Polio: The Odyssey of Eradication by Thomas Abraham
In 1988, the World Health Organisation (WHO) together with UNICEF and Rotary International launched the Global Polio Eradication Initiative (GPEI). The aim was to rid the world of the polio virus by 2000. Little did they know that it would take billions of dollars and thirty years to reach the 99% mark. Polio is nearly eradicated, but it persists in some of the poorest parts of Pakistan, Nigeria and Afghanistan. As Abrahams, a journalist who specialises in health risks, says in his prologue:
The risks of failure are high: the world has embarked on six disease eradication campaigns over the last 100 years. Of them, only one, smallpox has succeeded. […] it is a tribute to human optimism that disease eradication is still seen as a viable strategy.
On top of this, while fresh outbreaks of polio recurred at regular intervals in polio-free countries, […] there was a greater cause for concern. From time to time these outbreaks were being caused by the polio vaccine itself.
Before he examines the campaign in greater detail, thankfully, Abraham gives us a potted history of the scale of the problem, about the disease itself and the quest to create vaccines that worked.
We all think of Polio as the disease that caused terrible paralysis – it did, but only to a small percentage of those infected. For most it causes low grade symptoms if any in the gut and pharynx, it is only rarely when it passes into the central nervous system that it can cause the more severe complications. In tropical countries many were exposed to the virus as a child with few effects, it was endemic. But in the affluent West, epidemic outbreaks each summer tended to affect older patients, with a correspondingly higher risk of paralysis.
The campaign to develop a vaccine was kickstarted by having the highest possible possible sufferer. President Franklin D Roosevelt had been stricken in 1921, and when elected he did his best to present himself to the world as having triumphed over polio. (Modern thinking goes that he had actually suffered from Guillain–Barré syndrome but this was never tested for. Anyway, FDR went on to create a private foundation – the National Foundation for Infantile Paralysis (NFIP). The NFIP funded the two vaccines that would become the basis of the GPEI.
The next chapters consider these two vaccines – the Salk killed virus vaccine, which was injected; and the Sabin oral polio vaccine which was based on a weakened strain of live virus, (which was cheap to make and didn’t need trained staff to administer). This section is where the book briefly overlaps with last year’s shortlisted title The Vaccine Race . There was no love lost between Sabin and Salk, Sabin being particularly competitive – he also tested the vaccine on himself and his family!
This first third of the book was thrilling and educative – learning about the virus, visiting the ofttimes dodgy ethics of testing the nascent vaccines and the rivalries.
Sadly, I found the middle section really dull in comparison. It begins with the formation of the coalition of private and public organisations that founded the GPEI, but for me descended into several chapters of acronym after acronym which I kept forgetting with all the governmental and other organisations each with their own initials involved. The politics proved to be rather uninteresting compared with the epidemiology.
This is a particular shame, as I have a family connection to Rotary International, who have been raising money for their ‘End Polio Now’ campaign for years. Rotary’s contribution, joined by the Bill and Melinda Gates Foundation ten years ago, is inestimable, and without their $billions, the GPEI would have foundered ages ago. (Thank you!)
Things picked up again in the final third as Abrahams explores the GPEI now on the ground, looking in particular at the eradication campaigns in India and Pakistan. In the latter, shocking events brought home how dangerous the house to house vaccination programme could be when taking place in Taliban controlled areas:
Around noon, as Madiha and Fehmida were knocking on a door to see if there were any children that could be vaccinated, a motorcycle with two men on it drove up to them, and one man took out a gun and shot both women. Madiha fell immediately, but Fehmida managed to scramble to a nearby doorway, where one of the assassins followed her and shot her repeatedly.
There is one fascinating and awful facet that has arisen from the GPEI programme. The attenuated live vaccine performs better in the field than the killed vaccine, but – and it’s a big but, the live vaccine doesn’t prevent the vaccinated from excreting live polio virus which can mutate and go on to infect the unvaccinated – this is known as VAPP – Vaccine Associated Paralytic Polio, and has been genetically proven to derive from the vaccine rather than from the wild polio virus.
Looking at the WHO’s website , there is good news in that 99% of polio has been eradicated, Rotary claim 99.9% but I was shocked to discover the human cost. What is good is that remaining efforts continue with the aim of eradicating polio, but now also offer help with other medical needs.
Abrahams got really stuck in to his subject, travelling to see vaccination teams at work and interviewing key movers and shakers in the programme that endures still. He brought home the challenges remaining, not least those tragedies that have occurred in politically unstable, war torn areas. For that I can forgive him the less interesting middle section.
They are so close to finally eradicating polio, but the end, as yet, remains just slightly elusive. Fingers crossed! Measles next?
This was the first of my longlist reads for the Wellcome Book Prize shadow panel 2019. I don’t think this book will make the shortlist this year, but it is a very worthy longlist choice. (7/10)
Source: Review copy via Midas PR – thank you.
Thomas Abrahams, Polio: The Odyssey of Eradication (C Hurst & Co Publishers Ltd , 2018) ISBN: 978-1849049566 , hardback, 320 pages (incl notes & index).
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