Polio and the Syrian Crisis: The Accidental Bioterrorist

The continual use of chemical weapons in Syria has shocked the world. It has also reopened speculation around the possible use of biological weapons. In January 2014, US Director of National Intelligence James Clapper suggested in a statement to the US Senate Intelligence Committee that the Assad regime is capable of producing lethal agents, though it may not yet have an effective delivery mechanism.

But the potential use of such weapons is not the most pressing biological threat emanating from Syria. Earlier this month, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHIEC)[1] as a result of an unintentional bio-crisis: the re-emergence of polio, a deadly killer which was once almost eradicated. Over the last twelve months, twenty-five cases of polio have been confirmed in Syria, putting neighbouring Jordan, Iraq, Lebanon and Turkey at risk. Prior to its ongoing civil war, Syria had been polio-free for fourteen years but the country’s immunisation rates have plummeted from more than 95 per cent of eligible children before the conflict to around 52 per cent at the time of the polio outbreak.[2] Tellingly, the majority of the children affected were born after the vaccination programme fell apart.

(In)security and Bio-Threats

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

The challenging security environment that has facilitated its spread should sound alarm bells for the future. Genetic sequencing has linked the strain of polio responsible for the October 2013 outbreak in the Deir Al-Zour province in eastern Syria to one of Pakistani origin that has also been found in Egypt, Israel and the Palestinian territories in recent months. The speculation is that Pakistani fighters battling the Assad regime, or Syrian military personnel who have undergone training in Pakistan, may have inadvertently brought the virus to Syria with them.

Two-thirds of the 400 or so polio cases recorded globally in 2013 were caused by 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 these were concentrated in the Federally Administered Tribal Areas (FATA),[4] where the Taliban is particularly active, while Peshawar – the main city that is a way station for people transiting to Afghanistan – is the largest polio reservoir in the world.

Islamist Resistance to Vaccination

The apparent link between polio and Islamist activity is no coincidence: efforts to eradicate the disease in Pakistan, Afghanistan and Nigeria – the only 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 health workers are undercover Western spies. The latter claim is not without substance: Dr Shakil Afridi, a Pakistani physician working for the CIA, famously obtained DNA from children in Abbottabad in the hunt for Osama bin Laden, under the cover of a fake immunisation campaign. Such suspicion can have a devastating impact: twenty-seven polio workers have been assassinated in Pakistan since December 2012.[5] Nonetheless, as long as the virus remains endemic in Pakistan, jihadist fighters will be able to inadvertently carry it to other areas of instability across the globe.

This problem is not exclusive to Pakistan. In May 2013, cases of the disease were recorded in Somalia’s capital Mogadishu for the first time since 2007, caused by strains imported from northern Nigeria, where imams and local political leaders issued a polio-vaccination boycott in 2003. In February 2013, the Islamist group Boko Haram murdered nine young women working on polio-vaccination programmes. Meanwhile, the spread of the disease across Somalia itself has been 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 world reacts to this global public-health emergency in the coming months – particularly over the summer, which heralds what is traditionally the high-transmission season for polio – will determine whether we can realistically continue to aim for a world that 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 limit international travel from affected regions by those who cannot prove they have been vaccinated.  This is an approach that has also been replicated within countries. For example, Pakistani President Nawaz Sharif has stipulated that no unvaccinated child from FATA be allowed to enter the settled areas of Pakistan. He has also ordered army protection for polio vaccinators going into volatile regions of the country.

Other more creative measures should also be considered. The Organization of the Islamic Conference has issued fatwas in support of polio vaccination, and Pakistan has encouraged senior imams to speak out on the topic. On 16 May, the White House issued a statement that the CIA will no longer make operational use of vaccination workers.

But beyond these, there needs to be greater awareness amongst the broader security community of how this niche problem can develop into a global threat – an ancillary product of instability and violence that can 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 last few remaining strongholds must be approached with both in mind.