Polio was seeing a global resurgence. The COVID-19 pandemic may have helped it along

Health volunteer gives a child pulse polio vaccine, during a nation-wide pulse polio campaign in Bangalore on 31 January. Jagadeesh NV/EPA
02 March, 2021

In September 2020, in a mud-brick home in a village on the outskirts of Kandahar city in southern Afghanistan, 18-month-old Hazarat developed a fever, along with vomiting. On the third night of his illness, things took a turn for the worse when he was suddenly unable to move his left leg. Night after night, his mother took him from the family’s village, surrounded by barren mountains, to a hospital in the city, which was about a thirty-minute drive away. After examining him for three consecutive nights, doctors were resigned to the fact that the little boy was very likely to have acquired polio. After all, they knew that polio vaccination campaigns had been halted for several months. The circulation of the polio virus had most likely increased in the environment as a result. The doctors took a stool sample and sent it to a laboratory in Islamabad. One month later the diagnosis was confirmed: Hazarat had polio. “We cannot do anything,” the doctors told Malaka, Hazarat’s mother, who did not want to be identified by her family name.  He had acquired polio after missing his vaccination due to another virus—SARS-CoV2, more commonly known as the novel coronavirus. 

When I met Hazarat in October 2020, he sat on a blanket in the corner of his home. His head was shaved and he had bulging brown eyes. He wore a baby blue perumahan tunbaan—the traditional dress of Afghan men. “We don’t care about polio,” Malaka told me.  “This was the order of Allah. He created this boy and if Allah wants to disable him, fine. Only his one leg is not working. We hope that this problem will be solved. I hope his leg will start working.”

Hazarat is one of millions of children in south Asia who did not get their polio vaccine on schedule in 2020. In fact, UNICEF estimates that 50 million children in both in Afghanistan and Pakistan missed out on vaccines in 2020 due to the disruption in immunisation caused by the pandemic. In 2020, a total of 56 polio cases were reported in Afghanistan. In 2019, that figure was 29. While the number may appear low, it is the highest on record since 2011. In India, meanwhile, 8,06,963 fewer children got the birth dose of the polio vaccine between April and June of 2020 compared to 2019 and 12,31,578 fewer got the booster dose that is usually given to a child between the age of 16 months and two years. The country was in the strictest phase of its lockdown from mid-March to June. The immunisation programme has planned large vaccination drives from the beginning of 2021 to catch up.

The polio virus has three strains that are identified as type 1, type 2 and type 3, all which were found originally as wild strains. With widespread use of a vaccine using a weakened virus, there have also been several instances of vaccine-derived polio.  Disruptions due to the pandemic have lifted the lid from controls of wild type polio in places where it still exists. They have possibly allowed or the spread of a vaccine-derived version of the virus in places where the wild virus has been eradicated. “The main impact of COVID-19 was that it caused a hiatus in our polio eradication efforts and it allowed the virus to spread further than it would normally would,” Dr Jay Wenger, a director at the Gates Foundation and head of its polio-eradication efforts, said. “The virus kept going and there was no effective response. We couldn’t respond to new outbreaks. We have ground to catch-up on.”