Employing everyday public health efforts to respond to polio’s re-emergence

Ask most Americans to name a victim of polio 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 youngest brother.

My dad’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 years old at the time and became permanently paralyzed in his right leg. I remember the first time I met my uncle at our family home in Chennai, India, and asked him what happened to his leg. I could not imagine facing such challenge, and was relieved to be told that I would not 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 an illness of the past, thanks to more than half a century of concerted global health action to vaccinate children. Within the last few decades, the public health community saw a path toward global eradication of polio, especially with the World Health Organization declaring wild poliovirus eradicated in Africa in 2020. It would have followed smallpox, which was declared to have been eradicated worldwide in 1980. That didn’t happen, in large part due to the effects of global under-vaccination caused by a combination of mistrust, poor implementation, lack of access in conflict zones, insufficient funding, loss of global momentum, and work suspended because of the Covid-19 pandemic.

So I wasn’t completely surprised when a man was diagnosed with polio in Rockland County, N.Y., in July 2022, nor by the subsequent discovery of poliovirus in wastewater samples in New York City and other locales in the state. This is on top of a surge in polio found in wastewater samples across London. The U.S. is now one of 30 or so countries where circulating poliovirus strains have been identified.

This “new” infection, arriving in the midst of the Covid-19 pandemic and the monkeypox outbreak, stoked understandable fear and anxiety. A quick response by public health workers at the New York City and state health departments, with support from the Centers for Disease Control and Prevention, is helping ensure that polio remains what we have all been taught it was: a disease of the past.

The emergence of Covid-19 and the response to it was the first real impression of public health that many people had. That’s because so much public health activity is routine and happens behind the scenes, and its success is measured in prevention: stopping disease in its track or preventing it altogether, which is often invisible to the public. The efforts in New York City and state to contain polio are a clear example of such everyday public health work, and they offer a guide to other communities and states that might be faced with a reemergence of polio. The response requires working directly with communities with low polio vaccination rates as well as with pediatricians, parents, schools, and community leaders to educate, inform, and raise awareness, and to make a call to action to get children vaccinated against the virus without hesitation.

Public health, like politics, is often local. That’s why we have led community and provider roundtables, disseminated culturally respectful education and messaging in multiple languages, and worked to ensure that health care providers have sufficient supplies of polio vaccine. We are conducting frequent messaging and awareness campaigns in schools, community centers, and other gathering places, and meeting face-to-face with faith-based leaders and other respected and influential community members and organizations. We are getting the word out via local media, including announcements in neighborhood newspapers and local access television.

All of this is routine, shoe-leather public health work. that can be replicated in every city, state, or county in the nation, and should be part of the goal when talk turns to strengthening the U.S.’s public health infrastructure in the wake of the Covid-19 emergency.

Certainly, the work must be tailored to the constituencies served, especially when they are as diverse and at times as headstrong as New Yorkers. Yet my colleagues and I have been encouraged by how the most at-risk communities have responded to this outreach and acted on recommendations. In just two months, there was a 20% increase in polio vaccines administered in children up to 5 years old, compared to the same time last year, in New York City ZIP codes with the lowest vaccination rates for that age group. There has also been a 9% increase in polio vaccines administered citywide. Similar increases in vaccination rates, and the concomitant lowering of population-wide polio risk, are happening in other parts of the state, and can be achieved anywhere that public health workers are supported to do the largely unsung work at the root of the profession: on-the-ground community engagement, education, and delivery of key preventive services, informed by precise data collection and analysis.

But there is still much more that public health workers and agencies everywhere can and must do, including fighting back against misinformation that has led to the persistent decline in immunizations across the spectrum of vaccine-preventable diseases. That must be one of public health’s main goals moving forward, but it can’t do it alone. State and federal regulators must hold social media companies accountable for disseminating anti-science and anti-vaccination messaging without warning, context, or qualification.

As polio re-emerges from the shadows, global citizens and public health officials alike must acknowledge the factors that have made eradicating polio such a challenge. And when we talk of reimagining or reinvesting in public health infrastructure, we must build the foundation of a strong workforce and support for ground-level engagement that is the backbone of prevention. We must also honor the memory of polio victims from the past, like my aunt and uncle; meet the needs of those from the present, like the person tragically paralyzed in upstate New York; and celebrate the everyday heroes who make up our nation’s and the world’s extraordinary public health workforce by giving them the attention and investment they need to be successful.

Ashwin Vasan is a primary care physician and epidemiologist, the 44th commissioner of the New York City Department of Health and Mental Hygiene, and an assistant professor of population and family health and medicine at Columbia University.