The global initiative to eradicate polio had big dreams for 2019. It was the latest deadline for the eradication of the polio virus in both Afghanistan and Pakistan. Reports in July, however, indicate that 2019 can be added to a growing heap of missed deadlines. Not only is polio still rife in both countries, but its prevalence seems to be increasing.
Pakistan has seen four times as many cases of polio thus far in 2019 as it did in the same period last year. Set against this backdrop, the situation in India seems comparatively sanguine. The World Health Organisation (WHO) declared Indian polio-free in 2014, and it has stayed that way since.
But while polio may be in India’s rearview mirror, other viruses may be rushing to fill the niche left by its eradication. Back in 2015, reports emerged of 208 children in Uttar Pradesh, India’s most populous state, developing polio-like symptoms. Given that the World Health Organization had declared India polio-free scarcely a year ago, the news triggered panic. Had the dreaded virus made a comeback?
Eventually, a 20 June press release from the Ministry of Health and Family Welfare calmed these apprehensions. It said that even though the cases looked like polio, samples from the children were negative for the virus. What the children had was Acute Flaccid Paralysis (AFP), a broad basket of symptoms with causes other than polio. “India is polio-free,” the press release assured.
Four years later, it isn’t clear what happened to these children. Did they recover—many cases of AFP are transient, and patients make a full recovery. Did some remain paralysed for life? What caused their illnesses, if not the polio virus? No central or state agency knows the answer. This is because India has no systematic program to investigate non-polio AFP cases, even though 36,338 cases were recorded in 2018.
The lack of research in this critical area is “very tragic,” says C Durga Rao, a microbiologist at Bengaluru’s Indian Institute of Science. Rao has studied viruses associated with AFP in the past.
Even though no central agency investigates every case of AFP, sporadic studies conducted by Rao and other scientists point to the role of some troubling viruses. Many children with paralysis are infected by members of the genus enterovirus, to which polio belongs. This genus has microbes like EV71 and EVD-68, which have been dubbed “the next polio” because of the crippling disease they can cause.
For example, EV71, which circulates widely in East and Southeast Asia, kills or paralyses a large number of the children it infects. A study by Rao between 2007 and 2009 and another by Mumbai’s Enterovirus Research Centre between 2008 and 2012 found EV71 among AFP cases in India.