After smallpox, how did polio capture the imagination of the world to become the largest mass immunisation programme in history?
Thomas Abraham brings decades of journalistic expertise to tell a gripping tale of geopolitics, illiteracy, and the role of big money in Polio, The Odyssey of Eradication.
By the 1980s, the United States had already made rapid progress in containing polio by injecting some 1.5 million children with inactivated poliovirus vaccine developed by Jonas Salk. The efforts would be a waste if polio surfaced again as travellers re-imported it from countries where it was still present. For that, the world would have to become polio-free. But polio was not a top priority elsewhere. Each country had its own immunisation programme, based on local requirements. A determined coalition of American public and private organisations with deep pockets persuaded the world to launch a global campaign on a single disease instead.
In 1988, the Global Polio Eradication Initiative was born. This time, it would rely on the easy-to-use oral polio vaccine developed by Albert Sabin rather than on injection. The campaign would be implemented by the World Health Organisation, in collaboration with UNICEF and the US Centers for Disease Control. Rotary International and the Bill and Melinda Gates Foundation would provide the money power (along with boots on the ground to ensure total vaccination coverage).
Polio should be eradicated by the year 2000, the coalition declared. It did not foresee the sheer complexity of the campaign.
India had its own set of priorities but ultimately gave in. In 1992, thousands of Rotarians fanned out across the country with government health workers to put two drops of the oral polio vaccine on the tongues of 90 million children, in the largest single mass immunisation in the world. In a country with poor and varying levels of public health services, the programme predictably got bogged down. In a tropical climate the vaccine did not behave as expected. Power was erratic and the vaccine was often not stored properly. Many health workers simply didn’t do the rounds, often vaccinating just one child instead of the required 100. They already had a multi-disease immunisation programme to take care of and this meant additional work. Multiple doses of the vaccine were required for it to be effective.
In Uttar Pradesh and Bihar, the abysmal health services and widespread illiteracy stymied progress. Word soon spread that the vaccine would sterilise children and was being targeted at Muslims. A huge backlash followed. It took years of persuasion by local leaders and politicians to convince people to vaccinate their children. Only in 2011 was India declared polio-free, one of the last countries in the world to achieve that target.
But the virus is still holding out in some countries. Last year, some 100 cases were reported in Pakistan, Afghanistan, Syria, Nigeria and Congo. The original deadline of 2000 to eradicate polio has long gone, as have several revisions. Now, even the 2021 deadline appears to be unrealistic. Political turmoil and war, problems caused by the vaccine itself, and the exhaustion of public health workers who are forced to carry out vaccinations year after year, are all taking a toll on the programme. Clearly, the WHO underestimated the problems. Some $15 billion has been poured into the programme.
In Pakistan, the intractable war with the Taliban has derailed the programme. The Taliban has repeatedly shot dead dozens of women vaccinators in Western Pakistan. Suspicion is widespread that the vaccinators are American agents. That suspicion arose after Osama bin Laden was tracked down and killed by the Navy Seals in Abbottabad with the help of a doctor who was involved in a vaccination programme. The Pakistani army cracked down on the Taliban and fleeing Pashtuns carried polio back into Afghanistan’s border. Migrant Pakistani workers have been blamed for introducing it in Syria.
Many health experts continue to say that instead of focussing on a broad spectrum of preventable diseases, countries are being forced to aggressively go after just one disease. Should polio be a priority for them when other diseases demand greater attention? Should they focus on polio just because the wealthy countries have eradicated it and face the threat of it being re-imported from places still affected by it?
“If there is a lesson from all this for future global health programmes,” the author writes, “it is that their task would be far easier if they were more responsive to the needs of the people that they were supposed to serve, rather than the well-meaning donors funding their projects.”
Abraham got interested in polio in 2009 while working as a communications officer with WHO in Geneva and was struck by the energy and determination of the polio team. As he immersed himself into the subject, he was struck by the complexities of the programme, its failures, achievements and ethical ambiguities and intrigued by why the eradication programme was missing so many deadlines and worked on this book over the next decade.
The writer is a journalist and an editorial trainer.