The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on two continents. The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off limits to vaccinators 14 months ago.
The African outbreak began in May with just two cases of polio paralysis: one in Mogadishu, Somalia’s capital, and another in the huge Dadaab refugee camp in Kenya, where thousands of Somalis have fled fighting between Islamic militants, clan militias, government troops and African peacekeepers.
Now there are 121 cases in the region; last year, there were only 223 in the world.
The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the C.I.A. had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until American drone strikes ended.
Although only three North Waziristan children have suffered polio paralysis since then, even one case shows that the virus is in the area and could spread.
The new outbreaks may delay a recently announced $5.5 billion plan to eradicate polio by 2018. Nonetheless, public health officials still believe that, with enough local political will and donor money, they can prevail by using techniques that have worked before.
To prevent the disease from reaching Mecca during next month’s hajj, Saudi Arabia has tightened its rules. Pilgrims from any country with polio cases must be vaccinated at home and again on arrival. Last year, nearly 500,000 pilgrims were vaccinated on arrival, Dr. Ziad A. Memish, the Saudi deputy health minister, said recently.
The Pakistan outbreak is particularly frustrating because eradication had been going steadily forward despite the killings in December of nine vaccinators for which some blamed the Taliban.
Public health officials had counted themselves lucky that despite simultaneous vaccination bans in North and South Waziristan, no polio virus was known to be circulating in the 250,000 children in those areas. Vaccination posts were set up on nearby highways and on buses and trains. Urban hospitals packed the vaccine on ice for families willing to smuggle it back to neighbors. But it was not enough.
“The equation is simple,” said Dr. Elias Durry, emergency coordinator for polio eradication in Pakistan for the World Health Organization. “Where you can immunize, the virus goes away. Where you can’t, the virus gets in, and it will paralyze these poor kids.”