Vaccine hesitancy

A case of polio was detected in an unvaccinated adult man in a suburb of New York City earlier this week, the first since 2013 and the first domestic infection since 1979. The news surprised much of the world, as cases since 1979 have all been infections caught abroad. While the Centres for Disease Control is still investigating the matter, details made available so far would imply that the victim, who is no longer infectious but has been paralysed, was infected by someone who received the oral polio vaccine, which has not been used in the US since 2000.

The US has exclusively used the injected inactivated vaccine, which has almost no side effects or risks of vaccine-derived infection, but is more costly and harder to administer than the oral vaccine — also a cost-effective choice for poorer countries. This would imply that the victim or the person they caught the infection from had traveled abroad, or that the initial carrier was either an immigrant or an older person. More important, however, is that the victim was willfully unvaccinated, showing how dangerous vaccine refusal can be. While several countries, including Pakistan, have their share of vaccine skeptics, the US seems to have a disproportionately high number of such people. Whether that is due to the libertarian nature of US society or simply the prevalence of disinformation, the impact of vaccine refusal can be catastrophic, as we have seen in the US since the Covid-19 vaccine rollout. Barely two-thirds of Americans are fully vaccinated — one of the lowest rates in the developed world — despite a virtually endless supply of vaccines, while millions of people in the developing world are still begging and pleading for the jab. The human and economic impact of this has been massive. The US remains among the worst places in the world in terms of new Covid-19 infections and has recently crossed one million deaths — the only country in the world to have done so.

Vaccine refusal and incomplete vaccination remain the leading reasons why polio is still endemic in Afghanistan and Pakistan, and recent outbreaks of preventable diseases around the world show that disinformation is now putting the lives of millions of children at risk. Even more disconcerting is that according to WHO, about 80% of the population needs to be fully vaccinated against polio to achieve herd immunity, yet that relatively low bar is looking astonishingly high in several countries. Incidentally, the New York man is a member of an ultra-Orthodox Jewish community, whose mistrust of modern medicine, especially vaccines, rivals that of some misinformed conservative leaders in Pakistan. The man’s community reportedly only has a polio vaccination rate of about 60%, which puts the entire community at threat, just as it was in 2018 and 2019 when it went through one of the largest measles outbreaks in recent American history.

Vaccine complacency also needs to be addressed with urgency. Just look at our situation — from over 100 polio cases a year for several years, concerted efforts by successive governments and foreign partners brought it down to double digits by 2020, and a solitary case in 2021. Unfortunately, as we patted ourselves on the back, the case load has already shot up to a dozen this year. How far we have fallen since 1980, when humanity came together to eliminate smallpox.

Published in The Express Tribune, July 25^th, 2022.

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