This week the global health community is mourning the violent loss of nine workers who were killed while administering vaccines in Pakistan as part of a national polio vaccination program. According to the World Health Organization’s (WHO) global polio eradication initiative, Pakistan is one of three polio-endemic countries worldwide; the other two are Afghanistan and Nigeria. In addition, several other African nations (e.g., Angola, Chad and Democratic Republic of Congo) that were previously certified as polio-free have now been newly re-established. Today Pakistan represents the last remaining source of wild poliovirus type 3 in Asia, with 35 cases in 2012 and three major foci of transmission in the country, including Karachi, Pakistan’s largest city. Because achieving high vaccination coverage rates in Pakistan is absolutely central to meeting global polio eradication targets, the murder of the nine innocent workers who were killed as they went door-to-door providing oral polio vaccines to children is likely to have a chilling effect. This concern is especially relevant for Karachi, where at least five of the workers died and where vaccination efforts have now been suspended. Women comprise most of the health workforce for polio eradication efforts in Pakistan — for the very practical reason that it is easier for a woman to go into a household where other women may be present. There are concerns that women are being singled out, with suspicions that the Taliban may be involved in the killings.
More than two billion children have been vaccinated against polio over the last 25 years resulting in a reduction of more than 99 percent of the cases worldwide (see Figure 1, below). Through generous support from the Bill & Melinda Gates Foundation and other sources, the WHO is now aggressively pursuing the holy grail of global eradication. So far, smallpox is the only disease to be successfully eradicated, although we are also on the verge of eradicating guinea worm infection (dracunculiasis).
One historical irony of the targeted assassinations this week is that the polio vaccine itself was first developed and tested in an unusual spirit of détente and international cooperation. The viral strains that comprise the vaccine were discovered and developed in the Cincinnati laboratories of Dr. Albert Sabin during the 1950s, but the vaccine was actually made and first tested in the Soviet Union. Thus at one of the worst times of the Cold War between the United States and U.S.S.R., not long after the Sputnik launch, both nations put aside their differences to cooperate and build an important technology for peace. Later, the United States and Soviet Union collaborated to improve on the smallpox vaccine that led to eradication. We have used the term “vaccine diplomacy” to describe the largely underused role of vaccines in promoting peace. Indeed both polio and guinea worm eradication efforts were subsequently used as a basis for implementing cease fires in war torn areas of Afghanistan and Sudan.
Reports in the news indicate that the government of Pakistan is committed to resuming polio eradication efforts in their country. I would ultimately like to see the Pakistan health ministry expand its control efforts to many neglected diseases. In a recent article, I pointed out that quite a few neglected tropical diseases are endemic to impoverished regions of Pakistan and surrounding areas of the Middle East. We have found an intimate link between poverty and the emergence of neglected tropical diseases, so the fact that more than one-half of the population of Pakistan lives on less than $2 per day makes this nation a hotbed for neglected tropical diseases, including several different types of helminth, bacterial and viral infections. Another irony is that some of these same endemic diseases are also endemic to poor parts of the southern United States, and our vaccine development facilities at the Sabin Vaccine Institute, Texas Children’s Hospital Center for Vaccine Development and Baylor College of Medicine could be directed to jointly develop vaccines with Pakistani scientists, much as Dr. Sabin did with the Soviets more than 50 years ago.
Our research has shown that neglected tropical diseases disproportionately affect the world’s Islamic countries in Africa, Asia and the Middle East. Collaborating with scientists in these countries represents an outstanding opportunity to take the concept of vaccine diplomacy and apply its principles to a new level. Last week I began a fascinating dialogue with our U.S. Department of State to try and initiate the first steps in that direction.
Fig. 1. Map of global polio eradication. Courtesy of the Centers for Disease Control
Dr. Peter Hotez is president of the Sabin Vaccine Institute, dean of the National School of Tropical Medicine at Baylor College of Medicine, director of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development and the Fellow in Disease and Poverty at Rice University’s Baker Institute.