Newly Discovered Antibiotic Could Fight One of The Nastiest Superbugs
According to the team, led by researchers from the University of Konstanz in Germany and the University of Vienna in Austria, what makes the newly identified compound so effective is that it launches a self-destruct sequence inside N. gonorrhoeae (also known as gonococci).
The researchers started by looking at a group of alkyl quinolones (AQs), substances that some bacteria use to help trigger attack and defense mechanisms against other bacteria. As well as analyzing these AQs, the team synthesized new variations in the lab.
"One of these new AQ molecules actually did have a unique effect," says cell biologist Christof Hauck, from the University of Konstanz. "The chemical compound was able to kill gonococci without having a negative impact on other microorganisms or human cells."
That chemical compound was 2-nonyl-4-quinolone N-oxide or NQNO, which is taken from the Pseudomonas aeruginosa bacteria. In experiments, it was shown to block the growth of N. gonorrhoeae, stopping the bug in its tracks.
More specifically, NQNO stops the electron transport chain inside gonococci, an essential part of the energy production process in cells. That then leads to increased stress on the bacteria, which causes one of its own toxins to appear and kill itself off.
Even better, tests run by the researchers show that the compound doesn't harm some other, beneficial bacteria that can be found in the body. In mice models, the NQNO treatment was shown to be effective against gonorrhea, and the researchers were also able to create a more potent and effective version of it with some chemical engineering.
"From other microorganisms, we know about such self-destruction programs based on toxin-antitoxin systems, and our AQ substance seems to precisely target this Achilles heel of gonococci," says microbiologist Ann-Kathrin Mix, from the University of Konstanz.
N. gonorrhoeae is infamous enough that it's found a place on the Bacterial Priority Pathogens List put together by the World Health Organization (WHO), a 15-strong rogues gallery of the most dangerous superbugs.
Part of the challenge in combating it is that it has a special superpower: being able to pick and choose genetic material from other microbes that the bacteria comes into contact with, including genes that promote antibiotic resistance.
Work continues to combat gonorrhea and the tens of millions of infections it causes globally every year, and while it's still early days for this new treatment possibility, it could help us stay ahead of the rapidly evolving defenses of N. gonorrhoeae.
"Gonococci are notorious for quickly becoming resistant to antibiotics," says microbial biochemist Thomas Böttcher, from the University of Vienna.
"This is one of the reasons why gonococcal strains have recently emerged that are resistant to all antibiotics currently in use – such superbugs can no longer be treated with antibiotics."
The research has been published in Nature Microbiology.
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3 hours ago
Polio nearly beaten, but fake records, weak vaccine and missteps fuel its return
KARACHI, Pakistan -- For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids. Amid rampant misinformation and immense pressure for the campaign to succeed, Ayaz said, some managers have instructed workers to falsely mark children as immunized. And the vaccines, which must be kept cold, aren't always stored correctly, she added. 'In many places, our work is not done with honesty,' Ayaz said. The World Health Organization and partners embarked on their polio campaign in 1988 with the bold goal of eradication — a feat seen only once for human diseases, with smallpox in 1980. They came close several times, including in 2021, when just five cases of the natural virus were reported in Pakistan and Afghanistan. But since then, cases rebounded, hitting 99 last year, and officials have missed at least six self-imposed eradication deadlines. Afghanistan and Pakistan remain the only countries where transmission of polio — which is highly infectious, affects mainly children under 5, and can cause irreversible paralysis within hours -- has never been interrupted. The worldwide campaign has focused most of its attention and funding there for the past decade. But in its quest to eliminate the disease, the Global Polio Eradication Initiative has been derailed by mismanagement and what insiders describe as blind allegiance to an outdated strategy and a problematic oral vaccine, according to workers, polio experts and internal materials obtained by The Associated Press. Officials have falsified vaccination records, selected unqualified people to dole out drops, failed to send out teams during mass campaigns, and dismissed concerns about the oral vaccine sparking outbreaks, according to documents shared with AP by staffers from GPEI – one of the largest and most expensive public health campaigns in history, with over $20 billion spent and nearly every country in the world involved. In Afghanistan and Pakistan – which share a border, harbor widespread mistrust of vaccines, and have weakened healthcare systems and infrastructure – local staffers like Ayaz have for years flagged problems to senior managers. But those issues, along with concerns by staffers and outside health officials, have long gone unaddressed, insiders say. Officials tout the successes – 3 billion children vaccinated, an estimated 20 million people who would have been paralyzed spared – while acknowledging challenges in Pakistan and Afghanistan. Remote villages are hard to reach, some cultural and religious authorities instruct against vaccination, and hundreds of polio workers and security staff have been killed because of their alignment with a Western-led initiative. Dr. Jamal Ahmed, WHO's polio director, defended progress in those two countries, citing workers' tailored response in resistant pockets. 'There's so many children being protected today because of the work that was done over the past 40 years,' he said. 'Let's not overdramatize the challenges, because that leads to children getting paralyzed.' Ahmed said he believes authorities will end the spread of polio in the next 12 to 18 months. Its latest goal for eradication is 2029. The campaign says about 45 million children in Pakistan and 11 million in Afghanistan must be vaccinated this year. Children typically need four doses of two drops each to be considered fully immunized. Dr. Zulfiqar Bhutta, who has served on advisory groups for WHO, the Gates Foundation and others, said campaign officials should listen to the criticism of its tactics. 'Continuing blindly with the same strategies that we have relied on since eradication began is unlikely to lead to a different result,' he said. Internal WHO reports reviewing vaccination drives in Afghanistan and Pakistan over the past decade – given to AP by current and former staffers – show that as early as 2017, local workers were alerting significant problems to senior managers. The documents flagged multiple cases of falsified vaccination records, health workers being replaced by untrained relatives and workers improperly administering vaccines. On numerous occasions, WHO officials noted, 'vaccinators did not know about vaccine management,' citing failure to keep doses properly cold. They also found sloppy or falsified reporting, with workers noting 'more used vaccine vials than were actually supplied.' According to an August 2017 report from Kandahar, Afghanistan, local government authorities and others interfered in choosing vaccinators, 'resulting in the selection of underage and illiterate volunteers.' Vaccination teams worked 'in a hurried manner,' reports said, with 'no plan for monitoring or supervision.' A team in Nawzad, Afghanistan, covered just half of the intended area in 2017, with 250 households missed entirely. Village elders said no one visited for at least two years. Vaccine workers and health officials in Afghanistan and Pakistan confirmed the issues in the documents and told AP it's hard for campaign leadership to grasp the difficulties in the field. Door-to-door efforts are stymied by cultural barriers, unfounded stories about vaccines, and the region's poverty and transience. 'Most of the time when we go to vaccinate and knock on the door, the head of the house or the man is not at home,' said one worker, speaking on condition of anonymity because they weren't authorized to talk to the press. 'Many people find it offensive that a stranger knocks on the door and talks to a woman.' Some workers find families have moved. Occasionally, they say, the encounter abuse. 'We have shared these problems with our senior officials,' the worker told AP. 'They know about it.' In an email response to AP's questions about officials' knowledge of the issues, WHO polio director Ahmed noted 'operational challenges' in Afghanistan and Pakistan and said the program has 'robust monitoring and evaluation processes.' Worker Ayaz described 'fake finger marking' — placing the ink used to show a child is vaccinated on their pinky even when no vaccine has been given. 'There is so much pressure,' Ayaz said. Before the first polio vaccine was developed in 1955, the disease — spread mostly from person to person, through contaminated water and via fecal particles — was among the world's most feared, paralyzing hundreds of thousands of children annually. People avoided crowded places during epidemics, and hospital wards filled with children encased in iron lungs after the virus immobilized their breathing muscles. Polio is mainly spread when people are exposed to water infected with the virus. In countries with poor sanitation, children often become infected when they come into contact with contaminated waste. WHO says that as long as a single child remains infected, kids everywhere are at risk. Eradication demands near-perfection – zero polio cases and immunizing more than 95% of children. But public health leaders and former WHO staffers say campaign efforts are far from perfect, and many question the oral vaccine. The oral vaccine – proven to be safe and effective — has been given to more than 3 billion children. But there are some extremely rare side effects: Scientists estimate that for every 2.7 million first doses given, one child will be paralyzed by the live polio virus in the vaccine. In even rarer instances, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low. Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year. Most public health experts agree the oral vaccine should be pulled as soon as possible. But they acknowledge there simply isn't enough injectable vaccine — which uses no live virus and doesn't come with the risks of the oral vaccine — to wipe out polio alone. The injectable vaccine also is more expensive and requires more training to administer. More than two dozen current and former senior polio officials told AP the agencies involved haven't been willing to even consider revising their strategy to account for some of the campaign's problems. Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention who sits on an independent board reviewing polio eradication, said it would be impossible to eliminate polio without the oral vaccine. But he's urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly. Since 2011, he and colleagues have issued regular reports about overall program failures. 'There's no management,' he said, citing a lack of accountability. Last year, former WHO scientist Dr. T. Jacob John twice emailed WHO Director-General Tedros Adhanom Ghebreyesus calling for a 'major course correction.' John shared the emails with AP and said he's received no response. 'WHO is persisting with polio control and creating polio with one hand and attempting to control it by the other,' John wrote. In his response to AP, WHO polio director Ahmed said the oral vaccine is a 'core pillar' of eradication strategy and that 'almost every country that is polio-free today used (it) to achieve that milestone.' 'We need to step back and really care for the people,' he said. 'The only way we can do that in large parts of the world is with oral polio vaccine.' Ahmed also pointed to the success WHO and partners had eliminating polio from India, once considered a nearly impossible task. In the four years before polio was wiped out there, health workers delivered about 1 billion doses of the oral vaccine to more than 170 million children. Today, nearly all of the world's polio cases -- mostly in Africa and the Middle East -- are mutated viruses from the oral vaccine, except for Afghanistan and Pakistan. Scott Barrett, a Columbia University professor, called for an inquiry into how things went so wrong – particularly with a failed effort in 2016, when authorities removed a strain from the oral vaccine. They miscalculated, leading to outbreaks in more than 40 countries that paralyzed more than 3,000 children, according to an expert report commissioned by WHO. Last year, a mutated virus traced to that effort paralyzed a baby in Gaza. 'Unless you have a public inquiry where all the evidence comes out and WHO makes serious changes, it will be very hard to trust them,' he said. With an annual budget of about $1 billion, the polio initiative is among the most expensive in all of public health. This year, the U.S. withdrew from WHO, and President Donald Trump has cut foreign aid. WHO officials have privately admitted that sustaining funding would be difficult without success. Some say the money would be better spent on other health needs. 'We have spent more than $1 billion (in external polio funding) in the last five years in Pakistan alone, and it didn't buy us any progress,' said Roland Sutter, who formerly led polio research at WHO. 'If this was a private company, we would demand results.' Villagers, too, have protested the cost, staging hundreds of boycotts of immunization campaigns since 2023. Instead of polio vaccines, they ask for medicine, food and electricity. In Karachi, locals told AP they didn't understand the government's fixation on polio and complained of other issues — dirty water, heroin addiction. Workers are accompanied by armed guards; Pakistani authorities say more than 200 workers and police assigned to protect them have been killed since the 1990s, mostly by militants. The campaign also is up against a wave of misinformation, including that the vaccine is made from pig urine or will make children reach puberty early. Some blame an anti-vaccine sentiment growing in the U.S. and other countries that have largely funded eradication efforts and say it's reaching even remote areas of Afghanistan and Pakistan. In suburban southwest Pakistan, Saleem Khan, 58, said two grandchildren under 5 were vaccinated over his family's objections. 'It results in disability,' said Khan, without citing evidence for his belief. 'They are vaccinated because officials reported our refusal to authorities and the police.' Svea Closser, professor of international health at Johns Hopkins University, said Pakistan and Afghanistan were less resistant to immunization decades ago. Now, people are angry about the focus on polio and lack of help for diseases like measles or tuberculosis, she said, spurring conspiracy theories. 'Polio eradication has created a monster,' Closser said. It doesn't help, she added, that in this region, public trust in vaccine campaigns was undermined when the CIA organized a fake hepatitis drive in 2011 in an attempt to get DNA and confirm the presence of Osama bin Laden or his family. Workers see that continued mistrust every day. In a mountainous region of southeastern Afghanistan where most people survive by growing wheat and raising cows and chickens, a mother of five said she'd prefer that her children be vaccinated against polio, but her husband and other male relatives have instructed their families to reject it. They believe the false rumors that it will compromise their children's fertility. 'If I allow it,' the woman said, declining to be named over fears of family retribution, 'I will be beaten and thrown out.' _____ Cheng reported from London.
San Francisco Chronicle
4 hours ago
- San Francisco Chronicle
Takeaways from AP's report on problems in the worldwide campaign to eradicate polio
KARACHI, Pakistan (AP) — For nearly four decades, the World Health Organization and partners have been trying to rid the world of polio, a paralytic disease that has existed since prehistoric times. While cases have dropped more than 99%, polio remains entrenched in parts of Afghanistanand Pakistan. In its quest to eliminate the virus, WHO and its partners in the Global Polio Eradication Initiative have been derailed by mismanagement and what insiders describe as blind allegiance to an outdated strategy and a problematic oral vaccine, according to workers, polio experts and internal materials obtained by the Associated Press. Officials tout the successes – 3 billion children vaccinated, an estimated 20 million people who would have been paralyzed spared – while acknowledging challenges in Pakistan and Afghanistan. WHO polio director Dr. Jamal Ahmed defended progress in those two countries, citing workers' tailored response in resistant pockets. Here are some takeaways from AP's report on what's happened in one of the most expensive efforts in all of public health. Documents show major problems on polio vaccination teams Internal WHO reports reviewing polio immunization in Afghanistan and Pakistan over the past decade — given to AP by current and former staffers — show that as early as 2017, local workers were alerting problems to senior managers. The documents flagged multiple cases of falsified vaccination records, health workers being replaced by untrained relatives and workers improperly administering vaccines. On numerous occasions, WHO officials noted, 'vaccinators did not know about vaccine management,' citing failure to keep doses properly cold. They also found sloppy or falsified reporting, with workers noting 'more used vaccine vials than were actually supplied.' According to an August 2017 report from Kandahar, Afghanistan, vaccination teams worked 'in a hurried manner,' reports said, with 'no plan for monitoring." A team in Nawzad, Afghanistan, covered just half of the intended area in 2017, with 250 households missed entirely. Village elders said no one visited for at least two years. Polio workers say problems have gone unaddressed Health officials in Afghanistan and Pakistan told AP their efforts to vaccinate children are often stymied by cultural barriers, misinformation about the vaccines, and poverty. Sughra Ayaz has traveled door to door in southeastern Pakistan for the past decade, pleading for children to be immunized. Some families demand basics such as food and water instead of vaccines. Others, without citing proof for their beliefs, repeat false rumors and say they think the oral vaccine doses are meant to sterilize their kids. Ayaz said that given the immense pressure for the campaign to succeed, some managers have instructed workers to falsely mark children as immunized 'In many places, our work is not done with honesty,' she said. Some scientists blame the oral vaccine Polio eradication demands perfection — zero polio cases and immunizing more than 95% of children. But some scientists and former WHO staffers say the campaign's efforts are far from perfect, blaming in particular the oral vaccine. It's safe and effective, but in very rare instances, the live virus in the oral vaccine can paralyze a child. In even rarer cases, the virus can mutate into a form capable of starting outbreaks among unimmunized people where vaccination rates are low. Except for Afghanistan and Pakistan, most polio cases worldwide are linked to the vaccine; several hundred cases have been reported annually since 2021, with at least 98 this year. Most public health experts agree the oral vaccine should be pulled as soon as possible. But they acknowledge there isn't enough injectable vaccine — which uses no live virus and doesn't come with the risks of the oral vaccine — to eliminate polio alone. The injectable vaccine is more expensive and requires more training to administer. More than two dozen current and former senior polio officials told AP the agencies involved haven't been willing to even consider revising their strategy to account for campaign problems. Last year, former WHO scientist Dr. T. Jacob John twice emailed WHO Director-General Tedros Adhanom Ghebreyesus calling for a 'major course correction.' John wrote that 'WHO is persisting with polio control and creating polio with one hand and attempting to control it by the other.' Ahmed told AP the oral vaccine is a 'core pillar' of eradication strategy and that 'almost every country that is polio-free today used (it) to achieve that milestone.' Critics say there's no accountability Dr. Tom Frieden, who sits on an independent board reviewing polio eradication, said he and colleagues have urged WHO and partners to adapt to obstacles in Afghanistan and Pakistan. Since 2011, the board has issued regular reports about program failures, but had little impact. 'There's no management,' he said. With an annual budget of about $1 billion, polio eradication is among the most expensive initiatives in public health. WHO officials have privately admitted that sustaining funding will be difficult without signs of progress. Roland Sutter, who previously headed polio research at WHO, said donors had spent more than $1 billion in Pakistan trying to get rid of polio in the last five years — and made little progress. 'If this was a private company, we would demand results," he said. Ahmed pointed to the program's many successes. "Let's not overdramatize the challenges, because that leads to children getting paralyzed,' he said. Mistrust of the vaccine persists Vaccine workers and health officials say it's hard for campaign leadership to grasp the difficulties in the field. Door-to-door efforts are stymied by cultural barriers, unfounded stories about vaccines, and the region's poverty and transience. The campaign is up against a wave of misinformation, including that the vaccine is made from pig urine or will make children reach puberty early. Some blame an anti-vaccine sentiment growing in the U.S. and other countries that have largely funded eradication efforts. In a mountainous region of southeastern Afghanistan where most people survive by growing wheat and raising cows and chickens, many are wary of the Western-led initiative. A mother of five said she'd prefer that her children be vaccinated against polio, but her husband and other male relatives have instructed their families to reject it, fearing it will compromise their children's fertility. 'If I allow it,' the woman said, declining to be named over fears of family retribution, 'I will be beaten and thrown out.' Cheng reported from London.
Boston Globe
4 hours ago
- Boston Globe
The world nearly beat polio. But fake records, an imperfect vaccine, and missteps aided its comeback.
The World Health Organization and partners embarked on their polio campaign in 1988 with the bold goal of eradication — a feat seen only once for human diseases, with smallpox in 1980. They came close several times, including in 2021, when just five cases of the natural virus were reported in Pakistan and Afghanistan. But since then, cases rebounded, hitting 99 last year, and officials have missed at least six self-imposed eradication deadlines. Afghanistan and Pakistan remain the only countries where transmission of polio — which is highly infectious, affects mainly children under 5, and can cause irreversible paralysis within hours -- has never been interrupted. The worldwide campaign has focused most of its attention and funding there for the past decade. Advertisement But in its quest to eliminate the disease, the Global Polio Eradication Initiative has been derailed by mismanagement and what insiders describe as blind allegiance to an outdated strategy and a problematic oral vaccine, according to workers, polio experts and internal materials obtained by The Associated Press. Advertisement Officials have falsified vaccination records, selected unqualified people to dole out drops, failed to send out teams during mass campaigns, and dismissed concerns about the oral vaccine sparking outbreaks, according to documents shared with AP by staffers from GPEI – one of the largest and most expensive public health campaigns in history, with over $20 billion spent and nearly every country in the world involved. In Afghanistan and Pakistan – which share a border, harbor widespread mistrust of vaccines, and have weakened healthcare systems and infrastructure – local staffers like Ayaz have for years flagged problems to senior managers. But those issues, along with concerns by staffers and outside health officials, have long gone unaddressed, insiders say. Officials tout the successes – 3 billion children vaccinated, an estimated 20 million people who would have been paralyzed spared – while acknowledging challenges in Pakistan and Afghanistan. Remote villages are hard to reach, some cultural and religious authorities instruct against vaccination, and hundreds of polio workers and security staff have been killed because of their alignment with a Western-led initiative. Dr. Jamal Ahmed, WHO's polio director, defended progress in those two countries, citing workers' tailored response in resistant pockets. 'There's so many children being protected today because of the work that was done over the past 40 years,' he said. 'Let's not overdramatize the challenges, because that leads to children getting paralyzed.' Ahmed said he believes authorities will end the spread of polio in the next 12 to 18 months. Its latest goal for eradication is 2029. The campaign says about 45 million children in Pakistan and 11 million in Afghanistan must be vaccinated this year. Children typically need four doses of two drops each to be considered fully immunized. Advertisement Dr. Zulfiqar Bhutta, who has served on advisory groups for WHO, the Gates Foundation and others, said campaign officials should listen to the criticism of its tactics. 'Continuing blindly with the same strategies that we have relied on since eradication began is unlikely to lead to a different result,' he said. Documents show yearslong problems on polio vaccination teams Internal WHO reports reviewing vaccination drives in Afghanistan and Pakistan over the past decade – given to AP by current and former staffers – show that as early as 2017, local workers were alerting significant problems to senior managers. The documents flagged multiple cases of falsified vaccination records, health workers being replaced by untrained relatives and workers improperly administering vaccines. On numerous occasions, WHO officials noted, 'vaccinators did not know about vaccine management,' citing failure to keep doses properly cold. They also found sloppy or falsified reporting, with workers noting 'more used vaccine vials than were actually supplied.' According to an August 2017 report from Kandahar, Afghanistan, local government authorities and others interfered in choosing vaccinators, 'resulting in the selection of underage and illiterate volunteers.' Vaccination teams worked 'in a hurried manner,' reports said, with 'no plan for monitoring or supervision.' A team in Nawzad, Afghanistan, covered just half of the intended area in 2017, with 250 households missed entirely. Village elders said no one visited for at least two years. Vaccine workers and health officials in Afghanistan and Pakistan confirmed the issues in the documents and told AP it's hard for campaign leadership to grasp the difficulties in the field. Door-to-door efforts are stymied by cultural barriers, unfounded stories about vaccines, and the region's poverty and transience. Advertisement 'Most of the time when we go to vaccinate and knock on the door, the head of the house or the man is not at home,' said one worker, speaking on condition of anonymity because they weren't authorized to talk to the press. 'Many people find it offensive that a stranger knocks on the door and talks to a woman.' Some workers find families have moved. Occasionally, they say, the encounter abuse. 'We have shared these problems with our senior officials,' the worker told AP. 'They know about it.' In an email response to AP's questions about officials' knowledge of the issues, WHO polio director Ahmed noted 'operational challenges' in Afghanistan and Pakistan and said the program has 'robust monitoring and evaluation processes.' Worker Ayaz described 'fake finger marking' — placing the ink used to show a child is vaccinated on their pinky even when no vaccine has been given. 'There is so much pressure,' Ayaz said. Critics point to continued use of the oral polio vaccine Before the first polio vaccine was developed in 1955, the disease — spread mostly from person to person, through contaminated water and via fecal particles — was among the world's most feared, paralyzing hundreds of thousands of children annually. People avoided crowded places during epidemics, and hospital wards filled with children encased in iron lungs after the virus immobilized their breathing muscles. Polio is mainly spread when people are exposed to water infected with the virus. In countries with poor sanitation, children often become infected when they come into contact with contaminated waste. Advertisement WHO says that as long as a single child remains infected, kids everywhere are at risk. Eradication demands near-perfection – zero polio cases and immunizing more than 95% of children. But public health leaders and former WHO staffers say campaign efforts are far from perfect, and many question the oral vaccine. The oral vaccine – proven to be safe and effective — has been given to more than 3 billion children. But there are some extremely rare side effects: Scientists estimate that for every 2.7 million first doses given, one child will be paralyzed by the live polio virus in the vaccine. In even rarer instances, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low. Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year. Most public health experts agree the oral vaccine should be pulled as soon as possible. But they acknowledge there simply isn't enough injectable vaccine — which uses no live virus and doesn't come with the risks of the oral vaccine — to wipe out polio alone. The injectable vaccine also is more expensive and requires more training to administer. More than two dozen current and former senior polio officials told AP the agencies involved haven't been willing to even consider revising their strategy to account for some of the campaign's problems. Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention who sits on an independent board reviewing polio eradication, said it would be impossible to eliminate polio without the oral vaccine. But he's urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly. Since 2011, he and colleagues have issued regular reports about overall program failures. Advertisement 'There's no management,' he said, citing a lack of accountability. Last year, former WHO scientist Dr. T. Jacob John twice emailed WHO Director-General Tedros Adhanom Ghebreyesus calling for a 'major course correction.' John shared the emails with AP and said he's received no response. 'WHO is persisting with polio control and creating polio with one hand and attempting to control it by the other,' John wrote. In his response to AP, WHO polio director Ahmed said the oral vaccine is a 'core pillar' of eradication strategy and that 'almost every country that is polio-free today used (it) to achieve that milestone.' 'We need to step back and really care for the people,' he said. 'The only way we can do that in large parts of the world is with oral polio vaccine.' Ahmed also pointed to the success WHO and partners had eliminating polio from India, once considered a nearly impossible task. In the four years before polio was wiped out there, health workers delivered about 1 billion doses of the oral vaccine to more than 170 million children. Today, nearly all of the world's polio cases -- mostly in Africa and the Middle East -- are mutated viruses from the oral vaccine, except for Afghanistan and Pakistan. Scott Barrett, a Columbia University professor, called for an inquiry into how things went so wrong – particularly with a failed effort in 2016, when authorities removed a strain from the oral vaccine. They miscalculated, leading to outbreaks in more than 40 countries that paralyzed more than 3,000 children, according to an expert report commissioned by WHO. Last year, a mutated virus traced to that effort paralyzed a baby in Gaza. 'Unless you have a public inquiry where all the evidence comes out and WHO makes serious changes, it will be very hard to trust them,' he said. Mistrust of the polio eradication effort persists With an annual budget of about $1 billion, the polio initiative is among the most expensive in all of public health. This year, the U.S. withdrew from WHO, and President Donald Trump has cut foreign aid. WHO officials have privately admitted that sustaining funding would be difficult without success. Some say the money would be better spent on other health needs. 'We have spent more than $1 billion (in external polio funding) in the last five years in Pakistan alone, and it didn't buy us any progress,' said Roland Sutter, who formerly led polio research at WHO. 'If this was a private company, we would demand results.' Villagers, too, have protested the cost, staging hundreds of boycotts of immunization campaigns since 2023. Instead of polio vaccines, they ask for medicine, food and electricity. In Karachi, locals told AP they didn't understand the government's fixation on polio and complained of other issues — dirty water, heroin addiction. Workers are accompanied by armed guards; Pakistani authorities say more than 200 workers and police assigned to protect them have been killed since the 1990s, mostly by militants. The campaign also is up against a wave of misinformation, including that the vaccine is made from pig urine or will make children reach puberty early. Some blame an anti-vaccine sentiment growing in the U.S. and other countries that have largely funded eradication efforts and say it's reaching even remote areas of Afghanistan and Pakistan. In suburban southwest Pakistan, Saleem Khan, 58, said two grandchildren under 5 were vaccinated over his family's objections. 'It results in disability,' said Khan, without citing evidence for his belief. 'They are vaccinated because officials reported our refusal to authorities and the police.' Svea Closser, professor of international health at Johns Hopkins University, said Pakistan and Afghanistan were less resistant to immunization decades ago. Now, people are angry about the focus on polio and lack of help for diseases like measles or tuberculosis, she said, spurring conspiracy theories. 'Polio eradication has created a monster,' Closser said. It doesn't help, she added, that in this region, public trust in vaccine campaigns was undermined when the CIA organized a fake hepatitis drive in 2011 in an attempt to get DNA and confirm the presence of Osama bin Laden or his family. Workers see that continued mistrust every day. In a mountainous region of southeastern Afghanistan where most people survive by growing wheat and raising cows and chickens, a mother of five said she'd prefer that her children be vaccinated against polio, but her husband and other male relatives have instructed their families to reject it. They believe the false rumors that it will compromise their children's fertility. 'If I allow it,' the woman said, declining to be named over fears of family retribution, 'I will be beaten and thrown out.' Cheng reported from London.
