in these times
[sic] Health & Science

Polio is striking war-torn Syria, and the Assad regime is using this disease, which kills and cripples mostly toddlers, as a weapon of war. The outbreak is part of a tragic and preventable outbreak of the disease in Asian, African and the Middle Eastern nations, some of which had previously been declared polio-free. The unraveling of eradication efforts is so potentially dire that on May 5, the World Health Organization declared the “extraordinary” threat of polio a “Public Health Emergency of International Concern.”

Although there is no cure for polio, there is a cure for its spread: vaccination. After Jonas Salk discovered a vaccine in the 1950s, massive global vaccination campaigns came tantalizingly close to exterminating a disease that once affected hundreds of thousands each year.

Syria was declared polio-free in 1995, but the current war between Damascus and a tangle of opponents has selectively devastated vaccination efforts. In 2010, before the conflict, Syria’s vaccination rate was 91 percent; by 2012, it had plummeted to 68 percent. As of December 2013, as many as 700,000 children were unprotected, UNICEF said.

Most are in opposition-controlled areas, where the Assad regime “actively blocks” vaccination efforts and “has systematically withheld life-saving aid from crossing enemy lines,” writes Doctors Without Borders blogger Hernan del Valle.

“Assad’s method of fighting the war has generated the perfect conditions for polio,” Annie Sparrow, a U.S. public-health expert monitoring the outbreak, wrote in the New York Review of Books. It has led to rampant malnutrition and “appalling living conditions” in opposition-held areas—including the contamination of water, food and sewage that can host the virus.
There is little the United Nations or the World Health Organization (WHO) can do, since under the UN mandate, official organizations can only operate in a country if that government gives its consent.

More than 90 Syrian children have developed polio since May of 2013, Sparrow wrote. That figure vastly under-represents the threat: For every person displaying clinical symptoms, as many as 1,000 more may contract the virus—meaning 90,000 carriers could be “invisibly spreading the disease … for weeks on end,” she added. Exposed adults as well as children can spread the virus. Seeing a high risk of rapid spread, the WHO initiated emergency regional vaccination programs.

But although Syria is included in that effort, its vaccination campaigns systematically favored pro-Assad areas, despite the fact that every one of the country’s polio victims came from opposition-held areas, Sparrow charged. 

For decades, the list of countries with polio cases had been small and growing smaller, with India joining polio-free nations this year; only Nigeria, Afghanistan and Pakistan remained polio-endemic. But hope for exterminating the virus is being eroded by poverty, by lack of government support for clean infrastructure and universal vaccination, and by war. 

“The consequences of further international spread are particularly acute today given the large number of polio-free but conflict-torn and fragile states which have severely compromised routine immunization services,” WHO official Bruce Aylward told reporters in Geneva on May 5. In its first-ever international alert on polio, the WHO declared the spread an “extraordinary event,” a public health risk to other states, and called for a “coordinated international response,” including travel warnings and stepped up vaccination and surveillance for the virus.

Polio now threatens children in several African states, including Somalia, Kenya, the Central African Republic and Cameroon, which last year reported its first outbreak since 2009. The Dominican Republic and Haiti, which has a vaccination rate of only 60 percent, had polio cases in 2000.

In March, when Iraq announced its first case since 2000—a child near Baghdad—health officials cited the source as Syria, which, for its part, blames Pakistani “jihadists.”

Although the virus’ origin is uncertain, one thing is clear: The unconscionable promulgation of conspiracy theories has hampered prevention and facilitated spread. Some radical mullahs have denounced vaccination as a Western weapon to harm or sterilize Muslims. Unfortunately, these charges draw not only on paranoia, but also on fact. Western pharmaceutical companies, including Pfizer in Nigeria, have tested experimental drugs without consent. And in 2011 the CIA did send a Pakistani doctor, pretending to be a vaccinator, to Osama bin Laden’s suspected Abbottabad residence to obtain confirmatory DNA.

Those abuses handed vaccination opponents hard evidence that Western-backed medical personnel and immunization campaigns are used for less-than-humanitarian political ends. In the wake of the CIA plot in Pakistan, zealots have murdered dozens of health workers and forced suspension of essential vaccination campaigns. A WHO independent monitoring board called the situation in Pakistan “a powder keg.”

But in Syria, accountability for a resurgence in polio goes beyond paranoia, criminally stupid CIA plots, religious idiocy and neglect. Sparrow called the regime’s deliberate obstruction of vaccinations “a man-made outbreak.” It is also a war crime.