Safia Ibrahim didn’t learn to walk until she was six years old.
The now-37-year-old contracted polio as a baby in Somalia. It wasn’t until she moved to Canada as an eight-year-old child that she received treatment for her disease — leg braces and physical therapy — as there is no cure.
“I used to crawl. I didn’t get to play like the other children,” she said.
Even now, the Toronto mother of three still needs to use crutches or braces if she walks any distance.
Picture polio and you probably picture black-and-white photos of iron lungs and children hobbling in heavy braces. But this isn’t that far in Canada’s past — the country was only declared polio-free in 1994 — and in other parts of the world, polio is still a threat.
But public health experts say it might not be much longer.
“It’s been a bit like a marathon. It’s not a sprint. We’re really near, we’re getting there, but we’re not quite there yet,” said Dr. Anne Pham-Huy, a pediatric infectious disease specialist at the Children’s Hospital of Eastern Ontario (CHEO) and vice-chair of Immunize Canada.
Polio is a viral disease that mostly infects children. Around three-quarters of people who catch it show no symptoms, she said.
Among people who do show symptoms, they’re mostly non-specific things that could be mistaken for a cold or flu: fever, fatigue, nausea. But in about one in every 200 cases, it can cause muscle paralysis — sometimes permanently — or even death should respiratory muscles get paralyzed.
In the 1980s, there were 350,000 cases per year, according to Carol Pandak, director of Rotary International’s polio program. Thanks to concerted efforts and the launch of the Global Polio Eradication Initiative in 1988, there were only 33 cases of wild polio in 2018, in just two countries: Afghanistan and Pakistan.
And just this week, the World Health Organization announced that it had eradicated the second of three poliovirus strains — meaning there’s just one kind of wild polio left.
“We’ve made tremendous progress,” Pandak said. “And perhaps equally as important is that 18 million people who otherwise would have been paralyzed or died from polio are alive or walking today because of the global effort to eradicate polio.”
Health workers travel from door to door, dispensing oral vaccine and marking the pinkie finger of everyone who got the dose, Pandak said. The oral vaccine is easy to dispense and doesn’t have to be administered by a professional, but it has to be given several times in order to confer immunity.
The vaccination programs are often organized into National Immunization Days, she said, where whole countries get their shots at once.
It’s hard, time-consuming work, but Rotary estimates that around 430 million children got vaccinated against polio in 2017 alone.
“The first time you immunize a child against polio in some remote location, it is an extraordinary experience,” Pandak said. “You feel that you and that child are the only two people on the planet.”
She still keeps a photo of her first patient, a little girl in India, in her desk drawer, she said.
Vaccination, even in countries that don’t have “wild polio” circulating in the environment, is still very important, as workers have to contend with another threat: vaccine-derived polio.
Because the oral vaccine contains a weakened virus, vaccinated children can “shed” the virus in their stool, Pham-Huy said. In places with poor sanitation, other people might encounter the virus, and it can mutate after several encounters, potentially becoming dangerous again. If people aren’t properly immunized, they might catch it, she said.
There were 104 such cases of vaccine-derived polio around the world in 2018, according to the World Health Organization, significantly more than cases of wild polio. The Philippines recently embarked on a massive vaccination program as vaccine-derived polio cropped up there.
But experts are careful to note that the vaccine doesn’t cause polio. If everyone was properly vaccinated, they wouldn’t catch the occasional, rare case of vaccine-derived polio.
“It’s an indication of low immunity,” Pandak said.
And it is rare: between 2000 and 2017, more than 10 billion doses of oral vaccine were given out, and there were fewer than 720 vaccine-derived polio cases, according to the World Health Organization.
“We’re talking billions and billions of doses that were provided,” Pham-Huy said. “So this is a very rare risk.”
The injectable vaccine used in Canada doesn’t have any live virus, and so it would be “impossible” for people to catch polio from the vaccine, Pham-Huy said.
Security concerns can make it tricky for workers to visit some areas, and some people also mistrust the polio vaccine.
Ibrahim believes her parents were among them.
“If someone like me existed back then when I was just one-year-old and spoke to my parents regarding vaccination and polio, I don’t think I would have polio today,” she said.
“I’m not here to speak for the parents. I’m just here to speak for that child that cannot speak for itself yet, because I was that child.”
She’s excited by the news that one more polio strain has been eliminated, and she looks forward to celebrating the day when the disease is a thing of the past.
“This disease, polio, we’re about to eradicate it. We’re so close,” she said.
“It’s honestly indescribable because I don’t want another child going through what I’ve gone through.”