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Polio in Afghanistan

Polio forever seared two images in my mind.  That may account for my reaction to the story in the January 17th New York Times, “After Years of Decline, Polio Cases in Afghanistan Triple in a Year”.

There are other images, of lines of schoolchildren awaiting shots, I among them, in the 1950s.  Of patients with lameness in a leg, or chronic pain years down the road, not being one of the lucky ones like me.   But none is so hard to shake off as the man in the iron lung or the child found dead of asphyxiation.

When I was a little girl my father took me to see the man in the iron lung.  Daddy sang and played piano in a men’s gospel group that performed God’s music for the man, brother of one of the singers.  Only his head protruded from the monstrous hissing contraption.

Years later, not long out of medical school, a nurse colleague told me about the little boy whose needless death still haunted her.  Jeannie had a big heart, had been a Peace Corps volunteer in Colombia.  She left the hospital one night and returned the next morning to find the child dead from a power outage that shut down the ventilator forcing air into his helpless lungs.

Polio famously respects no boundaries of class or nationality.  Still, its mostly under-five-years-old victims are now found exclusively in underdeveloped countries in Africa and Asia.  The highly contagious disease is endemic only in Afghanistan, Pakistan, and Nigeria.  Cases in non-polio-endemic countries are the result of imported virus.

In 2009-2010 imported virus re-infected 23 countries previously polio-free.  Angola, Chad and the Democratic Republic of the Congo have been classified as having re-established transmission, i.e., the virus has been spreading again within those countries.  These developments have health officials alarmed, after decades of huge strides toward making polio the second infectious disease after smallpox to be eradicated from the planet.

Efforts to eradicate polio took flight after Jonas Salk developed the first effective vaccine in 1955.  This despite years of being targeted by the FBI under J. Edgar Hoover as a suspected communist.   It was in Czechoslovakia and Hungary that the first mass vaccination campaigns, using the Sabin oral vaccine, were carried out starting in 1959.  Czechoslovakia had no reported polio after 1960 and Hungary was declared polio-free in 1969.

The Western Hemisphere was certified polio-free in 1994.  The European Region, including all of the former republics of the Soviet Union, was polio-free as of 1999.  Then, in 2009 polio re-emerged in Tajikistan, which shares a border with Afghanistan.

Pakistan ranked first in 2011 polio cases with 197 of the 643 reported worldwide.  An October 17, 2011 article in the Los Angeles Times, “In Pakistan, polio vaccines cause for fear”, pays lip service to the notion that armed conflict has played a role in Pakistan bearing this distinction. The author refers to the “war against Islamic militants” along the Afghan border and to the migration of people from those areas as main factors in the difficulty of vaccinating people against polio.

The bulk of the article is devoted to the role of radical Islam in sowing irrational mistrust of the vaccines and to anti-Americanism. According to the article, anti-Americanism is fueled by the incident of the killing of 2 Pakistanis by CIA contractor Raymond Davis, and by the decision by Obama not to inform Pakistani leaders before the “US operation” against Osama bin Laden.  And, of course, the phony vaccination pretext used by the CIA to gain access to Bin Laden’s compound before the raid.

Not to suggest these are insufficient explanations for anti-American sentiments, it still shocks this reader that there is no mention of the undeclared war being waged by the US against Pakistan.  A war whose deadly drones have killed over 2000 Pakistanis, including 168 children in the last 7 years.

Where armed conflict exists, population displacement, malnutrition, and lack of access to health services all contribute to civilian death and suffering from all causes, including polio.   Iraq, declared polio-free in 1990, began to see cases in the 90s after the Gulf War and during the sanctions.

Afghanistan was on the verge of eliminating polio in 2001 prior to the launching of the US-led war. Armed conflict has played a role in virtually all countries where polio has persisted or re-emerged.  Nowhere is that more obvious than in Afghanistan.

Afghanistan’s 76 reported cases for 2011 (just revised upward to 80), the New York Times article points out, likely reflect many thousands.  “Each detected case is an indicator of hundreds of ‘silent’ ones, mainly children with mild infections who become carriers.”

Although the Times article mentions “conflict” in Afghanistan and quotes Peter Crowley of UNICEF as stating that “security was a factor”, there is not one word about the US war and occupation, now in its 11th year.

President Karzai blamed the Taliban for the tripling of cases, accusing insurgents of blocking vaccination teams, a charge denied by the rebels.  International health officials, reportedly shocked and alarmed by politicization of the issue, corroborated the assertion by the Taliban.  Such an official went on to make the astonishingly naïve statement, perhaps a display of wishful thinking: “Health is not a political thing.”

What is one to take from such a piece in the Times?  Where there is no analysis of such a peculiarly absurd statement, no mention of this longest war in US history.

Much has been written about Muslim opposition to polio vaccination, as in the LA Times, typically focusing not on concerns about safety of the oral Sabin vaccine, but about conspiracy theories.  That applies to Nigeria, the third of 3 currently polio-endemic countries in the world.

In 2003 polio vaccination in Muslim northern Nigeria was halted until vaccine safety could be verified, after which, in 2004, it resumed.  Despite the much written about Muslim mistrust of the West, this author has found not a single reference to the two wars being waged against Muslim countries by the US, let alone about the role of oil in those wars.

Nigeria’s oil reserve is the 7th largest in the world, and the country is the largest exporter of oil in Africa, which supplies the US with over 20% of its oil, more than that from the Middle East.  Nigeria, once the supplier of millions of slaves to the US, is now its largest trading partner in sub-Saharan Africa.

To address the current and historical political factors relevant to all countries experiencing polio outbreaks, including war, colonialism, neoliberalism, imperialism, and the global economic downturn exceeds the scope of this article.

Where armed conflict exists, the strategy to combat polio, buttressed by muddled analysis such as that in the NY and LA Times articles, consists of calls for “Days of Tranquility” and safe corridors so that public health workers, often risking their lives for a pittance in compensation, can carry out vaccination campaigns.  Are brief ceasefires the best we can hope for in the struggle to stop this completely preventable, devastating disease?

The tripling of polio cases in Afghanistan and its spread to many countries previously polio-free are the consequences of over 10 years of war waged by the US and its allies against Afghanistan, and of the undeclared US war against Pakistan.  The stricken children will sear their images in our country’s legacy.

Dr. CATHERINE WILKERSON, MD, is a primary care physician in Michigan.

 

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