The biggest threat to the polio eradication effort now is an explosion of vaccine-derived polio outbreaks in Africa that affected almost two dozen countries last year and paralyzed more than 500 children in 2020 and again in 2021.
On 17 February, Malawi’s Ministry of Health announced a nasty surprise: A 3-year-old girl who was paralyzed in November 2021 was infected with the wild poliovirus, which Africa officially vanquished in 2020. The sequence of the virus showed it had somehow made the leap from Pakistan, one of the last two holdouts of the wild virus. A week later came bad news from Afghanistan: Gunmen killed eight polio workers in the country’s northeast.
A big part of the problem is that countries don’t view vaccine-derived strains as an emergency, says Simona Zipursky, an adviser to the World Health Organization’s polio program, even though they behave just like the wild virus. “It is not like there is a milder variant as there is with COVID-19,” Zipursky says. Nigeria’s widely lauded victory over the wild virus—it was the last African country to achieve that feat—fed a sense that “the job was done,” says WHO’s Aidan O’Leary, who directs GPEI.
Pending its arrival, Senegal waited for almost 1 year before responding to a virus detected in late 2020, instead of using readily available supplies of mOPV2. “If the virus gets a head start for such a long time it is harder to stop,” says Mark Pallansch, who recently retired from CDC but remains involved in GPEI.
Accordingly, in February 2021, WHO’s Africa office sent pink slips to all GPEI staff. Unfortunately, the office was slow to say who would be kept on, and some people got nervous and quit, officials say. GPEI soon realized the Africa situation was “too hot right now” to proceed with the plan, Wenger says, and decided to continue to fund the 10 highest risk countries in Africa for another 2 years. But the damage had been done. “Things didn’t have to happen this way,” Pallansch says.
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