Polio and the Syrian Crisis: The Accidental Bioterrorist

Posted on July 29, 2013 at 8:51 pm

RUSI Analysis, 21 May 2014 By Jennifer Cole, Senior Research Fellow, Resilience & Emergency Management; Raffaello Pantucci, Senior Research Fellow

The World Health Organization’s recent declaration of a public-health emergency as a result re-emergence of polio in countries including Syria and Somalia highlights the nexus between insecurity, violent Islamist groups and the spread of deadly diseases.

Polio vaccine in Djibouti US Department of Defense photo

The continual use of chemical weapons in Syria has shocked the arena. It has also reopened speculation across the possible use of biological weapons. In January 2014, US Director of National Intelligence James Clapper suggested in an announcement to america Senate Intelligence Committee that the Assad regime is able to producing lethal agents, though it will probably not yet have a great delivery mechanism.

But the capability use of such weapons isn’t the most pressing biological threat emanating from Syria. Earlier this month, the realm Health Organization (WHO) declared a Public Health Emergency of International Concern (PHIEC)[1] attributable to an unintentional bio-crisis: the re-emergence of polio, a perilous killer which was almost eradicated. During the last 365 days, twenty-five cases of polio was confirmed in Syria, putting neighbouring Jordan, Iraq, Lebanon and Turkey in danger. Sooner than its ongoing civil war, Syria have been polio-free for fourteen years however the country’s immunisation rates have plummeted from greater than 95 per cent of eligible children before the conflict to around 52 per cent on the time of the polio outbreak.[2] Tellingly, nearly all of the kids affected were born after the vaccination programme fell apart.

(In)security and Bio-Threats

The global, long-term impact of what seems to be a lost opportunity to rid the area of this crippling disease is simply as devastating as any deliberate act of bioterrorism.

The challenging security environment that has facilitated its spread should sound alarm bells for the long run. Genetic sequencing has linked the tension of polio answerable for the October 2013 outbreak within the Deir Al-Zour province in eastern Syria to 1 of Pakistani origin that has also been present in Egypt, Israel and the Palestinian territories in recent months. The idea is that Pakistani fighters battling the Assad regime, or Syrian military personnel who’ve undergone training in Pakistan, might have inadvertently brought the virus to Syria with them.

Two-thirds of the 400 or so polio cases recorded globally in 2013 were because of strains imported to the affected country from elsewhere, again largely from Pakistan – while ninety-two actually occurred in Pakistan.[3]. Sixty-nine per cent of those were concentrated within the Federally Administered Tribal Areas (FATA),[4] where the Taliban is especially active, while Peshawar – the most city that may be a way station for folk transiting to Afghanistan – is the most important polio reservoir on the earth.

Islamist Resistance to Vaccination

The apparent link between polio and Islamist activity is not any coincidence: efforts to eradicate the disease in Pakistan, Afghanistan and Nigeria – the simplest three countries where the disease remains endemic, with ‘wild’ or naturally occurring strains still circulating – have long been challenged by Islamist militants who claim that the vaccinations are a Western plot to make their children infertile, to spread AIDS, or that medical examiners are undercover Western spies. The latter claim just isn’t without substance: Dr Shakil Afridi, a Pakistani physician working for the CIA, famously obtained DNA from children in Abbottabad looking for Osama bin Laden, under the duvet of a pretend immunisation campaign. Such suspicion could have a devastating impact: twenty-seven polio workers was assassinated in Pakistan since December 2012.[5] Nonetheless, so long as the virus remains endemic in Pakistan, jihadist fighters could be in a position to inadvertently carry it to other areas of instability around the globe.

This problem will never be exclusive to Pakistan. In May 2013, cases of the disease were recorded in Somalia’s capital Mogadishu for the primary time since 2007, brought on by strains imported from northern Nigeria, where imams and native political leaders issued a polio-vaccination boycott in 2003. In February 2013, the Islamist group Boko Haram murdered nine younger women engaged on polio-vaccination programmes. Meanwhile, the spread of the disease across Somalia itself was further helped by Al-Qa’ida-affiliated Al-Shabaab extremists discouraging parents from vaccinating their children by claiming that the vaccines contain AIDS.

A Polio-Free World?

How the area reacts to this global public-health emergency within the coming months – particularly over the summer, which heralds what’s traditionally the high-transmission season for polio – will determine whether we are able to realistically continue to attempt for a global which is polio-free.

Co-ordinating international efforts to support vaccination programmes in failed and fragile states is one response. Another measure – that has now been implemented by WHO – is to restrict international travel from affected regions by people who was recently vaccinated.  – an approach that has also been replicated within countries. As an example, Pakistani President Nawaz Sharif has stipulated that no unvaccinated child from FATA be allowed to go into the settled areas of Pakistan. He has also ordered army protection for polio vaccinators going into volatile regions of the rustic.

Other more creative measures must also be considered. The Organization of the Islamic Conference has issued fatwas in support of polio vaccination, and Pakistan has encouraged senior imams to talk out at the topic. On 16 May, the White House issued an announcement that the CIA will not make operational use of vaccination workers.

But beyond these, there must be greater awareness amongst the wider security community of ways this niche problem can change into a world threat – an ancillary fabricated from instability and violence that could have deep, longer-term ramifications. Security issues and the success or failure of WHO’s Global Polio Eradication Initiative are clearly, if intricately, linked. As such, efforts to wipe out polio in its previous couple of remaining strongholds needs to be approached with both in mind.

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