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Standing in line at the airport security last year, a poster caught my eye. “We are this close to ending polio”, Jackie Chan was saying, showing a small gap with his fingers. You could find Desmond Tutu, Jane Goodall, and Itzhak Perlman doing the same on billboards around the world. There was even a Gangnam Style version of the poster. A year later that small gap that celebrities were demonstrating with their hands seems to be widening, with a speed that now gives reason for alarm.
The World Health Organization (WHO) declared polio as a Public Health Emergency of International Concern on May 5, 2014. The number of cases has increased significantly this year and, according to the WHO, particularly in conflict-stricken areas, like the Middle-East and Central Asia. One of the main concerns is that the virus has re-appeared in areas where the disease had been eradicated. For instance, Syria was polio-free for 14 years until an outbreak started in 2013.
Polio and Cold War
The history of polio vaccination has been riddled with conflict. The Sabin vaccine itself, which is used today in eradication efforts, was developed in the midst of a global political crisis: the Cold War.
The disease opened avenues between the two sides of the Cold War that otherwise would have been unimaginable. The American Albert Sabin and the Russian Mikhail Chumakov worked together to orchestrate one of the largest vaccine trials in history, testing the live virus vaccine in the Soviet Union. West Germans answered the distress calls of Hungarian revolutionaries on Free Europe Radio and sent life-saving medical equipment during a polio outbreak in the 1956 revolution, one of the key moments of the Cold War. Mass vaccination campaigns in countries like Cuba served as the basis of the WHO’s eradication strategies with the Sabin vaccine decades later.
The Cold War partly explains why polio because so important in the 20th Century. For Americans, polio meant President Roosevelt’s heroic struggle and, through the March of Dimes campaign, the triumph of the voluntary cooperation of American citizens, who funded polio care and vaccine research, the latter resulting in the Salk vaccine. For the Soviets, testing the oral Sabin vaccine on over seven million citizens symbolized the victory of the communist ideal, while curbing polio with the live virus vaccine was a powerful demonstration of state authority. The stakes were high for both sides: polio threatened to cripple the bodies of the new, post-war generations. And in war, however cold, bodies matter.
Eradication and priorities
Worldwide polio eradication began in 1988, with the launch of the Global Polio Eradication Initiative, spearheaded by the WHO. Although Sabin and Chumakov had already discussed the live vaccine as a tool for eliminating polio in the 1950s, it was the successful eradication of smallpox, the first disease to be wiped off the face of the Earth, that provided the institutional infrastructure for a global project. The original goal was the eradication of polio by the year 2000. But polio is a tricky disease to tackle: most people who contract the virus have very mild symptoms and do not become paralysed. Moreover, in rare cases, the live vaccine itself can cause polio. Still, it seems to be the most efficient method of curbing the disease in areas where polio is still present (polio-free countries, like the UK, are using inactivated vaccine to maintain immunity). Although the original target - and some later ones – were not met, polio had been drastically decreasing worldwide, with new supporters of the enterprise, like the Bill and Melinda Gates Foundation. There have been no polio cases in India since 2011: the WHO declared the country officially polio free just over a month ago, a great milestone in the eradication efforts.
However, eradication itself can cause new problems or create its own hurdles. In areas where polio is a distant memory for most, some former polio patients, now faced with the post-polio syndrome, complain that physicians are no longer prepared to provide adequate care for them. Since polio is not seen as a threat in the Global North, it is of low priority and its treatment is not part of doctors’ training. Often, the repositories of the knowledge of polio care are the former patients themselves. In places where polio is – or is becoming – an everyday reality, some argue that it is not high enough on the priority list. In Nigeria, for instance, some parents are more concerned about the lack of access to basic medical care than about a disease that is usually not life-threatening, and thus resist vaccination. In countries experiencing extended armed conflict, like Syria, people are less likely to go through the trouble of vaccinating or carry their vaccination cards with them when they flee – understandably so. Conflict can also affect eradication efforts in more direct ways, leading to distrust in vaccinators and occasionally to violence against them.
In the 1950s and 60s, political and military conflict proved to be productive in preventing polio. Curbing the disease, which became particularly important in the Cold War, warranted international cooperation at a time of antagonism. Now, conflict is bringing polio back into the limelight, making it a significant international issue again. It remains to be seen if the charm can work twice, and collaboration can overcome the unfolding of new global epidemics.
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