Rotary International and its partners in the Global Polio Eradication Initiative (GPEI) have transferred the skills they acquired in the fight against polio to Covid-19. (The Global Polio Eradication Initiative (GPEI) is a public-private partnership led by national governments with five partners – the World Health Organization (WHO), Rotary International, the United States Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF) and the Bill & Melinda Gates Foundation. ”
A lot has changed since I wrote about polio on World Polio Day last year. Last year was notable because polio was eliminated from Nigeria and only Afghanistan and Pakistan had cases of “wild” or naturally occurring polio. These two countries have already had problems fighting polio due to misinformation, vaccine refusals and (in Afghanistan) the Taliban’s vaccination ban. Part of this distrust is due to the fact that the CIA launched a hepatitis vaccination program in 2011 to track down Osama bin Laden.
Then came the coronavirus pandemic, which caused vaccinations for polio and other vaccine-preventable diseases to stop for four months. Nearly 80 million vaccinations have been missed by children in Pakistan alone. This disorder has led to increased transmission of polio and tuberculosis (TB), which Dr. Madhu Pai has focused.
Many years of experience with polio has a silver lining – the extensive infrastructure has been adapted and is effectively used to contain Covid-19.
Efforts are slightly better in Pakistan than in Afghanistan, where polio monitors are now also monitoring Covid-19. They test wastewater, conduct contact tracing and testing, and provide extensive training on hygiene. The polio hotline is now used for Covid-19 information, with staff acting as qualified health communicators.
Carol Pandak, Ed.D., longtime director of PolioPlus, Rotary’s global polio eradication effort, told me that Rotary also distributed two million bars of soap in Afghanistan, set up hand-washing stations, and started water filtration systems to improve sanitation.
All Rotary health workers are recruited locally to help prevent the spread of the coronavirus in different areas. They’re also all stocked with masks and hand sanitizer, and provide extensive training for the local communities. I particularly appreciated Rotary’s efforts to use “trusted members of the community” to reach them, as well as female ulema (religious scholars) who use their religious education to shape discussions with mothers.
Outside of these polio-endemic countries, the GPEI is working through the Stop Transmission of Polio (STOP) program (CDC, WHO and Unicef) in Southeast Asian and African countries to expand to Covid-19 through vaccine-preventable diseases, leading the way in public efforts Health. They currently employ 107 people in 32 countries to provide expertise.
Environmental monitoring is a growing tool in the fight against polio. In Israel, for example, polio was found in sewage in 2013. This led to an urgent vaccination campaign and 980,000 children were vaccinated within 7 months. There were no new cases of polio. As they noted, “Surveillance is the way forward.This also applies to Covid-19. For example, the University of Arizona tested dormitory wastewater. They were able to quickly identify and isolate two asymptomatic students, preventing them from spreading in the 311-person dormitory.
Because our human Covid-19 tests were so scattered and inadequate here, some in the US are focusing on strategies to test wastewater for coronavirus instead. A comprehensive wastewater monitoring program was proposed as a cost-effective national strategy. Such pooled tests are more efficient, simpler, and can serve as an early warning for Covid-19 in a university, nursing home, or entire community as the coronavirus is shed in the stool.
There are some tempting suggestions that vaccinations for certain infections might help against coronavirus as well. One is whether a polio vaccination could boost the immune system, as Dr. Lipi Roy examined. Another reason is whether a BCG vaccination could reduce Covid-19. (BCG, or Bacille Calmette-Guerin, is a tuberculosis vaccine that is given in infancy in many countries where TB is common. It prevents the spread of TB or meningitis in children.) This idea is tentative and is under investigation. It’s not ready for prime time.
Polio (and TB) infrastructure is now being adapted to the Covid-19 response by deploying already trained personnel to conduct contact tracing and monitoring, use integrated data systems, and apply effective health messages to this new disease. Similarly, as Dr. Pai notes that the Covid-19 mobile apps, now used for symptom review, risk assessment, mapping, contact tracing, and links for testing, are being tweaked and re-used to improve treatment for polio, TB, and other infections. I think on this World Polio Day it would be wonderful if something good like these proposals came out of this pandemic and how we can learn lessons from one tragedy to mitigate another.
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