Analysis: As the polio virus is diagnosed in Gaza for the first time in 25 years, vaccinating thousands of children has now become an urgent issue
It was supposed to be eradicated, eliminated, gone for good. But earlier this month, the WHO confirmed Gaza's first recorded case of polio in more than two decades, in a 10-month old baby boy experiencing paralysis in his left leg.
The highly infectious disease returned with remarkable, alarming speed. "I've worked in places where polio has reemerged in conflict settings, for example Syria, but in Syria it took three and a half years for the virus to return. Here it's just 10 months," says Juliette Touma, Director of Communications for the UN Relief and Works Agency for Palestine Refugees, UNRWA. "It is extremely alarming that polio has returned to Gaza."
A combination of factors have allowed polio back in to the war-shattered enclave, she explains. "We have one child who has been confirmed paralysed: a 10 month old child, a newborn baby. The reason why he got polio is a combination [of things]; a) this kid was not vaccinated, and b) the conditions in Gaza are absolutely inhumane. It's far from hygienic, the water is polluted, people don't have the basics to stay clean."
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From RTÉ Radio 1's Drivetime, Executive director with UNICEF Ireland Peter Power on the spread of polio in Gaza
Poliomyelitis is caused by a virus and mainly affects children under the age of five. It can cause paralysis in a matter of hours, there is no cure for it and it can only be prevented by immunisation. The virus is transmitted from person-to-person, mainly through the faecal-oral route or, less frequently, by a common vehicle, for example through contaminated water or food. Once in the body, it multiplies in the intestine, from where it can invade the nervous system and cause paralysis.
While it's alarming, it’s "not surprising" polio has returned: Vaccination levels in children have dropped from "semi-universal" levels above 90% pre-war, to just over 80% in the last 10 months, Touma says. At least 50,000 children born during this time period are highly unlikely to have received any immunisations, according to aid organisations.
Disruption to water, sanitation and health systems in the Gaza Strip has also increased the risk of other diseases like measles, acute respiratory infections, hepatitis A and skin diseases among children, according to the WHO.
From AP, 10-month-old boy contracts Gaza's first case of polio in 25 years
In most, polio will cause a flu-like illness, but in a small percentage of people it will enter the nervous system, explains Professor Orla Hardiman, Professor of Neurology in the Trinity Biomedical Sciences Institute at TCD, and Consultant Neurologist at Beaumont Hospital. Hardiman has lead a post-polio clinic at the hospital for the last 30 years. "When it enters the nervous system, it specifically affects the nerves that control voluntary movement. A small percentage of people will develop a sudden-onset, extremely debilitating paralysis, which can also affect the breathing muscles, so people can end up not being able to breathe at all."
Up to 90% of people will experience none or mild symptoms. In others, initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. These symptoms usually last for 2–10 days and most recovery is complete in almost all cases. But one in 200 infections leads to irreversible paralysis, and among those paralysed, five to 10% die when their breathing muscles become immobilised, according to the WHO.
The paralysis can be either partial or complete, says Hardiman. "After the illness there's a period of of extreme weakness, and then in some cases, a slowish recovery, but a disability long-term."
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From RTÉ Archives, in a News report from 1965, boys in a Sligo national school receive an oral vaccination against polio
The first successful polio vaccine was created by US physician Jonas Salk in the 1950s and this was followed by a second type of vaccine - the oral polio vaccine - developed by physician and microbiologist Albert Sabin. According to the Global Polio Eradication Initiative, cases of polio have decreased by over 99% since 1988, from an estimated 350,000 cases in more than 125 endemic countries, to 12 reported cases in 2023.
"There was a WHO plan (the Global Polio Eradication Initiative) to eradicate polio completely in the same way as we had eradicated smallpox," says Hardiman. "That was almost there, but then with the advent of unrest and war, particularly in parts of the Middle East and in Africa, where the attempt to undertake mass vaccination was thwarted, there's been a reemergence of polio. It should have been possible to eradicate. It's just a massive tragedy."
In Ireland, polio became a notifiable disease in 1941 and the first epidemic followed in 1942. The last recorded case of polio here was in 1984. According to support group Polio Survivors Ireland, there are an estimated 7,000 survivors in the country, most of whom are now middle-aged or elderly.
From UNRWA, Senior Deputy Director of UNRWA Affairs in Gaza Sam Rose briefs the press on upcoming polio vaccine campaign in Gaza
When polio was first detected in Gaza in July, in six wastewater samples collected from Khan Younis and Deir al Balah ES sites in the Gaza Strip, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus wrote in the Guardian that it was just "a matter of time" before the virus reached the thousands of children in Gaza who have not been vaccinated during the ten months of conflict. Just a few weeks later, the organisation confirmed the first case.
Now, UNRWA, alongside UNICEF and WHO, are rolling out a campaign to vaccinate more than 650,000 children under the age of 10 with two doses each, some weeks apart. 1.2 million doses of the oral polio vaccine type 2 (nOPV) were brought into Gaza this week in cold storage.
"The idea is to get the vaccine to as many boys and girls as possible under the age of 10," says Touma. But it’s "extremely challenging to undertake such an operation in the context of war. This is precisely why we have asked for what we refer to as 'polio pauses’."
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From RTÉ News, fighting in Gaza to be paused for polio vaccinations
The administration of the vaccines is going to be done by largely by UNRWA. Around 1,000 people from the agency will be deployed across the Gaza Strip to administer the vaccines with mobile units, and in shelters and UNRWA primary healthcare centres. Around nine of their centres continue to be operational, she says. The war forced the organisation to close its schools in Gaza and many of them have now become shelters for those forced to flee. "We'll go to those shelters, and we'll also go to areas that are not the shelters. Because people continue to be forced to flee from one place to another."
On Thursday, the WHO announced an agreement had been reached between the Israeli military and Palestinian militant group Hamas on three separate, zoned three-day pauses in fighting in Gaza to allow for the vaccinations to go ahead. The vaccination campaign is due to start on Sunday. The WHO said it would start in central Gaza with a three-day pause in fighting, then move to southern Gaza, where there would be another three-day pause, followed by northern Gaza. A WHO senior official said that there was an agreement to extend the humanitarian pause in each zone to a fourth day if needed.
"Right now we confirmed one case but there could be more," says Touma. "Polio is a vicious virus that travels quickly. It doesn't need permits or visas to cross borders, or lines of fire, or lines of control. This is precisely why the vaccination campaign is absolutely critical to save lives, and to control the spread of the virus within Gaza and beyond, including to Israel."
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The views expressed here are those of the author and do not represent or reflect the views of RTÉ
