread for months before it’s detected.
Polio’s spread isn’t worrying for the fully vaccinated. But longstanding vaccine hesitancy in certain communities, the rise of misinformation and the deferral of routine treatments post-COVID has created pockets of vulnerability. While more than 92% of the U.S. population has been vaccinated for polio, that figure drops to 60% in Rockland County. In one ZIP code, the rate is just 37%.
Unlike many other diseases, eradicating polio is scientifically possible. The challenge is mustering the will. The Global Polio Eradication Initiative, a five-year campaign to reach 370 million children annually, aimed to raise $4.8 billion in a drive last week. It secured a little more than half that amount, which included $1.2 billion from Bill Gates. (Bloomberg Philanthropies is a regular donor to GPEI.) Key contributors such as the UK have cut back because of shrinking budgets and competing priorities. Even Gates, while affirming his commitment, said it might not be “forever.”
This is troubling. Research has shown that even a small decrease in the intensity of immunization can lead to large outbreaks. Getting much-needed funding to close the vaccination gap is essential, particularly in places like Afghanistan and Pakistan, where health workers not only face vaccine aversion, but mass migration, flooding, political instability and poor nutrition, which requires more dosing. India’s success overcoming similar hurdles shows that eradication is possible.
Increased surveillance is also key. New York is ramping up its wastewater testing and encouraging more liberal screening of unvaccinated patients in certain counties. Still, testing and sequencing is conducted by the Centers for Disease Control and Prevention, which can create bottlenecks. Expanding the CDC’s capacity would quicken local officials’ response time, a critical need if the virus spreads to other parts of the country.
For years, polio seemed to be on the brink of eradication. No longer. Only through sustained investment can the world protect millions of children from a devastating yet entirely avoidable disease.
