Why Polio Just Became a Global Health Crisis—and a Global Governance Crisis

Though only 650 cases were recorded last year, the World Health Organization declared the disease an emergency, but its importance goes beyond public health.

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A health worker administers polio drops to a child in Jalalabad, Afghanistan. (Reuters)

Few people probably associate the phrase "global health emergency" with polio, a disease that has been around for 5000 years and is on a decades-long decline so steep that there are less than a thousand recorded cases left on Earth, and it no longer even seems real to many in the developed world. "Global health emergency" might sound applicable to HIV/AIDS, malaria, or cancer, but polio?

And yet, that is exactly what happened late last Friday afternoon in Geneva, when the World Health Assembly, the governing body of the World Health Organization, declared polio a public health emergency, calling for the 194 member states to fully fund the Global Polio Eradication Initiative, and fill the currently $945 million gap in its budget for 2012-13. But this is about much more than just filling a budget shortfall: polio's threat is still very real, and the mission to finally stamp it out forever is a crucial one for reasons even bigger than the disease itself.

Since the world decided to come together to eradicate polio in 1988, the disease has been almost entirely eliminated. It killed or paralysed more than 350,000 children each year in the 1980s, but there were just 650 recorded cases in 2011. In January, India celebrated its first polio-free year in history, leaving the disease endemic in just three countries: Nigeria, Pakistan and Afghanistan. The latest figures from the World Health Organization show only 60 cases so far in 2012.

But polio is a different type of emergency than the ones we usually hear about in the news. Its biggest danger isn't the current number of cases, but the implications for failure: not only because a failure to eradicate could allow for a resurgence that could kill or disable thousands of children each year, but because of what it holds for the effectiveness of our global health systems itself.

Part of the risk has to do with money. Over the past quarter century, $9.5 billion has already been spent on polio eradication, driven by international organizations -- primarily the WHO and UNICEF -- as well as private donors such as the Gates Foundation and Rotary. The WHO's strategic advisory group of experts on immunization have said that failure to eradicate polio would be "the most expensive public health failure in history." A failure to make all that money achieve its intended goal could make it tougher to solicit donations from countries and individuals for future eradication campaigns.

The other element is symbolic. In a sense, polio will be a marker of either what the world can or cannot achieve in global health. "If we finish polio eradication, what it will prove is that with a relatively modest investment in the grand scheme of things, you can achieve real health outcomes," says Bruce Aylward, the Canadian epidemiologist who heads the WHO's eradication efforts.

Wiping out a disease is a difficult business. It is a feat we've achieved only once before, with smallpox in 1979. It's not that we lack the technology: the first polio vaccine was created by Jonas Salk in 1954, following the horrific 1952 epidemic in the United States, and the oral vaccine commonly used in the developing world was created by Albert Sabin in 1963. The real challenge is ensuring that the vaccine reaches every single child, especially those children likely to be missed by routine vaccination programs: those in the poorest, most remote corners of the globe.

For a disease like polio, the challenge is steeper still. Where almost everyone infected with smallpox develops a distinctive red rash, allowing sufferers to be identified and quarantined, polio has no visible effects on 99 percent of people who carry the virus. Its relative invisibility allows it to travel undetected, seeping into vulnerable pockets and popping up seemingly at random.

"What we've seen in the past 10 years is, as soon as you relax your control measures, polio comes back in far greater numbers," Michael Toole, Deputy Director of the Burnet Institute in Melbourne and a member of the eradication initiative's independent monitoring board, told me. He points to outbreaks in China in 2011 as well as Tajikistan and the Democratic Republic of the Congo in 2010 -- all countries previously declared polio-free. In 2005, there was a polio outbreak in an Amish community in Minnesota, infecting five children but paralyzing none.

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Rachel Hills is a freelance writer based in London. She is currently working on a book about sex, power, and identity.

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