War and Disease: The Case of Polio

by Paul Rogers                Pub. by  Open Democracy                        May 8, 2014

Sixty years ago smallpox was endemic across much of the world, killing two million people each year. In 1959 an international programme to eliminate the virus was started, not least because it was a disease amenable to large-scale vaccination. In 1977, the last case was diagnosed and recorded. It had taken just eighteen years to achieve the elimination of the entire disease in the wild.

This was the first-ever case of a major disease organism being destroyed in the wild, and there has only been one other - far less well-known. This is rinderpest, a dangerous viral infection most common in cattle.  It took several decades to exterminate, but success finally came in 2001.

A third disease has been the target of attempts at total elimination. This is poliomyelitis, which in the 1980s still infected hundreds of thousands of people. Polio is particularly prone to attack children and can leave them with severe impairments that can last a lifetime.

Poliomyelitis has been subject to an intensive programme of vaccination. By 2012, substantial success had been achieved, with only 223 cases diagnosed and the virus remaining endemic in three countries: Pakistan, Nigeria, and Afghanistan. The programme had been coordinated by the World Health Organisation (WHO) and backed by Unicef, though much of the funding - $850 million over two decades - came from the Rotary Foundation,  Where infection remains and is increasing are conflict-zones -it has risen in Afghanistan, spread to Syria and Iraq, and moved from Cameroon to Guinea.

The WHO is now calling for a huge new effort to curb the spread of polio through much tighter controls on travelling from endemic areas and a renewed emphasis on childhood vaccination. More generally, what is happening with polio is a stark reminder of how warfare can multiply susceptibility to disease among populations already damaged by poverty and insecurity.

2014 is the beginning of a long commemoration of the first world war that is estimated to have killed 11 million people. The appalling aftermath of the war is less remembered: an influenza epidemic, often termed “Spanish flu”, which started in 1918, was spread partly by troop movements and took hold among the weakened populations of an impoverished Europe. The human cost is not certain even now but may have been far in excess of 25 million people worldwide.

The disease was made worse by the war itself - and in human terms was even more of a killer. Polio will not reach the same extent as Spanish flu. But the risk of a pandemic is growing.    [Abridged]

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Paul Rogers is professor in the department of peace studies at Bradford University, northern England. He is Open Democracy's international-security editor, and writes a weekly column on global security