In a world in the midst of confronting a new infection and fighting a global pandemic comes a book that is a sober reminder of another war by medicine; a war against a much older disease — polio.
The new millennium of the 21st century was one of promise, say Dr. T. Jacob John and Dr. Dhanya Dharmapalan in their book, Polio: The Eradication Imbroglio: The Malady and its Remedy . Yet, two decades after the goal was set for 2000, the finish line in a race that promised to have a world “totally free” of polio seems to be only enveloped in a haze. The programme of stopping polio in its tracks, they say, is facing a crisis. The global combat against disease is a complex one, especially when the United Nations has the task of bringing all nations to the table on health matters.
Worldwide eradication
Health does matter. So, in the 1960s, when the World Health Assembly (WHA), by majority vote, resolved to wipe out small pox — there was an efficacious vaccine available — the eradication target was 10 years. The goal was reached in 11 years, say the writers. Next on the radar was polio when in 1988, the 41st World Health Assembly unanimously adopted a resolution for its worldwide eradication. It marked the launch of the Global Polio Eradication Initiative (GPEI), and the time allotted was a “more liberal” 12 years. The Health Assembly’s confidence of success rested on a vaccination platform, the Expanded Program on Immunization (EPI). By the time the EPI was launched, the plusses and minuses of the two vaccines that were available, namely the inactivated polio virus (IPV) and the live attenuated oral poliovirus vaccine (OPV), were studied and documented. But from 2000, the target year became 2005, and soon, other revisions began to be inked.
We are now in 2021. Nearly 90% of polio currently is vaccine-virus-induced, with the remainder by natural (wild) poliovirus, as a graph (p.198) explains. So if “success has eluded” the programme and if there is a “reason for this fiasco”, it all boils down to a simple error — the “tactical choice of only one of the two vaccines”, namely OPV and a “stubborn insistence on its exclusive use”. The WHA resolution was to use both vaccines, but the belief of the programme leaders was in the use of OPV alone.
Burning questions
Thus, there are burning questions. Why was the “completely safe and exquisitely efficacious” IPV relegated to the background? Why was OPV that was neither highly efficacious in the low-middle income countries battling polio nor completely safe in any country made the prime weapon? Who was interested in protecting the reputation of OPV? Why were polio experts who understood the error, left out of the policy-making echelons of the global polio eradication programme?
Readers familiar with the extensive ground reportage in the book, Polio: The Odyssey of Eradication (Thomas Abraham), would have been enlightened, among other things, on how the campaign got caught in a web of geopolitics. Enriching this further, and with multiple perspectives, would be the John-Dharmapalan book. Applying the principles of vaccine science (dealt with comprehensively in Sections One and Two, especially with insights into the stories of Jonas Salk and Albert Sabin), to public health, disease epidemiology and biomedical ethics (Section Three), it lays out a road map to revamp the eradication programme.
The fervent hope is that a misguided programme policy causing suffering to children and parents has to end. For, say the writers, all polio today is in the low income countries, while all rich countries enjoy full freedom from polio. It is an inequity created by an eradication programme. And it goes against the spirit of public health. More importantly, it involves the neglect of ethics and human rights. Will the programme leaders now relent and listen?
Polio: The Eradication Imbroglio: The Malady and its Remedy ; T. Jacob John, Dhanya Dharmapalan, Notion Press, ₹650.
murali.nky@thehindu.co.in
