We are talking again about polio – a disease that ran rampant in the 1950s, paralysing thousands of children every year. The successful introduction of polio vaccine in 1956 into the UK, and later more widely, has resulted in the elimination of this once dreaded disease from Europe and indeed most of the world. After the successful global eradication of smallpox in 1980, polio is the next human disease on the list targeted for eradication.
But for all the progress, we are not there yet. The first case of paralytic polio in almost a decade was reported in New York state in July, and a few days later vaccine-derived virus was reported to have been found in sewage in a neighbouring county. A related virus has now been reported in multiple samples of London sewage, prompting authorities in the capital to offer a polio vaccine booster dose to every child between the age of one and nine. This year Israel has had its first case of polio since 1989.
Over time, the threats from infectious diseases have reduced, but the need for vigilance never has. During the worst of the Covid-19 pandemic, routine childhood immunisation rates fell around the world, including in the UK, and they have not totally recovered.
The public health measures introduced – including increased handwashing, mask-wearing and physical distancing – resulted in a reduction in cases of some infectious diseases, including some that are vaccine-preventable. However, the pandemic also gave rise to conspiracy theories, including in relation to Covid-19 vaccines. Although these were espoused by a small minority of people in the UK, they were very vocal, received a lot of media coverage and there was an increase in vaccine scepticism generally, creating a perfect storm. An increase in the number of unimmunised people, a lack of background boosting of immunity from natural infection and dropping the public health measures means there is a very real danger that we will see increased rates of some of the diseases currently controlled by vaccination.
So how to respond? The resurgence of polio and the spread of monkeypox reminds us that infectious diseases do not respect national borders. As well as a moral duty, it is in our own interests to ensure that infectious diseases are controlled as effectively as possible across the globe. For polio this is only possible through vaccination. Yet, the UK government has cut its contribution to the global polio eradication effort. While it is understandable that all budgets are being reviewed in these financially stretched times, this is no time to slash something as vital as polio eradication. MPs need to be made aware of this change and its damaging effects.
Closer to home, we need to ensure that there is ready access to accurate information about vaccines and the diseases they prevent. Along with polio, most people will have had no experience of diseases such as diphtheria, which before the introduction of vaccination in the 1940s would kill thousands every year in UK.
It is often said that the success of a vaccination programme is its own worst enemy, as success equals no or little disease and hence not only is the reminder of the severity of the disease removed, but people consider vaccination to be no longer necessary. The current situation is a sharp reminder that this is not the case. Convincing some people to accept a vaccine (Covid-19) to protect against a pandemic disease that was killing literally millions of people in real time was challenging enough. It is even more difficult, perhaps, to encourage some of the public to accept a vaccine for a disease that has virtually died out.
But it is not impossible, as evidenced by high uptake of the vaccine in the UK as a whole, with over 90% of 12-month-old children receiving three doses of the primary vaccines including polio. The cause for concern is the large disparity in uptake between areas, with almost a third of 12-month-old children in some parts of London not fully protected. This huge gap in immunity leaves potential for spread of devastating diseases including polio.
Minimising this vaccine uptake gap relies on several key factors. The public require reliable, accurate and timely information in whatever form works best for them: written, digital or verbal. Many people need a conversation with a well-informed health professional whom they trust to discuss the pros and cons of the vaccine and answer their concerns; this takes time, which is at a premium in the NHS. For polio, the discussion is clear-cut: it is a devastating disease that can be effectively prevented by a very safe, well-established vaccine.
However, for some people the barriers to vaccination are more practical. It is well recognised that younger children in large families, as well as those living in more disadvantaged circumstances, are less likely to be vaccinated. The practical difficulties of accessing vaccination clinics with multiple conflicting priorities to manage may, despite best intentions, leave vaccination low on the list. It may be too costly to take time off work or pay for travel to the clinic. Vaccination becomes a low priority in the face of worries about the rapidly rising cost of living. This puts the ball firmly in the NHS’s court. We need to ensure that services meet the needs of the whole population with local adjustments. Could there be vaccinations provided in different settings: community centres, sites of religious gatherings or youth clubs, perhaps?
Vaccination saves between 2 million and 3 million children’s lives each year globally, but we cannot rest on our laurels. The public need reminding of the seriousness of diseases, and of the safety and efficacy of vaccines – and that until a disease is eradicated globally, we must keep vaccinating.
Prof Helen Bedford is professor of children’s health at UCL. This piece was co-authored by Dr David Elliman, consultant paediatrician at Great Ormond Street hospital
