Infectious diseases

Fighting polio

In a health center in Abeokuta, Nigeria, babies are vaccinated against polio.

Poliomyelitis (usually known simply as polio) is a highly infectious viral disease that attacks the central nervous system and can lead to permanent paralysis. Young children are particularly at risk, which is why polio is sometimes referred to as "infantile paralysis".

There is still no drug for treating polio, but we do have effective vaccines to prevent the disease.

Global Polio Eradication Initiative

In 1988, the World Health Organization (WHO) came together with the United Nations Children’s Fund UNICEF, the Rotary International humanitarian network, and the US agency Centers for Disease Control (CDC) to launch the Global Polio Eradication Initiative (GPEI). It is one of the oldest public-private partnerships in the health sector.

The aim of this initiative is to make the whole world free of polio. At the heart of its strategy is the comprehensive vaccination of all children everywhere in the first year of life through national immunization programmes. The GPEI has taken great steps forward since its foundation. Whereas 350,000 case of acute polio were registered in 1988, just 22 cases were recorded in 2017. The number of countries with regular outbreaks of polio fell over this period from 125 to three. The only countries still considered "polio endemic" are Nigeria, Pakistan and Afghanistan.

Vaccination teams in danger

In some parts of the polio-endemic countries the breakdown of security in recent years has prevented routine vaccination programmes from reaching all children. The GPEI has initiated special vaccination campaigns in these regions, with the health professionals have to be given armed protection. The overall situation has, however, eased since 2016.

In Pakistan, people’s resistance to polio vaccination is being countered by a community-based approach in which local health vaccinators who know the families personally take charge of vaccinating new-borns and other children not yet vaccinated. Another approach is to deploy mobile vaccination teams who can, for instance offer polio vaccinations at filling stations to travelling families on the road.

Oral vaccination: opportunities and risks

Infants are vaccinated against polio at a health station in Nigeria.

In the countries badly affected by polio, immunisation is mainly performed in the form of oral vaccination. A live vaccine is used, which means it contains live polio viruses of reduced virulence (attenuated) that are still capable of multiplication and are excreted in the recipient’s stool. This can lead to the infection of others coming into contact, who will then form antibodies against the virus. Since the vaccine viruses are attenuated, any infected person does not usually develop any symptoms. In this way, the live polio vaccine viruses can result in growing immunity across the population.

However, in regions where relatively few people are being vaccinated against poliomyelitis, the vaccine viruses may circulate over a long period. The danger here is that they genetically mutate and then do indeed become capable of causing full-blown polio infections. This is a problem of what is known as "vaccine-derived viruses". In recent years, polio cases of this kind have been encountered in, for instance, Ukraine, Syria and the Democratic Republic of Congo.

In countries where there have been no incidences of the disease for years, the health authorities can immunise without using the highly effective attenuated live polio viruses administered as an oral vaccine. The vaccine currently prescribed here is based on inactivated ("dead”) polio viruses and administered as a jab.

German activities

Germany is a close partner of the Global Polio Eradication Initiative. Germany has invested more than 550 million US dollars in polio control measures since 1985.

The most recent funding commitment was made at the 2017 GPEI donors’ conference in Atlanta (USA), where Germany pledged almost 20 million euros to assist efforts in Nigeria and two million euros for Pakistan.

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