The news that two young children in Nigeria were recently paralyzed by polio is tragic enough. But the blow that the outbreak dealt to the campaign to wipe out polio planet-wide was downright crushing — on a global scale.

“Although this is a setback and a disappointment, polio eradication is still absolutely feasible and on track,” Michel Zaffran, the World Health Organization (WHO) chief of polio eradication, nevertheless assured The New York Times in the wake of the outbreak. Yet the Nigerian cases show just how difficult fighting the disease can be.

Poliomyelitis, aka polio, is highly contagious — transmitted through contaminated food and water as well as fecal-oral contact — and incurable. It attacks victims’ nervous systems and can cause permanent paralysis, deformity, and even death. It’s tricky too because not all those infected with polio show symptoms, so they aren’t even aware that they’re spreading it.

Nigeria, formerly home to half of the world’s polio cases, had been polio-free for nearly two years, in fact, prior to these cases. (The WHO doesn’t declare an area polio-free until there are no confirmed cases for three years. Pakistan and Afghanistan were the only two countries still battling the disease). The United States has been rid of polio since 1979, while India and 10 Asian countries only fairly recently achieved the status in 2014.

Image: Gavi/Adrian Brooks

Citizens of 125 countries were contending with the threat as of 1988 and 350,000 people suffered from the disease. But thanks to vaccination campaigns that immunized more than 2.5 billion children, currently a mere 20 people in the world are known to have succumbed. The overall number of polio cases, in fact, has dropped by a staggering 99 percent.

Yet polio eradication depends on vaccination and in some war-torn or remote, underserved areas, finding, reaching, and administering the vaccine is nearly impossible. (The vaccine must be given several times requiring vaccinators to visit more than four times each year).

When vaccinators aren’t able to do their job, polio prevention is dangerously compromised. Exhibit A: Nigeria. The New York Times reports that both of these new cases occurred in a past Boko Haram stronghold, Borno state, where vaccinators have had limited access.

Things aren’t any easier in Pakistan where the Taliban reportedly “spreads poisonous whispers that the vaccine is actually an American plot to make Muslims infertile — or a devious way of spreading AIDS.”

Walter A. Orenstein, former director of the Centers for Disease Control and Prevention's national immunization program and associate director of the Emory Vaccine Center at the Emory University School of Medicine in Atlanta told National Geographic that “poverty, unrest, and war are major obstacles” to vaccination in the developing world.

And just last year, the Global Polio Eradication Initiative report put up a red flag about exactly these issues. Cautioning that “limited accessibility to children in conflict-affected areas has presented an intermittent but major barrier” to reaching nomadic groups, establishing permanent vaccination posts, and ensuring immunization in refugee camps, the group offered a warning about Nigeria. “Progress is encouraging,” they reported, “but fragile due to concerns over pockets of low immunity and challenges associated with population movements and insecurity in the Northeast.”

Image: United Nations Photo

Even in areas long past polio outbreaks aren’t immune to setback. In 2013 Live Science reports “an outbreak of polio occurred in Syria for the first time in 14 years, due to the interruption of public health services resulting from the country's civil war.” And until polio is eliminated in all countries, the risk remains that it could spread.

“As long as a single child remains infected with poliovirus, children in all countries are at risk of contracting the disease,” declared the WHO. Illustrating its point, the group adds, “Failure to eradicate polio could result in as many as 200,000 new cases every year, within 10 years, all over the world.”

Yet success is possible if health organizations and governments continue to try. The Nigerian government, for one is “intensifying its vaccination campaign, pledging six rounds of vaccination over the coming months,” according to the Washington Post.

The WHO also just mounted an urgent vaccination campaign in five African countries to address the recent risk: Chad, Cameroon, Niger, and the Central African Republic. After all, “when it comes to eradication,” Orenstein told National Geographic, “99 percent reduction isn't good enough. It has to be 100 percent. And it's doable.”

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Defeat Poverty

Polio: Why It Hasn’t Been Fully Eradicated — Yet

By Jennifer O'Neill