The World Health Organization (WHO) is gearing up to immunize over 640,000 children in Gaza with a novel oral polio vaccine (nOPV) this weekend. This ambitious plan raises important questions about how it will be carried out and what impact it may have. The main goal is to stop the spread of polio and prevent a potential outbreak or even a pandemic. However, there are significant concerns about the execution and monitoring of this unprecedented public health initiative.
The situation in Gaza is dire, with many children already having weakened immune systems due to ongoing conflict and limited access to essential resources. In response to the presence of circulating variant type 2 poliovirus (cVDPV2), there are plans to conduct two rounds of the vaccination campaign in the Gaza Strip at the end of this weekend (?). WHO and UNICEF are calling on all parties involved in the conflict to observe humanitarian pauses lasting seven days to help with vaccination efforts. These pauses are crucial to ensure that children and families can safely access health facilities and allow outreach workers to reach those who cannot visit for vaccination. Without these pauses, the success of the campaign could be jeopardized, leading to a resurgence of polio.
During each phase of the campaign, the Palestinian Ministry of Health (MoH), in partnership with WHO, UNICEF, UNRWA, and other organizations, will give two doses of nOPV2 to over 640,000 children under ten.
Poliovirus was detected in environmental samples from Khan Younis and Deir al-Balah in July 2024. Three children showing symptoms of acute flaccid paralysis (AFP), a common sign of polio, have been identified in the Gaza Strip. Their stool samples were sent for testing at the Jordan National Polio Laboratory.
To reduce the risk of vaccine-derived poliovirus emergence, nOPV2 was genetically modified for enhanced stability compared to the traditional Sabin oral polio vaccine (OPV). This vaccine is recommended for outbreak response and has received Emergency Use Listing from WHO. While pregnant women are not the primary target group for this vaccine, there is a theoretical risk of accidental exposure through pharyngeal or fecal shedding from vaccinated children in the household or nearby community.
The nOPV2 is a genetically altered version of the traditional Sabin OPV. It received emergency authorization in 2021 and full approval in December 2023. It was specifically developed to address the risk of circulating vaccine-derived poliovirus type 2 (cVDPV2) and offers greater genetic stability, significantly reducing the chances of reverting to a virulent form.
In outbreak situations, WHO recommends giving the second dose of nOPV2 one or two weeks after the first dose. This approach aims to effectively stop outbreaks of cVDPV2 and provide enhanced protection for vulnerable populations, especially young infants. However, in Gaza, the second round will be given just three days after the first, a shorter interval between rounds.
Administering genetically modified oral polio vaccine in a conflict zone where clean water is scarce and environmental conditions are deteriorating is risky. People live in crowded and unsanitary conditions, with many children suffering from skin infections and weak immune systems. Using nOPV carries risks in communities with inadequate immunity, as the vaccine virus can mutate and lead to vaccine-derived polioviruses (VDPVs). However, this risk is reduced due to its genetic modifications.
While WHO's coordination of these efforts and Israel's approval of the vaccination campaign seem commendable amid ongoing humanitarian crises, key questions remain about monitoring and surveillance of the effects of genetically modified oral polio vaccine. Who will be responsible for monitoring these children after they receive the new oral polio vaccine? What protocols are in place if they experience paralysis, if a new strain emerges from the vaccine, or if there is improper waste disposal?
As the situation develops, striking a balance between the urgent need for vaccination and the potential risks involved is crucial. The health and safety of Gaza's children rely on well-informed, scientifically sound decisions that prioritize their well-being in this challenging environment. Public health authorities must ensure that vaccination efforts are guided by science and that the community is adequately informed.
Dr Crane is a retired MD, who has an extensive experience in Emergency Medicine and Internal Medicine, holding board certification in Internal Medicine. She trained at Yale Medical School and completed her Internal Medicine residency at Boston City Hospital, now known as Boston Medical Center. With over 25 years in practice, she further studied public health at the T.H. Chan School of Public Health at Harvard.
Editor's note: Under normal circumstances text-book scientific solutions could well be beneficial and fruitful. But when implemented with total disregard to a conflict-zone's conditions, then those solutions could at some point be implemented in vain. In the case of Gaza, where the whole strip is under total siege and there is no possiblity to isolate patients or vaccinated children, then, out of the box solutions need to be brought forward. At @RebuildGaza24, we remain of the opinion that a permanent ceasefire and allowing for the entry of food, clean water and proper medication could well enable the Palestinian children of Gaza to develope a stronger immune system that would enable them to fight the side effects of the active OPV vaccine which could be fatal in their current case
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