A SURPRISING PANDEMIC SIDE EFFECT — Polio has reemerged in Malawi. And yes, you should care. The last wild polio case in the southeastern African country was 30 years ago, and polio was declared eradicated in all of Africa in 2020. It came back. Not on a wide scale. Not in a way that will set the world afire. Yet in a way that should make us understand the importance of prevention, vigilance and vaccination — for Covid and for everything else. Diseases that we scarcely think about and no longer fear, like polio or measles, can and do re-emerge. Soon after the detection of polio last month in a 3-year-old girl, who is now paralyzed, UNICEF started a huge, four-nation vaccination campaign to reach 20 million children in Malawi and its neighbors. The U.S. Centers for Disease Control and Prevention is involved with the stepped-up surveillance in the region. The rule of thumb is that if Malawi has diagnosed one child with paralysis, another 200 have been infected, somewhere, with less severe or asymptomatic polio cases. Surveillance shows the polio virus is not widespread and can be eradicated in the region again, Capt. Derek Ehrhardt, acting chief of the Polio Eradication Branch of the CDC, and the polio incident manager, told Nightly. It has probably been circulating since 2019, he said. Pakistan and Afghanistan are the only two nations where wild polio has not been eradicated. The genetic profile of the little girl's polio links her case to the virus in Pakistan, though how and when it got to Malawi and who it affected along the way are not yet known. That's a reminder, Ehrhardt said, that in an interconnected world, a threat in one place is a threat to all. The Malawi case should underscore two things to a U.S. audience, public health experts in and out of government say. First, it's a reminder of how the pandemic interfered with many ordinary — and necessary — primary and preventive health services at home and abroad. That includes routine childhood immunizations, like the polio vaccine. The timeline in Malawi suggests that the virus had spread before the pandemic, as some regions got less vigilant about maintaining high vaccination levels. But the coronavirus made it all much worse. Here in the U.S and around the world, some medical facilities were closed early in the pandemic, and many people have remained hesitant about going to a doctor or clinic as the pandemic persisted, whether for childhood vaccination or adult cancer screenings. In some parts of the world, staff and resources had to be shifted from routine care to the Covid emergency. Those primary care gaps need to be filled. That brings us to point number 2: vaccination. In the United States, babies and children get four doses of polio vaccine. Polio, which can cause paralysis or death, cannot be cured. It can only be prevented — with vaccines. Vaccine hesitancy did not begin with the coronavirus. But as we all know, fear of vaccines has intensified and become more politicized during the pandemic. Some public health officials worry the hardening anti-vaccination sentiment will roll back gains made against other childhood diseases. Even before the pandemic,groups of conservative lawmakers in a few states attempted to weaken vaccination requirements for kids to attend school. Precisely because vaccines have been so successful in eliminating these childhood diseases, people have forgotten how dangerous those illnesses can be. Sure, most kids don't die or suffer permanent harm. But some do. That amnesia, that complacency, is a public health risk. "A vaccine-preventable disease is no longer perceived as a threat which can provide fertile ground for rumors, mis- and dis-information about vaccines," Josh Michaud, a global health expert at the Kaiser Family Foundation, emailed Nightly. That's happening here and abroad. Polio undervaccination in Malawi. Covid undervaccination in the U.S. And undervaccination for a range of diseases across the globe. Marcia de Castro, a demographer who chairs the Global Health and Population department at Harvard's T.H. Chan School of Public health, remembers seeing a little boy who had polio and wore big clunky leg braces when she was a child in Brazil. "It marked me. I still remember the image of that boy," she said. "If Covid taught us something, it's that bad governance can destroy a response and destroy trust of the population in health institutions." That loss of trust can determine whether people get vaccinated, whether they vaccinate their kids. Against polio. Against Covid. Against measles. "One paralyzed kid is one too many," said the CDC's Ehrhardt, "We need to work until we get the job done." Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author on Twitter at @JoanneKenen.
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