Thomas Abraham’s Polio: The Odyssey of Eradication, shortlisted for The Hindu Prize for Non-Fiction, is a gripping exploration of the complexities that lie in the way of the worldwide project to banish polio. And is it a goal within reach or is it an example of public health efforts having gone off track? An excerpt from an interview:
Given that health has been a relatively new area for you, how did you get interested in the subject and in polio? Was your experience in Hong Kong a catalyst?
I had no experience, or even great interest, in health, until SARS (Severe Acute Respiratory Syndrome) erupted in early 2003. I was at the time living in Hong Kong and was approached by a publisher to write a book about it. This was what got me interested in health and disease, and how human beings respond to threats to their health. At a deeper level, SARS as well as the coronavirus now demonstrate the power that microbes have over our lives. The relationship between man and microbe is fundamental to our
physical as well as social and cultural evolution. This is what I explore in this book on polio, where I look at the effort to drive the virus that causes polio into extinction in much the same way that humans have driven so many other living beings into extinction. Viruses of course have existed on earth a lot longer than humans have (and will probably continue to exist after we disappear) so whether we can drive the polio virus to extinction and stamp out polio is still an open question.
The year 2019 was a setback for polio elimination, especially in Pakistan. Did the extent to which a major health campaign to get rid of a crippling disease became a hostage of geopolitics surprise you?
The polio eradication campaign has faced setbacks for several years now, not just in 2019. Its last big success was the elimination of polio from India in 2011. Since then, polio caused by the wild, or natural polio virus has remained entrenched in Pakistan and Afghanistan, but more worryingly, cases of vaccine derived polio have surfaced in many countries that were previously thought to be polio-free. The polio campaign does not like to talk about vaccine derived polio, for fear that people will lose confidence in the vaccine. But this is a growing issue the polio campaign faces.
Regarding geopolitics, a fascinating story that I was able to explore in this book is how polio eradication became a victim in the U.S. hunt for Osama bin Laden in Pakistan. Polio eradication in Pakistan has always been enmeshed with the rise of the Taliban in Pakistan, and the larger triangular conflict between the Taliban, the Pakistan government and the U.S.
This is not particularly surprising. Pakistan is located in a geostrategically important space, and health cannot really be insulated from the larger political environment.
Would you agree that the polio eradication programme has been struggling? What is the spark needed?
The polio programme has been struggling, and largely because those who are managing it and running it often tend to think in very fixed ways and are reluctant to change. I think one of the biggest mistakes made was to not to move much sooner towards an inactivated polio vaccine rather than the current oral live polio vaccine. The oral polio vaccine is much cheaper, easier to administer, and in most parts of the world, extremely effective. But it has the disadvantage of requiring multiple doses, as well as the side effect of creating vaccine derived polio viruses. The inactivated vaccine does not have these problems, but is more expensive and requires trained personnel to administer. Had the polio campaign raised the funds for a vaccine switch five years or so ago, and made polio vaccination part of other childhood vaccinations, many problems might have been avoided.
While India’s polio campaign has been a public health triumph, there are grey areas about what has not been achieved, especially in other areas of public health. What are your views on the human response to disease?
Eliminating polio was a singular achievement for India, particularly given that two States with the poorest performing governments in the country, Uttar Pradesh and Bihar, had the bulk of polio cases. The elimination of polio in India showed what the country is capable of achieving in the area of health if the political will exists. Unfortunately the same political push does not exist to achieve so many other health problems that cause much more death and disability than polio, ranging from eliminating malnutrition to controlling diseases like malaria, dengue and chikungunya. The government poured resources and political and administrative muscle into polio elimination because India’s inability to eliminate polio when so many other countries had was becoming a global embarrassment. Unfortunately, there is no similar international pressure to achieve other health targets.
In global health campaigns such as these, it may not be an exaggeration to say that donor funding plays a major role. Is there a danger then of picking only the low hanging fruit with the pressure of timelines and targets? Would this impact the next public health challenge?
Donor funding does play a major role in global health campaigns, but many of the existing global campaigns, particularly those required to achieve the sustainable development goals, are long-standing, deep-rooted problems. The health-related sustainable development goals include issues such as reducing the number of women who die in childbirth, the number of children who die in infancy, ending epidemics of diseases like malaria and so on. None of these is difficult to achieve; they do not require any sophisticated technology. All they require is for the government to invest more in our healthcare system, and also give to health the same importance that is placed on issues such as defence and foreign affairs.