Polio reappeared in the United States for the first time in a generation. On July 18, the New York State Department of Health told the US Centers for Disease and Control and Prevention that it had detected poliovirus, which can cause paralysis or death in a small percentage of cases, in a young adult from Rockland County outside of New York. Town.
New York authorities later detected the virus in sewage from Rockland and neighboring Orange County, evidence of transmission in the local community.
This first case prompted the British and Israeli authorities to step up their surveillance – they also discovered polio.
A polio crisis could be brewing. But despite the description of poliomyelitis as “one of the most feared diseases in the United States”, the CDC is trying to maintain full government control over poliovirus testing. Only federal authorities and some states that already perform polio testing would be equipped to monitor the pathogen.
By withholding testing equipment and protocols private labs — such as Massachusetts-based surveillance startup BioBot — are expected to detect and track the virus, the CDC risks allowing the virus to spread unnoticed in some communities, while limiting the study of a possible epidemic.
“They want to do it themselves,” Vincent Racaniello, a professor in Columbia University’s Department of Microbiology and Immunology, told The Daily Beast. “Just like they wanted to control COVID testing at the start of the pandemic.”
Fact is, even the CDC admits it botched the initial response to covid. Last week, Rochelle Walensky, the director of the CDC, told the agency’s 11,000 employees that the CDC needed a top-to-bottom overhaul. “To be frank, we’re responsible for some pretty dramatic and pretty public errors, from testing to data to communications,” Walensky said. said.
The CDC may be on the verge of repeating some of its mistakes. Amy Kirby, an Emory University epidemiologist who leads the CDC’s National Wastewater Surveillance System, did not respond to a request for comment.
Poliovirus spreads through direct contact with feces. Before the invention of an oral vaccine in the early 1950s and a massive childhood vaccination campaign, polio epidemics caused more than 15,000 cases of paralysis each year in the United States alone.
Vaccines crushed poliomyelitis. By the 1970s, the disease had virtually disappeared from almost all the poorest and most remote countries such as Afghanistan. When it reappeared, it was usually following international travel – and local health authorities quickly isolated those infected and halted the spread.
The CDC has only tracked poliovirus in a US community once between 1979 and 2022. In 2005, the Minnesota Department of Health identified poliovirus in an unvaccinated baby girl in a largely unvaccinated Amish community. Three more children fell ill before the virus was contained.
“[It] shouldn’t be hard to do.”
Today, 90% or more of people in the wealthiest countries, including the United States, are vaccinated against poliomyelitis. But childhood vaccination rates have plummeted as anti-vax attitudes take hold among a growing minority of people. It’s no coincidence that Rockland County, where the CDC detected poliovirus last month, has a lower vaccination rate than the rest of the country: about 60 percent.
“The occurrence of this case, combined with the identification of poliovirus in sewage from neighboring Orange County, underscores the importance of maintaining high immunization coverage to prevent paralytic poliomyelitis in people of all ages,” said the CDC. highlighted in a report he posted last week.
The public health stakes couldn’t be higher as the world faces not only the ongoing COVID pandemic, but also an accelerating outbreak of monkeypox. But the impending potential disaster did not motivate the CDC to provide private labs with the DNA primers they would need to detect polio. “Essentially no one is allowed to do that except the public [i.e. government] health labs,” Rob Knight, director of a genetic computation lab at the University of California, San Diego, told The Daily Beast.
Without the primers and other materials, private labs – and the researchers associated with those labs – cannot help the government detect polio in other communities. Racaniello compared the CDC’s reluctance to expand polio testing to the agency’s equally tight control over COVID testing during the early months of the novel coronavirus pandemic. “What didn’t work well”, Racaniello noted in a tweet.
In the worst case, poliomyelitis spreads for weeks without anyone noticing, just like monkeypox spread unnoticed at firstbecause many doctors have confused it with herpes or another sexually transmitted disease.
The CDC’s recalcitrance appears to be bureaucratic. From a technical perspective, detecting poliovirus in sewage is no more difficult than detecting SARS-CoV-2 or any other virus, Knight explained. Take a sewage sample, run a PCR test.
But in the United States, polio regulations are stricter than for other diseases. “From a regulatory perspective, you have to account for every sample that might have polio,” Knight said. Polio surveillance, he added, is a “red tape nightmare to set up”.
There is also the cost factor. Scaling up polio testing in private labs could cost millions of dollars. And the labs might want government help to pay. CDC leaders may have noted growing reluctance of the US Congress to pay for COVID testing and concluded that it is simply easier for the CDC to keep polio testing in-house.
But easier doesn’t necessarily mean better, not when public health is concerned. With some effort and a little money, private labs could bolster the government’s surveillance system. “[It] Shouldn’t be hard to do sewage testing,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast. “BioBot and others already doing surveillance could rise quickly.”
Speed and comprehensive monitoring are important when it comes to infectious diseases. A small effort from the CDC and some government funding could mean the difference between a once-in-a-generation polio outbreak stagnating in two small New York counties or a much larger outbreak potentially affecting the entire United States.
Or even the whole world.