Polio Resurgence: A Call to Regain Trust to Vaccines

While polio has become a distant memory in most parts of the world, the disease has managed to resurge in countries where it was once eliminated like, Syria, Papua New Guinea, Indonesia, Myanmar and Philippines, where the latest case of polio outbreak has been recorded. Poliomyelitis, commonly known as polio, is an incurable and highly contagious disease that is caused and transmitted by poliovirus which are members of the Enterovirus genus (Ochmann & Roser, 2017). And recently last year, the Philippines had declared its epidemic state of the said disease With a total of nine cases recorded as of December 2019. The World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and other partners of the Global Polio Eradication Initiative (GPEI) are now in alliance with the Department of Health and local health authorities to help in eradicating the disease in the country. According to the article of Makati Medical Center (2019), “Polio Outbreak in the Philippines: Should you be scared?”, there are actually three main reasons why polio re-emerged in our country: first, the declining number of children who get vaccinated, next, the inability to detect early symptoms of the disease, and lastly, the practice of poor sanitation in communities. The Department of Health sees low vaccination coverage, poor early surveillance of polio symptoms, and substandard sanitation practices as culprits in this re-emergence (Paris, 2019).

Surely, the disease has been plaguing humankind for thousands of years. Dating back to early 1403-1365 BC, a carving of a man with a leg deformity depicted in an Egyptian stele (rock carving), showed similar symptoms with a paralytic polio. The disease’s origins are not exactly identified, however, according to Ochmann & Roser (2017), the epidemiologists were still able to identify how the disease evolved and spread across the world throughout the years based on its characteristics. Polio is also known as infantile paralysis as children below 5 years of age are the most vulnerable to the disease. The disease targets the person’s nervous system and can be fatal as it causes paralysis, breathing problems, or even death, in worst cases. These viruses travel through the oral-fecal route and spreads through intake of water and food and contact with objects contaminated by the feces of an infected person. Most of the cases of polio are asymptomatic or do not shows any symptoms, making it hard for the disease to be detected. However, when symptoms appear, it differs depending on which type it is.

Lately, the Philippines broke its record of being a polio-free country for 19 years and vaccine hesitancy is one of the contributing factors to the current polio outbreak, according to WHO’s representative in the Philippines, Rabindra Abeyasinghe. The lack of trust of the citizens in vaccination programs in the Philippines was brought by the controversy around the vaccine, Dengvaxia, one of the reasons why parents of children are refusing free vaccines from the government. The blow-up of news related to the deaths of children who were vaccinated by the Dengvaxia created hysteria in the country, leaving parents wary of vaccinating their children despite no confirmation of deaths linked to the vaccine to date. “There is no cure for polio — it can only be prevented with multiple doses of polio vaccines that have long been proven safe and effective” (DOH). Polio has no cure, but immunization can protect and prevent individuals from acquiring both vaccine-derived or wild forms of the virus that mainly affects children under five years of age as representative of UNICEF Philippines, Oyun Dendevnorov, stated, that “there is no other way for children to be protected against polio than getting vaccinated”. The first step in fighting the re-emergence of polio in the country is by receiving one dose of the inactivated polio vaccine (IPV) intravenously (Makati Medical Center, 2019). According to Crosta (2017), IPV consists of series of injection that starts at the child’s third month after birth and continue until the child reaches 4-6 years old. After the child has received IPV, oral polio vaccine (OPV) is given to the child through oral drops. When injected, the weakened form of the virus then replicates itself in the digestive tracts of the children, activating an immune response in the body through building up of antibodies. On the other hand, in face of the urgent need of children to get vaccinated, the data from the United Nations Children’s Fund (UNICEF) Philippines showed that polio vaccination of children dropped to 95% in 2018. Furthermore, it was also revealed that only 66% of children completed their oral polio vaccine while only 45% completed their injection of inactivated polio vaccine in 2018.

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Furthermore, it is not only the low percentage of immunization that contributed to the resurgence of the disease, polio. The poor surveillance on the Acute Flaccid Paralysis (AFP) of the cities reported positive with poliovirus also led to poliovirus spreading throughout the country once again. Acute Flaccid Paralysis, as defined by the World Health Organization (WHO), is a complex clinical syndrome which triggers unforeseen paralysis or sudden weakness in any part of the body of a child whose age is below 15. AFP surveillance is essential in promoting a polio-free country as it helps “detect paralytic poliomyelitis due to wild poliovirus transmission in a population”, according to WHO. However, this so-called AFP leads to many causes, hence, this calls for the need of the health authorities to evaluate each AFP to find out if it is polio-related or not. The need of the local health authorities to act quickly in improving the environmental surveillance is a major step in strengthening the country’s immunization program and as well as improving the sanitation and environmental hygiene of the communities, thus preventing the disease from spreading across the whole country once again.

Besides the dwindling amount of people being immunized and poor polio surveillance, another crucial factor that caused the virus to spread is low sanitation in urban areas and dirty environment where strands of the virus may thrive. In the article ‘Philippines: Polio comeback due to poor sanitation, low vaccination turnout’ by Dalumpines (2019), Dr. Julinda Acosta said in an interview that the poliovirus recirculated once more because of poor environmental sanitation and lack of proper hygiene as well as the low coverage of immunization since 2014. This is mainly due to the absence of toilets in riverbanks, “It is observed that open defecation is prevalent in congested areas of the city”, Acosta said. It is stated that the host may acquire a poliovirus by ingesting a contaminated food and water may dirty objects that are being swallowed by children. In fact, children that handles objects that are dirty and contains small amount of fecal matter with strands of the virus can make them high at risk in acquiring the disease since they don’t practice proper handwashing.

In face of the arising polio outbreak in the Philippines, the DOH, in partnership with UNICEF and WHO, planned to combat the issue through performing a synchronized polio vaccination campaign in Davao, Manila, and Marawi City where strains of VDPV1 and VDPV2 were found. Furthermore, the DOH launched its “Sabayang Patak kontra Polio” campaign in Manila on August 19, where the poliovirus sample was found. The following month, Rotary Philippines launched an NCR-wide polio vaccination campaign, beginning in Quezon City. The DOH reassured the general public that aside from the door-to-door initiatives, they are also focusing to distribute resources in health centers across the nation. Aside from vaccination, WHO reminds families to practice proper hygiene, washing of hands with soap, using a toilet, eating food that is fully cooked, and drinking safe water. Moreover, the DOH said that it had also planned measures to enhance prevention of the disease in Metro Manila. Among these are the heightened AFP surveillance, as well as an immunization campaign for children below 5 years.

After the hysteria that Dengvaxia has created three years ago, the public’s mistrust to immunization campaigns related not only to dengue has caused outbreaks of highly infectious diseases such as measles and polio. The campaign on dengue vaccination campaign may have failed but that doesn’t mean that we should lose trust to vaccines that have long been proven to be safe and effective. The discovery and formulation of the polio vaccine by Jonas Salk has saved millions of lives throughout the years across the world. The resurgence of polio in the Philippines shows just how important it is for the health authorities to remain vigilant and to focus on improving the environmental surveillance across our country, for the community to continue to invest not only in polio eradication programs but also to the different immunization campaigns by the government, and to keep the environment clean as well. All of these are solid evidence to support the need for vaccination and proper sanitation in every community. Across the Philippines, DOH, UNICEF, and WHO highly encourage families to get their children vaccinated as both IPV and OPV have been proven to save millions of lives over the decades, and of course, to promote a hygienic way of living where viruses cannot prosper and endanger human lives.