“Shoe leather” public health efforts and the re-emergence of poliomyelitis


AAsk most Americans to name a polio victim and they’ll say President Franklin Delano Roosevelt. Ask me the name of a polio victim and I would offer two: my father’s older sister and his younger brother.

My father’s sister was a medical student in India when she died of polio in 1950. She contracted it from their younger brother, my uncle, who was five at the time and became permanently paralyzed of the right leg. I remember the first time I met my uncle at our family home in Chennai, India and asked him what had happened to his leg. I couldn’t imagine facing such a challenge and was relieved to learn that I wouldn’t have to because I had been vaccinated against polio as a baby.

Americans, and those in many other countries, have been lulled into thinking that polio is a disease of the past, thanks to more than half a century of concerted global health action to immunize children. Over the past few decades, the public health community has seen a path to global polio eradication, particularly with the World Health Organization declaring wild poliovirus eradicated in Africa by 2020. It is believed to have followed smallpox, which was declared eradicated from the world in 1980. This has not happened, largely due to the effects of global under-vaccination caused by a combination of mistrust, poor implementation, lack of of access in conflict zones, insufficient funding, loss of global momentum and suspended work due to the covid19 Pandemic.


I was therefore not completely surprised when a man was diagnosed with polio in Rockland County, NY, in July 2022, nor by the subsequent discovery of poliovirus in sewage samples in New York and in other locations in the state. This is on top of a rise in polio found in sewage samples across London. The United States is now one of approximately 30 countries where circulating strains of poliovirus have been identified.

This ‘new’ infection, which arrived amid the Covid-19 pandemic and monkeypox outbreak, has stoked understandable fear and anxiety. A rapid response from New York City public health officials and state health departments, with support from the Centers for Disease Control and Prevention, is helping to ensure that polio remains what we were all taught. she was: a disease of the past.


The emergence of Covid-19 and the response to it was the first real public health impression that many people had. Indeed, much public health activity is routine and takes place behind the scenes, and its success is measured in terms of prevention: stopping the disease in its tracks or preventing it completely, which is often invisible to the audience. The efforts in New York and the state to contain polio are a clear example of such daily public health work, and they offer a guide to other communities and states that may be facing a re-emergence of polio. The response requires working directly with communities with low polio vaccination rates as well as paediatricians, parents, schools and community leaders to educate, inform and raise awareness, and issue a call to action so that children are vaccinated against the virus without hesitation. .

Public health, like politics, is often local. That’s why we’ve led community and provider roundtables, delivered culturally sensitive education and messaging in multiple languages, and worked to ensure healthcare providers have enough polio vaccines. We conduct frequent messaging and awareness campaigns in schools, community centers and other gathering places, and meet face-to-face with religious leaders and other respected and influential community members and organizations. We spread the word through local media, including ads in neighborhood newspapers and local access television.

All of this is routine public health work. which can be replicated in every city, state or county in the country, and should be part of the focus when discussions turn to strengthening America’s public health infrastructure in the wake of the Covid emergency -19.

Certainly, the work must be tailored to the constituencies served, especially when they are as diverse and sometimes as stubborn as New Yorkers. Yet my colleagues and I have been heartened by how communities most at risk have responded to this awareness and acted on the recommendations. In just two months, there has been a 20% increase in polio vaccines given to children up to age 5, compared to the same period last year, in New York zip codes with rates of lowest vaccinations for this age group. There was also a 9% increase in polio vaccines administered citywide. Similar increases in vaccination rates and the concomitant reduction in population-wide polio risk are occurring in other parts of the state and can be achieved anywhere public health workers are supported to do the work. largely misunderstood at the foundation of the profession: grassroots community engagement, education, and the delivery of key prevention services, informed by accurate data collection and analysis.

But there is still much more that public health officials and agencies everywhere can and should do, including combating the misinformation that has led to the persistent decline in vaccinations across the spectrum of vaccine-preventable diseases. This must be one of the main goals of public health in the future, but it cannot do it alone. State and federal regulators must hold social media companies accountable for spreading anti-science and anti-vaccination messages without warning, context or qualification.

As polio emerges from the shadows, global citizens and public health officials must recognize the factors that have made polio eradication such a challenge. And when we talk about reinventing or reinvesting in public health infrastructure, we need to lay the foundation for a strong workforce and support for engagement at the field level which is the backbone of prevention. We must also honor the memory of polio victims of the past, such as my aunt and uncle; meeting the needs of those in the present, like the tragically paralyzed person in upstate New York; and celebrating the everyday heroes who make up the extraordinary public health workforce of our country and the world by giving them the attention and investment they need to succeed.

Ashwin Vasan is a primary care physician and epidemiologist, 44th Commissioner of the New York City Department of Health and Mental Hygiene, and Assistant Professor of Population and Family Health and Medicine at the University of Columbia.


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