For the first time in a generation, polio has reappeared in the United States. On July 18, the New York State Department of Health told the U.S. Centers for Disease and Control and Prevention that it had detected the polio virus, which can cause paralysis or death in a small percentage of cases, in a young adult from Rockland County. outside New York City.
New York authorities then discovered the virus in sewage in Rockland and neighboring Orange County — evidence of transmission in the local community.
That first case prompted authorities in the UK and Israel to step up their surveillance — they also found polio.
There could be a polio crisis. But despite describing polio as “one of the most feared diseases in the US,” the CDC is trying to maintain total government control over testing for the polio virus. Only the FBI and certain states that already do polio testing would be equipped to check for the pathogen.
By withholding the testing materials and protocols, private labs — such as Massachusetts-based surveillance startup BioBot — are supposed to detect and monitor the virus, the CDC is at risk of the virus spreading undetected in some communities, while the study of a possible outbreak is limited .
“They want to do it themselves,” Vincent Racaniello, a professor in the Department of Microbiology and Immunology at Columbia University, told The Daily Beast. “Just like they wanted to check the COVID tests at the start of the pandemic.”
The thing is, even the CDC admits it messed up the initial response to COVID. Last week, Rochelle Walensky, the CDC director, told the agency’s 11,000 employees that the CDC needed a major overhaul. “To be fair, we’re responsible for some pretty dramatic, pretty public errors, from testing to data to communications,” Walensky said.
The CDC may be about to repeat some of its mistakes. Amy Kirby, an Emory University epidemiologist who heads the CDC’s National Wastewater Surveillance System, did not respond to a request for comment.
The polio virus is spread through direct contact with feces. Before the invention of an oral vaccine in the early 1950s and a large-scale campaign of childhood vaccinations, polio outbreaks caused more than 15,000 cases of paralysis each year in the US alone.
Vaccines have crushed polio. By the 1970s, the disease had virtually disappeared from all but a handful of the poorest and most remote countries such as Afghanistan. When it reappeared, it was mostly as a result of international travel – and local health authorities quickly isolated the infected and stopped further spreading.
The CDC tracked polio virus only once in a U.S. community between 1979 and 2022. In 2005, the Minnesota Department of Health identified polio virus in an unvaccinated girl in a largely unvaccinated Amish community. Three other children became ill before the virus was under control.
“[It] shouldn’t be hard to do.”
Today, 90 percent or more of people in the wealthiest countries, including the US, are vaccinated against polio. But childhood vaccination rates are declining as a growing minority of people take an anti-vax stance. It’s no coincidence that Rockland County, where the CDC discovered the polio virus last month, has a lower vaccination rate than the rest of the country: about 60 percent.
“The occurrence of this case, coupled with the identification of poliovirus in wastewater in neighboring Orange County, underscores the importance of maintaining high vaccination coverage to prevent paralytic polio in individuals of all ages,” the CDC stressed in a report. that it posted last week.
The public health stakes couldn’t be greater as the world faces not only the ongoing COVID pandemic, but an ever accelerating monkeypox outbreak. But a possible impending disaster has not motivated the CDC to release to private labs the DNA primers they need to detect polio. “Essentially no one is allowed to do it except in public” [i.e. government] health labs,” Rob Knight, chief 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 researchers associated with those labs — can’t help the government find polio in other communities. Racaniello compared the CDC’s reluctance to expand polio testing to the agency’s equally tight scrutiny of COVID testing during the early months of the novel coronavirus pandemic. “Which Didn’t Work Out,” Racaniello noticed in a tweet.
The worst-case scenario is that polio spreads for weeks without anyone noticing—much like monkeypox spread unnoticed at first, because many doctors mistook it for herpes or another sexually transmitted disease.
The CDC’s recalcitrance appears to be bureaucratic. From a technical standpoint, detecting the poliovirus in sewage is no more difficult than detecting SARS-CoV-2 or any other virus, Knight explained. Take a sample from sewage, conduct a PCR test.
But in the US, the rules regarding polio are stricter than for other diseases. “From a regulatory standpoint, you have to consider every single sample that could contain polio,” Knight said. Polio surveillance, he added, is a “paper nightmare to set up.”
There is also the cost factor. Stepping up polio testing in private labs could cost millions of dollars. And the labs may want government help to pay for it. CDC leaders may have noticed the 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 indoors.
But easier does not necessarily mean better, even when it comes to public health. With some effort and a little money, private labs could strengthen the government’s surveillance system. “[It] shouldn’t be difficult to test for wastewater,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast. “BioBot and others who are already overseeing can get up and running soon.”
Speed and comprehensive surveillance both matter when it comes to infectious diseases. A little effort from the CDC, and some government funding, could make the difference between a once-in-generation polio outbreak coming to a halt in a few small New York counties, or a much broader outbreak potentially affecting the entire US.
Or even the whole world.