Can Polio Be Eradicated?

Here's a nice little article from the New York Times a couple of years ago that talks about whether polio really can be eradicated and, in particular, about how one expert, Donald Henderson, who worked on the eradication of smallpox has changed his mind. What caused this change of opinion was a conversation with another of the smallpox team Dr. Ciro de Quadros

While nothing has changed about the virus or the vaccine, several things Dr. de Quadros told him were persuasive, he said.

“I was unaware of how committed Gates is,” he said. “He’s saying polio is his No. 1 priority.”

I like the anecdote about Dr de Quadros's work in the field during the smallpox campaign:

“I watched him perform in Ethiopia,” said Dr. Henderson, who recruited Dr. de Quadros into the smallpox campaign. “The obstacles were unbelievable — the emperor assassinated, two revolutionary groups fighting, nine of his own teams kidnapped, even a helicopter captured and held for ransom. He kept the teams in the field — and that helicopter pilot went out and vaccinated all the rebels.”

Why polio hasn't gone away yet

Polio was on the CNN home page yesterday with an article entitled Why polio hasn't gone away yet.

The World Health Organization has an action plan for the next 18 months that could very well lead to eradication, says Oliver Rosenbauer, spokesman for polio efforts at the organization.

But there's a $945 million funding gap, he said. Already, polio immunization activities in 24 countries have been cut this year.

And then there are logistical issues of getting vaccines to the children who need them most.
There's an Opinion piece too by Dr. Muhammad Ali Pate and Dr. Christopher Elias: Don't fall at the finish line in the race to eradicate polio. Dr. Pate is Minister of State for Health in Nigeria and Dr. Elias is president of Global Development at the Bill & Melinda Gates Foundation.

As public health practitioners and as parents, we believe that every child, no matter whether they were born in a U.S. hospital or a hut in Nigeria, deserve to be protected from this preventable disease. And we believe that because eradicating polio is something that benefits us all, we all share in the responsibility to make that happen.

Vaccination then and now

As I mentioned in an earlier class vaccines become victims of their own success. As the diseases they cause become rare and fade from our memory we tend to focus on the possible side effects of the vaccine - sometimes real, sometimes imagined.

However when the actual disease in in your neighborhood, crippling and paralyzing children then you queue around the block to get your child their vaccination shot.

One fact I didn't mention in lecture was that neither Jonas Salk nor Albert Sabin (who invented the oral polio vaccine) patented their vaccines - they donated the rights as gifts to humanity. In fact there's a fairly famous story about Jonas Salk, who worked at the University of Pittsburgh, being asked by a reporter “Who owns your polio vaccine?” On hearing the question, Dr. Salk looked at the reporter and said “Who owns my polio vaccine? The people! Could you patent the sun?”

Polio at the Smithsonion

Thanks to a link from Clark I discovered that the Smithsonian National Museum of American History has a fantastic online exhibition about Polio.

I think they've done a great job with a nice combination of text, pictures and audiovisual material. In addition to the direct impact of the disease itself it is interesting to read how the large number of disabilities caused by it led to fundamental changes in the way that the disabled were treated in this country.

“Before Mom found an opportunity to go down to the grade school office to register me, three members of the school board came to visit us …. ‘It has been brought to my attention that you folks have a son in a wheelchair. It is our duty to inform you he will be unable to attend school….’”
—Don Kirkendall, 1973

India celebrates a milestone

New Delhi, Feb. 25 2012: The World Health Organisation has deleted India from its list of polio endemic countries, acknowledging the absence of any new instance of illness caused by the wild polio virus for more than a year since a child was diagnosed with the disease in Howrah in January 2011.

“This is the first time in history we’re able to put up a map like this one,” Bruce Aylward, an assistant director-general for polio in the WHO, told a conference here today. He presented a map displaying polio cases over the past year in Africa, Pakistan, Afghanistan and China but none in India.

Indian health authorities had recorded 741 patients paralysed by the wild polio virus in 2009 and 42 patients in 2010, but have detected no new patients since January 2011.

“But the big risk is to think we’ve finished,” Aylward said. India will need to remain free of any paralysis caused by the wild polio virus for three years from the last case before it can seek WHO certification for having eradicated polio — in January 2014.

Recall that because there may be 100 cases of mild, subclinical,  polio for each diagnosed case then India may have had dozens of cases of Polio last year. That's not to say that this isn't a big step in the right direction - just that surveillance and vaccination need to remain high and the presence of endemic polio in Afghanistan and Pakistan will always threaten India until those countries too can establish her immunity and eradicate this disease.

Following this vaccination success India is now looking to eradicate measles and tetanus.

Polio - a miscellany

We didn't have much time to talk about polio but if you'd like to know more here are some polio related items culled from past posts. 

Polio in comic book form

The story of Polio in comic book form. by James Weldon, a journalism student at the University of British Columbia. Learn the full story from the polio virus itself as it tells all in a group therapy session for 'diseases nearing extinction' with smallpox, guinea worm and leprosy. Lots of little jokes in here and a surprising amount of information.

Iron Lungs

When people are nostalgic for the 'simpler' times of the 1950's (after the war but before the turbulence of the sixties) they usually conveniently forget about horrors such as polio and iron lungs. These days many people probably only think of an iron lung as a Radiohead song, and even then many people miss the metaphor - something that keeps you alive but becomes very restrictive.


I am amazed by people who have lived their whole lives in them but have remained cheerful and happy. As well as the story about John Prestwich there is also the story of Martha Mason who has lived in an iron lung for over 60 years.

(A)s one of the few surviving people left who live their lives encased in an iron tank, she said she intends to continue as she always has -- making the most out of what life has offered her.
"Get as much joy from life for yourself and others as you can squeeze out of it," she said.

Polio eradication - is it worth it?

Check out this New York Times article about Polio eradication that contains some interesting comments about Bill Gates funding for the initiative in particular:

The effort has now cost $9 billion, and each year consumes another $1 billion. By contrast, the 14-year drive to wipe out smallpox cost only $500 million in today’s dollars. 

“Bill Gates’s obsession with polio is distorting priorities in other ... areas. Global health does not depend on polio eradication.” 

Bin Laden vaccination Ruse

There's a fairly factual report in the New York Times, Vaccination Ruse Used in Pursuit of Bin Laden, but they miss the serious implications of this that are discussed in this post at Wired, File Under WTF: Did the CIA Fake a Vaccination Campaign?

This is awful. It plays, so precisely that it might have been scripted, into the most paranoid conspiracy theories about vaccines: that they are pointless, poisonous, covert shields for nefarious government agendas meant to do children harm.

Polio

The report of the 30 June - 1 July meeting of the Independent Monitoring Board (IMB) report has been released. Although affirming that polio eradication can be achieved in the near-term, the IMB states that 'this will not happen if things continue as they are'. 

You can read the latest about the global battle to eradicate polio at the Global Eradication Initiative website.

For a contrary view check out this New York Times article about Polio eradication that contains some interesting comments about Bill Gates funding for the initiative in particular:

The effort has now cost $9 billion, and each year consumes another $1 billion. By contrast, the 14-year drive to wipe out smallpox cost only $500 million in today’s dollars. 

“Bill Gates’s obsession with polio is distorting priorities in other ... areas. Global health does not depend on polio eradication.” 

More iron lungs

When people are nostalgic for the 'simpler' times of the 1950's (after the war but before the turbulence of the sixties) they usually conveniently forget about horrors such as polio and iron lungs. These days many people probably only think of an iron lung as a Radiohead song, and even then many people miss the metaphor - something that keeps you alive but becomes very restrictive.

I am amazed by people who have lived their whole lives in them but have remained cheerful and happy. As well as the story below about John Prestwich there is also the story of Martha Mason who has lived in an ironlung for over 60 years.

(A)s one of the few surviving people left who live their lives encased in an iron tank, she said she intends to continue as she always has -- making the most out of what life has offered her.
"Get as much joy from life for yourself and others as you can squeeze out of it," she said.

Polio: a virus' struggle

The story of Polio in comic book form. by James Weldon, a journalism student at the University of British Columbia. Learn the full story from the polio virus itself as it tells all in a group therapy session for 'diseases nearing extinction' with smallpox, guinea worm and leprosy. Lots of little jokes in here and a surprising amount of information. Enjoy.

Iron Lung

Although Radiohead used the Iron Lung as a metaphor for how something can both keep you alive and be highly restrictive I'm not sure how many people today have heard of them or are aware of just how widespread they once were (I mean Iron lungs, not Radiohead). Fortunately the Iron Lung exhibit at the University of Virginia will tell you virtually everything you need to know. Don't miss the designs to build your own!

The demise of the iron lung is due to both the decline of polio and also the use positive pressure ventilation using endotracheal tubes.

Although the iron lung now appears almost medieval in appearance it is important to note that for long term use (that polio patients with paralysis would require) the iron lung leaves you able to talk, eat and drink normally which is not the case with tracheal intubation. (Not to mention that intubation is an invasive procedure with associated risks of nosocomial infection).

Global Polio Eradication

Keep track of the battle against Polio at polioeradication.org. This is where you can find a weekly update, maps, and numerous interesting reports and documents. I found this report interesting because it really brought home the magnitude of the task:

In the teeming streets of Uttar Pradesh, ensuring each of the estimated 38 million children in India's most populous state is immunized remains one of the global polio eradication initiative's greatest challenges. Here, more than 400,000 children are born every month and until recently, up to half those names were not making it onto the official government registry.

Week by week, mobile polio immunization teams, which literally walk from house to house throughout Uttar Pradesh to ensure blanket immunization coverage, continue to find unregistered, unimmunized newborns. These infants are not only susceptible to contracting polio; they also act as a reservoir for the virus to survive in the community and make for inaccurate immunization coverage figures.

Polio eradication

–Polio eradication will hopefully happen within the next few years. You can track developments at the WHO website. The eradication of polio will be a big step for global healthcare: it will demonstrate that smallpox was not a unique case, and that with cooperation, funding and willpower diseases can be defeated. More importantly the eradication of polio will then free up resources to tackle other diseases. There are only a limited number of resources, and hopefully when polio is gone they can be directed towards other diseases like measles, guinea worm and trypanosomiasis.

As I mentioned, a polio vaccine was only available in the 1950's. The World Health Organization estimates that there are 10 to 20 million polio survivors worldwide and, as one of the largest disabled groups in the world, polio survivors helped to advance the modern disability rights movement. Wikipedia has an interesting list of famous polio survivors.

Some more on that Nigerian Polio Vaccination Ban...

The map to the left displays the territory size as a proportion of the worldwide polio cases from 2000 to 2005. The reason for the overwhelming amount of polio cases in Nigeria? The Nigerian Muslims boycott of the Polio Vaccine. The boycott began in the northern Islamic state of Kano in Nigeria and other Nigerian states quickly followed suit. Kano state officials have insisted that the vaccine is unhealthy based on the fact that in 2003, Nigerian health experts found estrogen and other female sex hormones in the vaccine. They claim this vaccination effort to be a U.S. plot to spread AIDS and infertility. As the boycott continues, polio cases have been reported in 7 other African countries where it was previously believed to be eradicated.