Can polio and Guinea worm both be eliminated in 2016?

Nuru Ziblim, a Guinea worm health volunteer in Ghana, educates children on how to use pipe filters to avoid the parasite when they go to the fields with their families. Credit: The Carter Center

This was originally published on Global Health TV on January 14, 2016.

Only once in history has a human disease has been eliminated from the face of the earth. That was smallpox, eradicated in 1980.

There is a reasonable chance that in 2016 two diseases could be eliminated  — polio and guinea worm.

We won’t eradicate either disease this year. Eradication requires that several years pass with no new cases being detected. But it does look like 2016 is the year we could eliminate both diseases.

To be sure, we have been close before with polio, and then lost ground. The World Health Organization (WHO) says that “failure to stop polio in these last remaining areas could result in as many as 200,000 new cases every year, within 10 years, all over the world.” So there is little room for error.

Polio

Polio cases have decreased by over 99% since the WHO’s Global Polio Eradication Initiative was launched in 1988, from an estimated 350,000 cases that year to 51 cases in Pakistan and 19 in Afghanistan in 2015 — a mere 70 cases.

Sona Bari, WHO spokesperson for the Global Polio Eradication Initiative, said our chances of eliminating polio in 2016 are better than ever before.

“Pakistan and Afghanistan have come up with innovative ways to reach the children who are most vulnerable, whether living in remote locations, in under-served communities or even in conflict zones,” she said. “For example, vaccinators from the community vaccinate their neighbors rather than coming in from other communities during a time-bound vaccination drive. Or when there is a pause in conflict, vaccination teams will go in and vaccinate an area. Most importantly, the people and the government in both countries are committed to eradicating polio, sometimes going to extraordinary lengths to fulfill their duties.”

The campaign to eliminate polio has already gone on longer than the campaign to eliminate smallpox. The progress has been slow and steady, with numerous setbacks. In 1994, WHO declared the Americas region free of polio, followed by the Western Pacific region in 2000, the European region in 2002 and the Southeast Asia region (including India) in 2014.

 On July 24, 2015, Nigeria marked one full year without a single new case of locally acquired polio, ending polio’s reign of terror in Africa and prompting Bill Gates to declare a polio-free Africa as the number one “good news story of 2015.”

Is 2016 the year polio will be eliminated, a National Geographic blog asks? “I’m going to be an optimist and say the big public health story of 2016 will be the last case of polio in the world,” Dr. William Moss, head of epidemiology at the International Vaccine Access Center at Johns Hopkins University, told National Public Radio.

Guinea Worm

Polio may have to share that honor with Guinea worm. The Carter Center, which has led the international campaign to eradicate the disease since 1986, announced on Jan. 7 that only 22 people still had Guinea worm in 2015, and those cases were in 20 endemic villages in Chad (9 cases), Mali (5), South Sudan (5) and Ethiopia (3).

The Carter Center told me they are keeping their fingers crossed that these cases in 2015 were some of the last. If Guinea worm is eradicated, it would be the first parasitic disease eradicated and the first disease eradicated without the use of a vaccine or medicine.

In 1986, when the Carter Center started this campaign, there were an estimated 3.5 million Guinea worm cases occurring in 21 countries in Africa and Asia.

“Guinea worm reductions in South Sudan and Mali in 2015 are even more remarkable because both countries have significant insecurity or civil unrest and had the largest number of cases in 2014,” said Dr. Ernesto Ruiz-Tiben, director of the Carter Center’s Guinea Worm Eradication Program. “For these nations to make this much progress against disease under such dire circumstances is heroic by any measure.”

“As we get closer to zero, each case takes on increasing importance,” said former U.S. President Jimmy Carter. “Full surveillance must continue in the few remaining endemic nations and neighboring countries until no cases remain to ensure the disease does not return. The Carter Center and our partners are committed to seeing that this horrible parasitic disease never afflicts future generations."

“I would like to see Guinea worm completely eradicated before I die— I’d like the last Guinea worm to die before I do,” said President Carter, recently diagnosed with cancer, in August.

With President Carter now in remission and the last Guinea worm possibly being exterminated in 2016, it looks like he may get his wish.

So it’s a race to the finish line between polio and Guinea worm. Conquering just one of these would be a major accomplishment. If we get both, 2016 will go down as one of the most significant years in global health history.