Jonas Salk's research led to the use of the deactivated polio virus to inoculate and immunize children. The first large scale vaccinations took place in Cuba, where Fidel Castro welcomed the vaccine, which at the time aroused suspicion from western leaders. Since then, the polio vaccination effort has progressed in fits and spurts. In the 1960's researchers discovered SV40 contamination of the vaccination, that elicited fears about safety. But over time the effort steadily gained momentum. In 1988 the World Health Assembly led a worldwide program to eradicate the disease. It worked. In 2003, the World Health Organization (WHO) reported fewer than 700 cases worldwide, down from 350,000 in 1988.
Yet the history of polio has shown that infectious disease eradication is challenging even with an effective vaccination. The majority of polio cases occur in more remote regions of the world, where people have little access to running water, sanitation, food, or basic health provisions. Poorer countries are challenged from distributing vaccines with refrigeration and transportation difficulties. Ice packs chill the vaccines effectively, but need to be refrozen. In rural areas where basic amenities like electricity are scarce, this is sometimes impossible. Transportation to distribute the vaccines is difficult in remote terrain especially where vehicles can't pass. Accurate records of vaccinations need to be maintained and villages need to be notified of upcoming vaccinations and convinced that the medicine is safe for their children.
The World Health Organization (WHO) reports that from 1998 to 2003, "the world's largest public health campaign", spanned 200 countries, employed 20 million volunteers and consumed $3 billion dollars via the Global Polio Eradication Initiative. In 2003 the WHO was confident that all the effort would pay off since only six countries remained polio-endemic: Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. Doctors predicted that polio would be successfully eradicated by December 2005, a postponement from 2002, which was a postponement from 2000. Polio has recently re-emerged in eleven countries. In four of these countries the recently reported outbreaks were imported virus due to migration or travel. Yemen reported 179 new cases and Indonesia 2 new cases in the past week.
The new outbreak is being traced to Africa where several countries blocked vaccination programs in 2003-2004. Officials in Nigeria for instance, began to suspect polio vaccines were a plot of Western countries against the fertility of Muslim girls and halted their vaccination campaign. In Mali 11 were jailed for not allowing citizens to be immunized for religious reasons.
This was the last push of the campaign before the deadline. The good news is that the number of cases worldwide is small. But at this stage of the campaign, the cost to treat each subsequent case increases significantly. The effort requires constant vigilance. In India, where polio is indigent, 24 million or so births per year require that many new vaccinations. Adding to the difficulty, India's resources allow less than $4 per person to be spent on health care -- other African countries can spend half that much.
The high costs of the current effort invites cost benefit analysis by health economists and public health officials, who estimate that as many as 5 million cases have been prevented, however; the remaining cases could cost as much as $600/case. Some argue that the money to treat these remaining cases could be spent on basics like electricity or sewers (sewage is often the source of the virus).
Sometimes eradication via vaccination seems elusive, always 6 months out of reach. But ridding the world of polio -- crippling scourge of a virus that it is, will always be worthwhile goal.
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