Containing polio

Officials at the World Health Organization warned this week that a recent outbreak of polio among children in Syria potentially could threaten the entire region unless urgent steps are taken to halt its spread. The United Nations reported that the two-and-a half-year Syrian civil war has devastated the country's health-care system, disrupted vaccination programs and left millions of families living in squalid refugee camps whose unsanitary conditions make them ideal breeding grounds for diseases like polio.

The re-emergence of polio in Syria, which had been virtually eliminated in that country over the last two decades, inevitably will increase the misery of civilians caught up in the conflict. But it also has profound implications for the rest of the world. Thanks to a WHO-sponsored global vaccination initiative, polio had been on the brink of extinction for years worldwide, surviving only in a few remote pockets of eastern Pakistan, Afghanistan and northern Nigeria. Health officials had hoped to eradicate the disease entirely by 2018. But that date that may now have to be postponed as a result of its sudden resurgence in Syria.


On Tuesday, U.N. officials confirmed 10 new cases of polio among children in northeastern Syria who recently had become sick. Eight of the children were younger than 2, suggesting that they had become infected after the collapse of the country's health-care system and vaccination programs. Before the war, 95 percent of Syrians had been immunized against polio and other communicable diseases. But health officials say that now there may be a half million children and adults in the country who have never been inoculated with the polio vaccine.

The source of the latest outbreak remains unclear, but officials suspect the particular strain of the poliovirus found in Syria originally came from Pakistan and may have been brought to Syria by Islamist fighters from that country's lawless frontier along the border with Afghanistan. The disease is known to exist among the relatively isolated population of the region, where the local Taliban warlord has banned vaccinations as an unwanted Western influence. The fact that his ignorance could affect millions of people thousands of miles away shows how difficult it will be to defeat polio in a world in which individuals are constantly moving across international borders carrying with them the potential to spread the disease.


That's health officials worst nightmare, and it appears already to have happened in Syria, where experts say the number of confirmed cases uncovered so far are likely to be only the tip of the iceberg. Since up to 20 people may be carrying the polio virus for every one who shows symptoms of the disease, it's possible that several hundred people in Syria are already infected and are spreading the virus without knowing it. The main transmission routes of infection are through contaminated water and food supplies, and since the war began the controls meant to safeguard the quality of the country's water and food distribution systems have virtually collapsed.

Syria's neighbors have already stepped up their own vaccination programs to counter the threat posed by the massive influx of refugees crossing their borders. Lebanon, Jordan, Iraq and Turkey together have already taken in more that 2 million Syrian refugees, and Egypt and Israel have also offered asylum. But those efforts still have left millions of children who remain in Syria at risk of contracting polio and furthering its spread within the country.

Delivering vaccine in a country wracked by civil war represents the biggest obstacle health officials face in trying to contain the disease. The UN says this year it vaccinated 800,000 Syrian children against polio, but it is still unable to reach many areas of the country where government and opposition forces are locked in combat and refuse to guarantee the safety of health workers trying to enter contested areas.

Breaking such deadlocks so that vaccinations can resume ought to be a priority for peace talks between Syrian opposition groups and the government of President Bashar Assad scheduled for next month, and the U.S. should use whatever influence it has to make sure the issue receives the attention it deserves. Neither side has anything to gain from allowing Syria's polio outbreak to evolve into a full-scale epidemic, and the international community needs to press the warring parties hard to avert a brewing public health crisis that threatens not only Syrians but people around the world as well.