Calls for a vaccine ceasefire In the wake of discovery of polio in Gaza’s sewage, and the verification of the case of an infant with poliomyelitis, have been erroneously interpreted by some as being politically motivated.
As public health professionals, we welcome the fact that Israel’s government has agreed to organize pauses in the fighting in Gaza for the purpose of carrying out a vaccination campaign for 640,000 Gazan children and that early reports show the campaign has been successful. This follows Israel’s decision to facilitate the transfer of over 280,000 vials of vaccines to Gaza. We fervently hope that the vulnerable Israeli hostages, including two children, will also be included in this humanitarian operation. Appropriately, measures are also underway to protect Israeli soldiers from polio.
Sadly, the politicization of public health is not new. Neither is public mistrust of expert advice from health professionals. The association between war and the risk of infection and contagion has also been known for hundreds of years. It is fallacious to think that these risks are a thing of the past, harking back to the time of Napoleon or to the two world wars. Even in the 21st century, armed conflicts have caused outbreaks of infectious disease, affecting both civilian and military populations.
The conditions of war, including disruptions in water, electricity, and sewage infrastructure, destruction of health facilities and systems, and displacement of large populations, all provide fertile ground for the spread of infection. If, in addition, the supply and administration of vaccines is disrupted, the risk of communicable diseases further increases. These are precisely the circumstances that underlie the current threat of a polio epidemic in Gaza and Israel.
The call for limited ceasefires in order to enable a vaccination campaign is neither exceptional nor political. It is consistent with growing international consensus. In recent decades, vaccination pauses have taken place during conflicts in many areas of the world, including Yemen, Sri Lanka, Afghanistan, Colombia, and El Salvador.
Vaccine pauses won't hurt Israel's war effort
YET, WHILE peace is clearly a fundamental determinant of health, ceasefires for the sake of vaccination have not historically altered the military prosecution of the respective wars or their political outcomes. In fact, Ian Russell and colleagues, from the University of Edinburgh, who compiled a dataset of these pauses (titled Breathing Spaces Report) noted, “In sum, the vaccination ceasefires… appear to be largely distinct and often disconnected from broader attempts to encourage peace negotiations amid armed conflict. The two sets of events and processes seem to serve different functions, aim for very different immediate outcomes, and diverge in their ability and ambition for long-term social and political change.”
Vaccination ceasefires are congruent with a public health worldview combining solidarity with a keen understanding of the risks and benefits of action vs inaction. All the more as the world is, hopefully, in the final stages of polio eradication. Global experience teaches us that vaccination campaigns must be carried out in a comprehensive, multidisciplinary fashion, with great attention to logistics, safety, and speed.
Ceasefires protect health workers, logistics personnel, children, and their families. Without this guarantee of safety, pockets of unvaccinated children will remain, presenting further and ongoing risks to the population both in Gaza and Israel.
Providing conditions that will enable vaccination campaigns not only conforms with a global professional consensus, it is also the view of the Israel Pediatrics, Infectious Diseases, and Public Health Physicians associations, all of which have published clear statements to that effect. These are neither calls from the Left nor the Right. They are professional, humane and values-based appeals with potential benefits to vulnerable Gazans and Israelis alike.
Beyond facilitating vaccination, pauses also enable additional steps, including intensive monitoring of sewage, enhanced access to health services (which can themselves be partially rehabilitated during this time), improvement of sanitary conditions, access to clean water, and attention to other health determinants, including food security, shelter, and housing.
THE CURRENT polio outbreak in Gaza was not inevitable; but it was predictable. Early in the war, in October last year, some of us asked the government to pay heed to potential threats to the public health of our soldiers and the civilian Gazan population, if transfer of basic food, water, and medicine was impeded and sanitary conditions deteriorated. Unfortunately, our forecast has come to pass.
While still in shock at the horrors our country had just experienced, we then wrote to four government ministers, warning about the possibility of infectious disease epidemics: “Our blood boils and our minds are unable to absorb the horrors and crimes perpetrated by the Hamas terrorists… the barbaric crimes… planned and committed.
“The priority is to return the hostages [and provide] physical and psychological treatment for the injured, the survivors, their families, and the many who have been forced to leave their homes. Together with that, as public health professionals concerned with the health of populations, we ask that you ensure the provision of water to the residents of Gaza…” Subsequently, we took a firm stand against the unacceptable notion that epidemics might be a useful option in war.
Our statements were based not only on values but also on professional knowledge that epidemics know no borders. Today, consistent with our previous positions, we fully support the decision to enact humanitarian pauses to facilitate mass vaccination, a crucial public health measure for both Gazans and Israelis. A successful campaign will require international and regional cooperation and community engagement, in order to overcome mistrust.
We also need to begin to think about the “day after,” for the sake of the health of all the citizens in our region, including children on both sides. Those who accuse us of politicizing the issue are voicing a minority opinion, and the burden of proof that they are not motivated by politics is on them.
Also signed on to this article are Orly Manor, Hagit Hochner, Hagai Levine, Dorit Nitzan, Itamar Grotto, A. Mark Clarfield, Manfred Green, and Eldad J Dann. The writers are professors of medicine and public health at various universities in Israel, as well as leaders and members of the Israel Association of Public Health Physicians.