Yesterday, we got the tremendous news that after having lead the world in the number of polio cases as recently as 2009, the World Health Organization announced that there have been zero polio cases in India for three consecutive years. In today’s Express Tribune, we see a discussion of whether and how Pakistan can now rise to the challenge of polio eradication. In the article, we learn that the US drone killing of Pakistan Taliban leader Hakimullah Mehsud not only disrupted the developing plans for peace talks between the Taliban and Pakistan’s government, but it also affected polio vaccinations in North and South Waziristan:
According to the State Minister for National Health Services, Regulations and Coordination Saira Afzal Tarrar, NWA and South Waziristan did not receive any immunisation in months, contrary to former North Waziristan Agency (NWA) surgeon Jan Mir Khan, who was part of recent polio efforts. “After the drone strike that killed Hakimullah, it all stopped. Not just the peace talks, but also our efforts,” she says.
The terrible impact of the CIA’s vaccination ruse employing Dr. Shakeel Afridi in the search for Osama bin Laden has been extensively documented here, but this is the first time I have seen a suggestion that backlash to a drone strike directly resulted in polio vaccines being denied to children. Tarrar is not ready to give up, however, and believes that Pakistan and the Taliban will eventually come to an agreement that will allow vaccinations to resume:
Saira Tarrar also emphasised that the people of the area need to be part of the solution. “Parents are now sick of the ban; this pressurises the Taliban.”
“There is an accessibility problem in Fata, but by 2014, we will get a bargain and get some access.” And access is key, as far as Elias Durray, the head of Polio Eradication at the World Health Organization in Pakistan is concerned. “Immunisation prevents circulation. The virus won’t vanish on its own.”
Let us hope that Pakistan can achieve full vaccine coverage and have polio disappear as quickly in Pakistan as it did in India. Of course, this will require the US actually letting peace negotiations between the Taliban and Pakistan come to fruition, so success is far from guaranteed.
There are public calls on a remarkable number of different fronts for a renewed commitment to polio vaccination in the Khyber Pakhtunkhwa province of Pakistan, which is now governed by Imran Khan’s PTI party. Direct appeals to Khan are coming from the World Health Organization and from Bill Gates. A major conference of Islamic scholars also came out with a statement backing polio immunization and providing push-back against the view that immunization campaigns aim to sterilize Muslims or are run by Western intelligence agencies.
Dawn gives us the details of the WHO push:
World Health Organisation, Pakistan polio chief Dr Elias Durry on Thursday apprised Pakistan Tehreek-i-Insaf chairman Imran Khan in Lahore of the threat to the health of Khyber Pakhtunkhwa children due to non-vaccination, it is learned. PTI, which has the most seats in the Khyber Pakhtunkhwa Assembly, leads a coalition government in the province.
According to the relevant officials, the meeting has coincided with the confirmation of three fresh polio cases from Federally Administered Tribal Areas by National Institute of Health.
They said Fata had reported five, Khyber Pakhtunkhwa four and Sindh two of this year’s 13 countrywide polio cases.
Khan is eager to help in the campaign and has taken part in promoting immunization before his party was elected to govern KP:
The officials said WHO had publicly recorded its reservations about polio eradication efforts in Khyber Pakhtunkhwa, especially in Peshawar.
They said the PTI chairman, who had inaugurated various polio campaigns in the country’s several cities, apprised the WHO, Pakistan polio chief of his eagerness to see fight against polio succeed.
The officials said Imran Khan carefully listened to Dr Elias Durry’s concerns about Khyber Pakhtunkhwa children’s vaccination and assured him that he would convey them to the PTI-led provincial government for necessary action on emergency basis.
“Imran Khan said he would issue special instructions to the provincial chief minister (who belongs to PTI) to ensure vaccination of all children under five as ensuring better health care in the province is his government’s top priority,” an official said.
Also joining the push for immunization is Bill Gates, as we learn from the Express Tribune:
Famous American business magnate Bill Gates has sought Imran Khan’s cooperation to eradicate polio in Khyber-Pakhtunkhwa, as the province apparently failed to provide security to polio workers.
Gates sent a personal letter through his emissary to chairman Pakistan Tehreek-e-Insaf (PT) Imran Khan asking for his party’s cooperation in furthering the anti polio vaccination programme in Khyber Pakhtunkhwa, said an official statement.
Imran Khan is scheduled to speak to him on the phone to discuss modalities of moving against polio which takes the lives of so many children in Pakistan especially in Khyber Pakhtunkhwa.
Especially welcome news comes from a meeting held by Islamic scholars who produced a statement in favor of immunization and condemning the killing of vaccination workers. They also condemned Dr. Shakil Afridi and any other participation of intelligence agencies in vaccination programs: Continue reading
With the winter flu season now over in the Northern Hemisphere, we can safely say that the feared global pandemic from the newly emerged H7N9 flu virus did not occur. As the weather in China warms up, cases are dwindling in the manner usually seen for any flu virus:
After months of mounting concern, Chinese health officials are breathing a sigh of relief: no new human cases of H7N9 have been reported in the country in more than a week. The milestone marks the first time since March, when the H7N9 outbreak first began, that human cases haven’t continued to increase.
In the week beginning May 13, one previously infected patient succumbed to the virus, according to a statement issued on Monday by China’s National Health and Family Planning Commission. That death brings the H7N9 fatality toll to 36, with 130 confirmed cases in total.
Vigilance will be needed next fall to see if the virus is now lurking, ready to re-emerge once weather conditions are more favorable.
Unfortunately, the situation with another emerging virus is not improving. The newly named (pdf) Middle East Respiratory Syndrome Coronavirus (MERS-CoV) still bears watching since the death toll from this virus has now reached 30:
Three more people have died in Saudi Arabia from the new SARS-like coronavirus, bringing the worldwide death toll to 30, the World Health Organization (WHO) said on Friday.
Saudi health officials also told the WHO of a new case in the eastern province of al-Ahsa, increasing the number of cases worldwide to 50, WHO spokesman Glenn Thomas told reporters at a news conference in Geneva.
As shown in the schematic above, coronaviruses get their name from the crown-like spikes on their surface. The common cold is caused by various members of the coronavirus family.
Another coronavirus that got headlines in the past was the virus causing Severe Acute Respiratory Syndrome, or SARS. That virus was first identified in 2003. This otherwise informative description of the virus and its outbreak that resulted in over 8000 cases and 750 deaths states that SARS is “here to stay”, but the CDC, in this backgrounder on coronaviruses, notes that there have been no reported cases of SARS since 2004.
From the link above where MERS-CoV was given its new name, we get more information on the virus (references removed): Continue reading
A steady, but slow and at least for now, not accelerating, spread of the new H7N9 bird flu virus continues. Although infection of poultry in markets in Shanghai has been confirmed and thousands of birds culled, ongoing work on the virus has yet to provide what appears to be a full description of how the virus spreads in animal hosts and gets transmitted to humans.
The latest figures from China put the death toll at 9 and the number of confirmed cases at 28 people infected. The question of whether the virus can be passed from one person to another is still under intense investigation, and two possible family clusters are being investigated. WHO spokesman Gregory Hartl was quoted by Xinhua:
“At this point, there is no evidence of sustained human to human transmission,” he said, adding that there are some “suspected but not yet confirmed cases of perhaps very limited transmission between close family members.”
“They are still being investigated,” he said.
Hartl told Xinhua one of the suspected family clusters was in Shanghai, with three family members having similar symptoms and one of them being confirmed of H7N9.
The confirmed case died, so has another suspected family member, according to Hartl.
The other suspected family cluster, which included two family members with one of them being confirmed, was in Jiangsu Province, he said.
Hartl said that even if the infection of H7N9 is confirmed in other family member, further investigations are still needed to make sure whether that’s a human to human transmission between constant and close contacts or an infection with virus from the same environmental source.
That final point from Hartl illustrates the difficulties that scientists face in developing a full description of how the disease is transmitted. At the same time that we do not yet know fully which animals are the reservoir from which humans are infected, we are simultaneously trying to determine whether family members are passing the virus to one another. That question is complicated by the fact that because the family members live in close proximity to one another but by definition also are exposed to the same local environment, multiple family members could have been infected from the same animal source or one family member could have passed the disease to another.
Moving to the question of the animal host, the same Xinhua article that quotes Hartl also informs us that no pigs have been found to be infected with the virus. Recall that large numbers of pig carcasses had been disposed of in rivers in the same areas of China around the same time H7N9 emerged, so some scientists wondered whether the virus arose in pigs and caused those deaths. There were also observations of dead birds. Xinhua has new information on analysis of bird infections: Continue reading
At least two more polio workers have been killed today in Pakistan, raising the death toll to eight since the latest three day immunization drive started this week. Reuters brings details from today’s attacks
Wednesday saw four separate attacks, all in the north. In the district of Charsadda, men on motorbikes shot dead a woman and her driver, police and health officials said.
Hours earlier, gunmen wounded a male health worker in the nearby provincial capital of Peshawar. He was in critical condition, said a doctor at the Lady Reading Hospital where he is being treated.
Four other women health workers were shot at but not hit in nearby Nowshera, said Jan Baz Afridi, deputy head of the Expanded Programme on Immunisation. Two women health workers were shot at in Dwasaro village in Charsadda, police said.
The attacks on Tuesday in Karachi happened in very rapid succession, as reported by the Express Tribune:
Madiha, 19, and Fahmida, 44, were the first two to be slain in the Gulshan-e-Buner area of Landhi. Within 15 minutes, Naseema Akhtar, was shot dead in Orangi Town, while her colleague, Israr, was critically injured in the attack.
Thirty minutes later, Kaneez Jan, was shot dead in Ittehad Town, while her coworker, Rashid, was injured in the attack.
As was pointed out in July when a doctor in Karachi was shot during the vaccination drive at that time, violence directed at polio workers was not expected there. Instead, it was expected in the tribal areas where both the general rumors of the vaccination program being run by spies and the vaccination plan being a plot to sterilize Muslims are rampant. In addition, there was the more specific admonition by Taliban leader Hafiz Gul Bahadur that vaccinations in the tribal areas would not be allowed until US drone attacks stopped.
Remarkably, even though the Taliban in Pakistan have spoken out against the immunization drives in the past, they appear to be denying responsibility for the current attacks. From the Reuters article linked above:
The Taliban have repeatedly threatened health workers involved in the campaign. Some said they received calls telling them to stop working with “infidels” just before the attacks.
But a spokesman for the Pakistani Taliban, Ihsanullah Ihsan, told Reuters his group was not involved in the violence.
Despite that denial, we learn from the New York Times that Taliban figures were blamed for today’s attacks:
A spokesman for the Pakistani Taliban denied responsibility for the attacks, although the insurgents have a history of threatening polio eradication programs, claiming they are a cover for American espionage activities.
But the police in Peshawar said that Taliban fighters based in Mohmand tribal agency, north of Peshawar, were involved in at least two of the attacks in the Peshawar area.
As I pointed out in my post yesterday, I blame Leon Panetta’s confirmation that Dr. Shakil Afridi helped the CIA with his vaccination ruse for significantly escalating the verbal and now physical attacks against workers distributing polio vaccine. In a Twitter conversation with @ArifCRafiq yesterday evening, we discussed the relative timing of the disclosure of Afridi’s involvement, Panetta’s confirmation of the CIA link and the attacks on polio workers. Rafiq suggested that this Guardian article published July 11, 2011 was the first mention of Afridi. The final sentence of the article stands out as the most important for Panetta’s subsequent actions:
The CIA refused to comment on the vaccination plot.
As commenter FrankProbst pointed out in a comment on yesterday’s post, approving the fake vaccination plot was a big mistake by the CIA, but confirming it compounded that mistake. Panetta’s confirmation of Afridi’s role was in January of this year, as Marcy posted. In my opinion, Panetta’s confirmation kept the issue of Afridi prominent in the news and provided a much stronger case for those who wanted to stoke the previously existing rumors that vaccination plans are run by spies.
As for Afridi himself, I still wonder if he has quietly been moved out of Pakistan. I asked one of his most vocal supporters, Dana Rohrabacher, on Twitter if he had more information on Afridi’s status that could be shared. He replied that he intends to “launch a save Dr. Afridi campaign” early in January. In the meantime, I’m still waiting for evidence that he remains in the Peshawar Central Jail.
In the midst of these events, we shouldn’t lose sight of the fact that polio eradication is very nearly within reach. Besides Pakistan, polio is reported to be endemic in Afghanistan and Nigeria. The Reuters article above points out that as recently as 1994, there were 20,000 cases in Pakistan. From CNN, we see that there were 173 cases reported in Pakistan last year and only 53 this year. Considering that hundreds of thousands of health workers are involved in the polio vaccination campaign aimed at protecting millions of Pakistani children, the current halt in the program could have devastating consequences for many of those children and for the drive to eradicate polio from the earth.
Back in December, the National Science Advisory Board for Biosecurity (NSABB) asked that two papers pending publication on scientific research into deadly forms of the H5N1 bird flu virus be redacted when published. This was a bad decision for several reasons, as I pointed out:
At this point, if the details of just which precise mutations occur in the pathogenic virus that was developed are published, it should make no difference, because press reports have already confirmed that the most basic approach one could take, involving a simple genetic selection experiment, gives the result of the more pathogenic virus. It’s even likely there are other combinations of mutations that would make an extremely pathogenic virus if the selection process were repeated in a new experiment.
But the folly of the NSABB decision goes much deeper and is just another aspect of the hysteria that has gripped the United States since the al Qaeda attack on 9/11 and the anthrax attack just a few weeks later. One aspect of this hysteria has been an attempt to make far too many things secret. Much attention has been paid to the over-classification of intelligence information, but the over-classification of scientific information is just as insidious.
No matter how many bits of intelligence or scientific information are made secret, the fact remains that determined terrorists have a multitude of fully described weapons systems to employ in an attack. By stifling publication of basic scientific research into materials that could have weapons potential, the opportunity to develop useful countermeasures becomes significantly diminished.
The “genetic selection” experiments to which I referred are described in one of the two papers that were up for redaction. It showed that by simply passing the bird flu virus through ferrets multiple times, a version of the virus that is more deadly to mammals (and presumably humans) was produced. But as I pointed out in the post, bioterrorists already have available a number of deadly agents that don’t require further research to make them effective. By censoring the work on more deadly bird flu, flow of information to researchers who wish to develop treatments for the disease (and these researchers vastly outnumber bioterrorists) is inhibited. Although those wanting to censor the work intended to make the full details available to a select few, that “solution” is untenable in that it predetermines just who is “important” enough to receive the information. Free flow of information is key to research and one can never predict just who will make the next advance, so pre-selecting those who get the key information is a silly notion.
The good news is that scientific research is an international process, and so “advisory” boards hand-picked by the US “homeland security” lobby do not have the final say. Today’s New York Times, in a front page story, reports that the scientific papers will be published in their entirety. The narrow-mindedness of how the US government has come to stifle scientific thought comes through loud and clear in this article. The final decision on publication was made at a large meeting held by the World Health Organization in Geneva: Continue reading