Polio vaccinations to begin in Gaza amid concerns of virus' spread outside of war zone

The World Health Organization on Friday said it will begin distributing millions of vaccines to children across Gaza to address a polio outbreak in the region that could spread outside the war zone.

The effort beginning Sunday aims to achieve over 90% vaccination coverage. Health workers will spend three days each in central, southern and northern Gaza, to stop the disease from spreading. The effort comes during a fragile humanitarian pause that likely won't last long enough for workers to achieve sufficient immunization in the small Palestinian territory, global health officials said. They said they need more time to navigate damaged roads and infrastructure. Overall instability and population movement have made the campaign against polio difficult.

“We welcome the pause,” Dr. Tedros Adhanom Ghebreyesus, director-general of WHO, said in a press briefing from Geneva. “We hope that all parties will respect that. But at the same time, we don’t think that pause is enough. We still insist on a cease-fire because ultimately the best medicine and the best vaccine is actually peace.”

The effort comes after a 10-month-old boy contracted polio and became partially paralyzed. Gaza hadn't seen cases in 25 years, thanks to high vaccine uptake before the war. The boy had type 2 polio virus, which the WHO said had been eradicated in its wild endemic form in 1999. However, type 2 polio from weakened virus in oral vaccines began spreading in Gaza. A WHO news release said sequencing indicates it’s linked to a strain detected in Egypt that began circulating in the Palestinian territory around September or October. According to WHO, this type of polio happens when vaccines with live, weakened virus that are used to build up antibodies are excreted by people. With inadequate sanitation, the virus can then spread in immediate communities, such as was the case when the war broke out.

There have been three suspected polio infections in the embattled territory since lack of clean water, poor sanitation and overcrowding created ideal scenarios for the virus to likely spread throughout Gaza. Officials warned it could spread outside of Gaza, including to Israel, where members of some religious groups oppose vaccinating their children, as well as to Lebanon and Syria.

With the campaign, around 640,000 children under 10 are expected to receive a two-dose vaccine, with oral doses given four weeks apart. United Nations officials said Israel agreed to a temporary pause in its war against Hamas militants and their allies. The WHO vaccine campaign will start in central Gaza before moving to the south and then the north. The vaccine campaign has already amassed 1.2 million vaccines and another 400,000 doses are on the way, with around 2,180 community outreach workers trained to inoculate children, Ghebreyesus said.

Calling into the briefing from Gaza, Dr. Richard Peeperkorn, WHO’s representative in the Palestinian territories, said polio vaccination campaigns normally happen with door-to-door visits. But because of the war, thousands of workers will set up at nearly 400 designated fixed points for parents to bring their children to receive vaccines. In addition, around 300 mobile health teams will go to families in areas where it’s difficult for them to move.

“It’s not ideal, but nothing is ideal in Gaza,” Peeperkorn told reporters. “We have an agreement where we all are in agreement as technical partners. We think it’s all feasible if all the pieces of the puzzle are in place.”

Still, he described the vulnerability of the campaign with “micro-planning” that’s critical for vaccines, even in a small, densely populated region of the Gaza Strip, which is just 139 square miles. This includes “cold chain” issues, or ensuring the vaccine can be effective with proper refrigerated storage. He outlined some of the logistical complications of organizing vehicles and sufficient fuel to get doses and workers where they've needed to be during the 11 months of the war.

Officials pointed to critical public health concerns as infrastructure ? including hospitals and routine immunizations with primary care providers ? collapsed during the war. Respiratory infections are pervasive, as are skin and diarrheal diseases and hepatitis.

“We focus very much on polio and the polio campaign,”  Peeperkorn said, “but we’re deeply concerned about the overall health situation.”

Globally, polio cases have declined 99% since 1988. In that same time, WHO said there were 24 outbreaks of vaccine-derived polio in 21 countries, causing fewer than 760 cases.

This article originally appeared on USA TODAY: WHO provides details of plan for polio vaccine rollout in Gaza