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One day soon, perhaps in the next 90 to 180 days, a toddler in Pakistan or Afghanistan, let’s call her Aisha, will be stricken with a fever and will develop a permanent paralysis, probably in the legs; before long Aisha will be diagnosed with polio. What will make her case different from the millions of polio cases before it, will be that it will never happen again.
Friday, Rotary and UNICEF, held their annual World Polio Day to celebrate the progress being made in the global effort to eradicate the disease that once killed 2,400 people in a single year in New York City alone.
While this disease could not be eradicated without an effective vaccine and much credit is appropriately due Jonas Salk, credit must also be given to the Global Polio Eradication Initiative, the team of organizations that has been working to end polio since the mid-1980s. Their goal has been to deliver the vaccine to every child on the planet, ensuring that the poorest of the poor in the most remote villages on the planet are provided with the life- and limb-protecting vaccine.
The partners in this effort, Rotary, UNICEF, the World Health Organization (WHO), the U.S. Centers for Disease Control (CDC) and the Bill and Melinda Gates Foundation, have worked since Rotary and UNICEF launched the effort back in 1988. At the time, approximately 350,000 people were diagnosed with polio every year.
So far in 2015, only 51 children have been diagnosed with polio, just a bit more than one case per week. This is almost 7 times fewer than we saw just last year when 356 cases were observed, about seven per week.
As the weather cools, the virus struggles to infect more children. So, it is hoped that this winter, inoculation efforts can snuff the virus out. With the world focused intently on the eradication of polio, every case is scrutinized.
Dr. John Sever, Vice Chair of Rotary’s International Polio Plus Committee and a former colleague of Dr. Salk, explained to me at the event that the genetic tracking of the disease suggest that despite the low numbers, a few strains of the virus continue to circulate independently in Pakistan and Afghanistan. A focused effort will be required this winter to bring an end to polio.
The battle is expensive, tallying over $10 billion since the 1980s. Rotary has, according to General Secretary John Hewko, contributed $1.5 billion to fight against polio. The Gates Foundation has become the primary private funder of the fight, but Rotary continues to raise money for the effort with a two-for-one match from the Gates Foundation. Rotary’s International Polio Plus Chair Mike McGovern made a plea for more donations to end the event.
Mia Farrow, a polio survivor herself and mother of an adopted son with polio, delivered a video message at the event. She was the first of the evening to note that eradicating polio will yield a $50 billion dividend.
The infrastructure put in place to fight polio has already been deployed in the cause of other diseases, most notably the Ebola epidemic. In addition, the work has improved access to routine immunizations for other diseases as well.
The effort has not been without opposition. In fact, as Anthony Lake, UNICEF’s CEO reminded the global, live-streamed audience, polio warriors are “risking—and sometimes losing—their own lives in the effort” to save other lives. Dozens of health workers have been murdered in recent years, mostly in Pakistan, specifically because they were providing polio vaccines. Lake called the workers “heroes.”
Noting how close we now are to eradicating polio, invoking a football metaphor, Lake said, “When the goal line is this close, we cross it.”
Jeffery Kluger of Time Magazine, who acted as the moderator for the evening’s event, reminded the audience of the 1916 polio epidemic in New York that cost 2,400 children their lives. The live audience sitting in New York was particularly struck by this statistic.
Kluger then asked the CDC’s John Vertefeuille to explain the roles played by the two polio vaccines over the years. Salk’s vaccine, an inactivated virus, is injected and is now used throughout the developed world. It provides immunity to all three types of polio virus (1, 2 and 3, as they are unimaginatively known). The Sabin vaccine, developed a few years later, is a live, attenuated virus that is delivered orally. The Sabin vaccine is also a trivalent version, but in recent years a bivalent version (omitting the type 2 virus) has been developed and used with great success. The type 2 wild polio virus was eradicated in 1999.
Vertefeuille explained that the developing world is now incorporating the Salk vaccine, commonly referred to as the IPV, which is injected, into their routine immunization programs. This is a critical step in the final eradication of the disease as the bivalent oral vaccine, on rare occasion leads to children becoming ill and spreading the disease. This less virulent form of the disease does leave some patients paralyzed. Hence, the need to switch to the IPV, which cannot lead to a circulating virus.
Dr. Jennifer Bremer of the television show The Doctors, took a few moments on stage to plead with parents in the United States to continue to have their children vaccinated. She explained the principle of herd immunity that comes from having a threshold proportion of a population immunized. For polio, she said, the threshold is about 80 to 85 percent. When the threshold isn’t met, the risk of an outbreak grows, she explained. She suggested that the reasons people don’t have their children vaccinated is due to misinformation or a lack of information. She concluded by saying, “Everyone who can be vaccinated should be vaccinated.”
Jeffrey Kluger, TIME, with actor Archie Panjabi, Rotary Polio Ambassador. Photo by Devin Thorpe.
Near the end of the program, Kluger shared the story of being approached by his then nine-year-old daughter as he was doing research on polio. She saw the image of a young girl suffering from the paralyzing effects of polio and asked him if she could catch the disease. Knowing she had been properly immunized, he was grateful, he says, to be able to say in four simple words, “No, honey, you can’t.”
Tragically, our “Aisha” will contract polio within the next unknown number of months. At first, no one will take particular note of her case as the global surveillance teams monitor weekly data coming in from Pakistan, Afghanistan and the rest of the world, but no other cases will come. It will take years to certify the world as truly polio free. As time without polio increases, Aisha will, ironically, become a celebrated symbol of the eradication of this disease.
Soon, if not this winter then next, every parent on the planet will be able to answer their children’s inquiries about contracting polio just as Kluger did his, with the simple four-word response, “No, honey, you can’t.”
