Recent reports of a poliomyelitis (polio) outbreak in neighboring Papua New Guinea (PNG) have raised concerns about the risk of the poliovirus spreading to Indonesia. Health authorities have taken measures to prevent travelers from importing the virus, especially from Papua and West Papua, which border Papua New Guinea — even though Indonesia has been polio-free since 2014.
With vaccination coverage rates in some countries remaining stubbornly low, we are unlikely to reach the goal of being a polio-free world by 2018 in the few weeks remaining of the year.
Poor polio vaccine coverage of 50 to 60 percent across PNG — according to the World Health Organization — is believed to have contributed to the country’s vaccine-derived polio outbreak in September, which saw 14 confirmed cases. The outbreak happened a mere two months before more than 20 Asia-Pacific leaders gathered in Port Moresby for the 2018 Asia-Pacific Economic Cooperation (APEC) Summit from Nov. 17 to 18. Swift response measures against the outbreak were taken primarily in heavily populated areas.
Concerns in Indonesia were triggered because the PNG polio outbreak was happening when seven children with acute flaccid myelitis — symptoms of which include sudden weakness in the arms or legs — were found in several areas of Papua, including two cases in Merauke. The Health Ministry closely monitored the disease and later confirmed that the children’s symptomatic paralysis was not caused by polio.
Another preventive measure is to integrate a polio vaccination program with the measles and rubella (MR) immunization program currently running in Papua. The program is part of the ongoing mass MR immunization campaign in 28 provinces outside Java that targets around 32 million children aged 9 months to just under 15 years. However, the program has reached only 63 percent of the targeted children in Papua, far lower than the minimum 95 percent needed to establish herd immunity.
The vaccine-derived PNG poliovirus outbreak and the wild poliovirus transmissions occurring in Afghanistan, Nigeria and Pakistan show that polio eradication remains an unfinished job for the world.
One effort being undertaken to increase the polio vaccination rate is the Global Polio Eradication Initiative, a public-private partnership that issued the Polio Eradication and Endgame Strategic Plan 2013-2018. The plan includes routine vaccination to achieve a high enough population immunity that can prevent transmission of the poliovirus.
Experts warn that until polio is eradicated globally, all countries remain at risk of the disease. “Polio is a highly infectious disease, and we have seen time and again that it easily spreads or reemerges in areas with low vaccination coverage. A new reemergence of polio this year in Papua New Guinea underscores this risk,” WHO polio eradication director Michel Zaffran told The Jakarta Post.
Before the disease can be completely eradicated worldwide, Zaffran added, countries must maintain high vaccination coverage levels everywhere as well as strong disease surveillance.
The WHO praised Indonesia’s routine immunization program; Indonesia last saw cases of polio in 2006. Still, vaccination must continue, including through Polio National Immunization Week (PIN). Good and well-funded polio eradication programs and skilled healthcare professionals have contributed to the country’s success.
“These are good proactive measures taken by the Indonesian government. We value the commitment the Indonesian government has shown in terms of maintaining [its] polio-free status and protecting children,” said Vinod Kumar Bura, an epidemiologist and a medical officer at WHO Indonesia.
Bura continued that the introduction of inactivated poliovirus vaccine (IPV) to Indonesia’s routine immunization schedule underlined the nation’s commitment to the global endgame for polio, which mandated oral poliovirus vaccine (OPV) withdrawal in stages.
All countries today use at least one dose of IPV in their routine immunization schedule. In Indonesia, IPV was introduced to all provinces in 2016. Containing three serotypes of poliovirus IPV can strengthen children’s immune system for better protection against polio. However, the injectable vaccine is more expensive than the oral type, but will become the only polio vaccine available after the use of all OPV has been stopped.
Research and product development coordinator Roland Sutter of the Global Polio Eradication Initiative said that with support from stakeholders, including the public-private Gavi Alliance partnership on immunization, IPV had been introduced to all countries.
“For the poorest countries, and also those that are eligible for Gavi support, including Indonesia, IPV is provided free-of-charge,” said Sutter, also a member of the WHO’s polio eradication department.
Innovative purchasing mechanisms and new vaccine formulations are two other major breakthroughs that a global coalition of partners is aiming for, to help reduce the cost of the vaccine and to ensure a supply of IPV for all countries.
World Polio Day, which falls on Oct. 24, should serve as a wake-up call for the Indonesian government and people to lapse into complacency regarding the country’s polio-free status. With the high potential of the disease’s reemergence, especially where vaccination coverage is low, more urgent work is needed to maintain our polio-free status, including ensuring high population immunity with quality surveillance.
People must fully engage with immunization programs, while better public awareness is needed on the vaccine’s benefits and polio’s serious impacts on one’s health and the national economy. Parents must be more willing to listen to experts that tell them that the vaccine is safe and effective, and that it does not contradict religious beliefs — one factor behind resistance against immunization.
Once a polio-free world is achieved, polio would become the second disease to be eradicated in Indonesia after smallpox — and no small accomplishment.
Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.