Two Years’ Later – Now or never: on the edge of polio eradication

On 27 March 2014, the World Health Organization certified that the entire South East Asia Region was Polio free. This was a huge milestone, meaning that four out of the six WHO regions are now formally Polio free, and that every country within the region (Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka,  Thailand and Timor-Leste) are Polio free.

We are so close to the end of Polio, however new threats loom, with reemergence of the disease in Syria as a result of internal violent conflict. Children are those devastated by Polio. Below is piece published in May 2012, two years ago, and now, more than ever, we should work to finish this momentous task.

The piece below was originally published on ABC’s The Drum.

At some point in recent history, Australians forgot about the iron lung; the full-body metal chamber, changing air pressure so that polio sufferers could simply breathe in, and out.

We forgot about the Australian children who were left paralysed or whose legs were permanently deformed.

At some point, we lost our deep, dark fear of polio. Forgetting, thankfully, was perhaps as a result of an incredible medical advancement; when Australian Dr Percival Bazeley CBE, working with Dr Jonas Salk, developed, and then pioneered the Australian delivery of the Salk polio vaccine.

This remarkable moment in medical science is at the centre of events this week at the 65th World Health Assembly of the United Nations World Health Organization; the world’s highest-level health policy forum. Ministers of Health, national delegations, and leading international health experts and advocates converge on Geneva, Switzerland to meet and discuss the world’s most pressing health issues, such as pandemic influenza.

On Friday, Geneva time, I watched the World Health Assembly, composed of 194 countries, declare polio a global health emergency and that vaccinating children across the world is an immediate international health priority.

Although we have come incredibly close to the complete global eradication of polio, a sudden escalation of cases has demonstrated the vital importance of consistent, community-wide vaccination. According to the World Health Organization, we are facing a “now or never” moment to permanently eradicate polio globally.

Vaccination is the solution. Since the introduction of a coordinated global vaccination effort 20 years ago, led by the World Health Organization and Rotary International, the number of polio cases worldwide has dropped 99 per cent. No longer are millions of lives around the world lost to polio, and no longer are nearly 1,000 children permanently paralysed every day.

For doctors, scientists and health human rights experts the possibility of global polio eradication is both exciting and inspiring. For those living in endemic polio areas, and for the 200,000 children who are predicted to otherwise be crippled by polio, this is simply life.

The dangers of failure to vaccinate are too great; not only for individuals, but for communities, and as has been seen in this case, the entire globe. Consistent vaccination is absolutely essential. Contrary to the cries of anti-vaccination lobby groups, failure to vaccinate is not only scientifically and medically unfounded selfishness, but dangerous. Laurie Garrett, Senior Fellow for Global Health at the Council of Foreign Relations, has not only expressed that “[w]e’re so close on polio eradication that it hurts”, but that the rise of anti-vaccination movements are causing the “export” of vaccine-preventable diseases, including polio, to developing countries where ready access vaccinations is sparse.

As a result, in addressing its international legal and moral responsibilities in this global health emergency, it is essential that Australia takes steps to continue to ensure that parents are provided with education on the medical and scientific facts of vaccination. Maintaining and ensuring consistent, community-wide vaccination, even here in Australia, is the only way global eradication of polio will become a reality; ensuring the health and human rights of millions around the world.

Ban Ki-moon, Secretary General of the United Nations, last week warned that:

“Wild viruses and wildfires have two things in common. If neglected, they can spread out of control. If handled properly, they can be stamped out for good. Today, the flame of polio is near extinction – but sparks in three countries threaten to ignite a global blaze. Now is the moment to act.”

Now is the world’s moment to act. Now is every Australian parent’s moment to ensure that their child is vaccinated against polio, and that the iron lung is relegated back to its rightful place in museum exhibits of the remarkable achievements of medical science.

Alexandra Phelan is an Australian international health and human rights lawyer, presently based in Geneva, Switzerland. View her full profile here.

Malaria on Manus Island: a threat to human rights

This post was originally published on ABC’s The Drum.

International health and human rights lawyer Alexandra Phelan argues that by exposing asylum seekers to the risk of malaria on Manus Island, the Government could be violating human rights conventions.

When the Australian officials head to Port Moresby this week to discuss the reopening of the Manus Island detention centre, their risk of contracting malaria on a short-term visit to Port Moresby (according to the Government’s own Smart Traveller website) is relatively low.

However, if the officials make their way to Manus Island, located north of Papua New Guinea to inspect the detention centre site, their health professionals would likely advise that they take prophylactic antimalarial drugs.

Given this visit is part of a government-related mission, the cost of these antimalarials would most likely, and rightly so, be covered by tax-payer funding.

Malaria is contracted by the bite of a mosquito infected with one of the five species of Plasmodium parasite. The parasite travels to your liver, where it multiplies and then ruptures liver cells, spreading to your red blood cells and then throughout your body. This process causes fever, shivering, headache, and vomiting. In the case of Plasmodium falciparum (the cause of 90 per cent of Papua New Guinea malaria cases), if not treated within 24 hours, the infection proceeds to severe malaria resulting in coma and death, especially in young children and pregnant women. In malaria endemic areas, local populations may develop partial immunity, meaning that individuals who have not grown up in the endemic area are at greatest risk.

There is currently no vaccine for malaria – prevention is through the use of antimalarials, which require important medical consideration of each patient’s age, weight, pregnancy status, underlying illnesses, the risk of side-effects and the increasing prevalence of the parasite’s antimalarial resistance.

Papua New Guinea is a malaria endemic country; in the World Health Organization’s (WHO)2011 World Malaria Report, the WHO concluded that 94 per cent of Papua New Guinea’s population is at high risk of malaria infection, with the remaining 6 per cent of the population at low risk. No person in Papua New Guinea is deemed by the WHO to be risk-free of malaria. In 2010, there were 1.4 million suspected malaria cases in Papua New Guinea, out of a total population of 6.9 million. In 2010, there were 616 reported deaths attributed to malaria, six times more than any other country in the Western Pacific Region.

Papua New Guinea is clearly the highest risk country in the entire Western Pacific Region for malaria. But to make matters worse, the WHO categorises Manus Island, where the Government proposes to send asylum seekers, as having the highest numbers of probable and confirmed malaria cases in all of Papua New Guinea.

The Manus Island detention centre was initially established in 2001 under the Howard government’s Pacific Solution policy. In February 2002, an outbreak of malaria affected at least 15 asylum seekers detained at Manus Island, a claim denied by then-minister Philip Ruddock, but supported by local doctors on Manus Island.

In response to the outbreak, the Royal Australasian College of Physicians (RACP) called for asylum seekers detained at Manus Island to be immediately removed. Then-president of the RACP, Richard Larkins, said that:

“[G]iven the medical evidence about the prevalence of malaria, in particular the chloroquine [an anti-malarial] resistant strains, on Manus Island, the responsible course of action is to immediately evacuate the detention centre. This is the only truly effective way people at risk can be protected, especially pregnant women and children, but also any others with low immunity.”

The Manus Island detention centre was closed in mid-2004, after asylum was granted to Aladdin Sisalem, who had been the sole detainee at the centre for the previous 10 months.

If plans to re-establish Manus Island are followed through, Australia will most definitely risk violating a number of the asylum seekers’ human rights and protections under international law, in particular, the asylum seekers’ right to health under article 12 of the International Covenant on Economic, Social and Cultural Rights, and possibly, their right to life.

The right to health provides that everyone has the right to a standard of living adequate for the health and wellbeing of themselves and their family. It imposes obligations on countries to take steps to prevent, treat and control disease. The principle of non-regression prevents countries from “going-backwards” in the realisation of the right to health. It is also arguable that by sending individuals to a country where their health is knowingly at risk so substantially as to risk their lives, the protections of their right to life under the International Covenant on Civil and Political Rights could be engaged.

These rights are universal, regardless of an individual’s status under a piece of Australian legislation. Even more so, due to their circumstances, asylum seekers are especially vulnerable and at risk of having their rights violated. Sending asylum seekers offshore to Manus Island where malaria is endemic, and present in its most deadly strain (Plasmodium falciparum), risks violation of the asylum seekers’ rights and contravention of Australia’s obligations under international law.

There are only two ethical options left for the Australian Government. The first option is to invest Australian tax payers’ money in improving the facilities on Manus Island, providing mosquito nets, and supplying universal medical prophylaxis and healthcare with informed consent to detainees (which may be impossible with pregnant women, children and those most vulnerable to malaria). The second option is to immediately abandon any plans the Government has to send asylum seekers to Manus Island.

When Australian Government officials on Manus Island this week take their medically-assessed and freely consented to antimalarials, don their long shirts and pants, spray their insect repellent, and don’t have to worry about closing their mosquito nets securely around their hotel beds thanks to the air-con, perhaps they can take a moment to consider whether it would be conscionable for the Australian Government to expose persons in its custody and care to the conditions on Manus Island.

Alexandra Phelan is an Australian international health and human rights lawyer, and was involved in writing a book chapter on a human rights based approach to malaria at the World Health Organization, to be released later this year. View her full profile here.