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The Eradication of Polio

Vaccines. Is there a better way to divide opinion before we even get started? But before eyes begin to roll and low mutterings over Bill Gates’ master plan to destroy the world, this video is going to steer clear of the Covid-19 vaccination debate as much as possible and instead focus on the quite extraordinary global collaboration that has brought the debilitating poliovirus to the brink of eradication. 

I’m sure many of you watching have grown wearisome of the V-word but to get an idea of where we are today, it might well help to look back at what has come before. The global war on Polio has seen astonishing success and yet it has been dogged with the same kind of issues that we see today. 

As always on Megaprojects, we’re not here to preach, but rather to simply tell the tale of this particular bruising battle against a virus that cast a fearsome, dark shadow across much of the 20th Century.    

Poliovirus

Polio virus model

For those born after the 1980s in developed nations, the fear of Polio has well and truly faded from the public consciousness. Like nuclear war and food rationing, the poliovirus is something that our parents and grandparents had to contend with, but in the modern world, it has been all but wiped out. In fact, only two countries in the world, Afghanistan and Pakistan, are still endemic with polio.

Polio is a virus that can be spread through contact, contaminated water, bodily fluids and faeces. Like Covid-19, many people who contract Polio are asymptomatic or only suffer mild symptoms like fever, headache, nausea and fatigue. However, for a small number, things get considerably worse. Around 1% of those who contract polio will experience lifelong paralysis of the arms, legs or breathing muscles, with around 5-10% of these dying as a result. To make matters worse, symptoms can sometimes appear as long as 15 years or more after contracting the illness and can lead to what is known as the ‘late effects of polio’, which include new muscle weakness, joint and muscle pain and fatigue. 

So for many, Polio is neither life-altering nor life-threatening, but for the unlucky few, life will never be the same again. 

Dawn of the 20th Century 

It’s difficult to pinpoint how long Polio has been around, but we have likely been plagued by this illness for at least a couple of thousand years. An Egyptian carving from 1400 BC, shows a young boy with a leg deformity similar to what can occur with Polio. 

But while Polio has almost certainly been around for a long time, up until the end of the 19th Century, it remained relatively uncommon. Now, we have to take into consideration that the virus wasn’t isolated until 1909, so therefore this type of illness didn’t have a specific name before then. Certainly, people had Polio before the 20th Century, but it was at the turn of the century that we saw a dramatic rise. 

And paradoxically, one of the potential causes for this rise was our newfound desire for cleanliness. Before this, immunity to Polio was frequently passed down through generations, normally from when a baby was still within the womb and through breastfeeding. Polio comes in two stages, the first is a mild stage that remains in the digestive system, while the second, far more destructive stage attacks the nervous system. Because of this, before the 20th Century, most children would have encountered Polio while still covered by their maternal immunity, which was normally enough to fight off the disease. 

As our environments became more sanitised, children began to encounter the virus less, which sounds like a good thing but meant that they failed to develop their own long-term immunity against Polio. 

Early Epidemics  

Sporadic outbreaks of Polio occurred in the lead up to the start of the 20th Century – 26 cases in Boston in 1893 and 132 cases, with 18 deaths, in Vermont the following year. Things got much worse for the heavily populated New York City and in 1907, 2,500 cases were recorded, with a full-blown epidemic, the first anywhere in the world, declared on 17th June 1916.  

Now, if you consider how much of the world dealt with Covid-19, how the authorities attempted to deal with Polio in the early 20th Century will sound like a draconian sledgehammer to many. Names and addresses of those known to be suffering from the virus were openly published in newspapers, with placards designed to warn people off even placed outside their homes. Confirmed cases were quarantined (or should I say barred from leaving) as panic swept through the city. 

While the virus had been isolated by two Austrians, Karl Landsteiner and Erwin Popper in 1909, it remained very much an enigma that provoked hysteria as many attempted to flee New York. In 1916, 2,000 deaths were recorded in the city, with a further 4,000 across the country. Hardly staggering numbers, but enough to scare the living hell out of people. Considering the Spanish Flu, which would eventually kill roughly 50 million people across the world, was only two years away, it was the beginning of an unimaginably difficult period. 

Worldwide Spread 

Unlike Covid-19 which spread rapidly around the world, Polio’s spread was much harder to map and typically came in waves, often coinciding with summer. The U.S saw a fall in cases after the initial early epidemic in New York, but by the late 1940s and early 1950s, it had come roaring back and completely eclipsed the earlier outbreaks, peaking in 1951 with nearly 58,000 cases and just short of 3,000 deaths. The UK also saw its first serious outbreak in 1947 and by the 1950s, the nation was experiencing over 7,000 cases of paralytic polio each year, with up to 750 deaths. Polio was now spreading around the world and by the 1980s, 1,000 children each day were left paralysed as a result of the virus. But by that point, an answer had emerged. 

Vaccines

Polio vaccinating

And that brings us back to one of the most polarising debates in our modern world. Treatments or preventative steps for Polio had been wide-ranging ever since the disease emerged. At first, rumours that it was cats spreading Polio led to more than a few of our feline friends meeting a rather premature end. 

The Iron Lung, which was first tested in 1928, is something you may have seen in films and involved a Polio sufferer lying inside a metal tube while electric motors attached to modified vacuum cleaners, worked to alternative the pressure within the tube – essentially forcing the lungs up and down and so providing an early rudimentary form of ventilator. This certainly helped, but considering the cost and size, it wasn’t something available to all. 

William Hammon, an American physician working at the University of Pittsburgh, isolated serum containing antibodies against poliovirus in 1950. After clinical trials, results showed it to be 80% effective in preventing the development of paralytic poliomyelitis, but unfortunately only for around 5 weeks. This serum was still widely used when available, but something much better was right behind it. 

A Polio vaccine had first been trialled in 1935 but without success. However, as numbers picked up again in the 1940s, a research group at the Boston Children’s Hospital, successfully cultivated the poliovirus in human tissue – a breakthrough that not only led to our Polio vaccines but the Nobel Prize in 1954 for John Enders, Thomas H. Weller and Frederick C. Robbins

The first bonafide Polio vaccine was discovered in 1952 by Jonas Salk and his team at the University of Pittsburgh, but though it was announced to the world shortly after, it went through nearly three years of testing before being fully licensed. This involved the Francis Field Trial, which was the largest medical experiment in history at that time, involving nearly 2 million children who had either been given the vaccine, a placebo or nothing at all. The results showed that the Salk vaccine to be 60–70% effective against PV1 (poliovirus type 1), over 90% effective against PV2 and PV3, and 94% effective against the development of bulbar polio (paralysis). 

The United States, which was experiencing annual epidemics, was quick to begin immunisation with polio cases falling from 35,000 in 1953 to 5,600 by 1957. This was in no small part thanks to the March of Dimes, a non-profit organization founded by President Franklin D. Roosevelt in 1938, as the National Foundation for Infantile Paralysis to combat Polio and other afflictions affecting children. The President is believed to have suffered from polio throughout his life and it’s widely regarded as being the cause of the paralytic illness that led to his death in 1945.   

In November 1961, Polish-American Albert Sabin’s oral polio vaccine (OPV) appeared for commercial use. This had been in trials for the better part of 5 years but had already been administered to 10 million Soviet children in 1959. This vaccine, which was much easier to administer with just two drops in the mouth required, led to another large-scale vaccination program and by 1961 only 161 cases were recorded in the United States. 

But while these vaccines proved astonishingly successful, we’d be remiss not to mention a couple of major incidents that not only knocked confidence in vaccines at the time but that perhaps can also be linked with vaccine hesitancy today. 

The Cutter incident of 1955 involved the Cutter pharmaceutical company which produced over 100,000 doses of the Salk vaccine that had not been properly inactivated – meaning they came with live poliovirus. After these vaccines were administered, it led to 40,000 cases of polio, 250 cases of paralytic illness, 10 deaths and years of legal troubles for Cutter. Even though the faulty vaccines were entirely down to poor pharmaceutical management, confidence in the Salk vaccine took a beating, which paved the way for much wider use of the OPV vaccine.   

The second incident occurred in the 1960s when the rhesus monkey kidney cells used as part of the Salk vaccines produced between 1955 and 1963 were found to be infected with the simian virus-40 (SV40). An estimated 10–30 million Americans, and perhaps hundreds of millions in Asia, were exposed to SV40 through vaccinations. And here’s where things get controversial. While SV40 is present within certain cancers and tumours, research suggests it is not a cause. Several large-scale studies across the world looking into whether cancer rates spiked within the groups that were vaccinated with the faulty vaccine, found no increase whatsoever.        

1988

In 1988, Polio vaccines had been available for almost thirty years, and yet, the virus remained endemic in 125 countries across the world – including the well developed France, Spain and West Germany in Europe. At this point, it’s probably just easier to say what countries were polio-free, and they were, the U.S, U.K, Canada, Australia, New Zealand, Italy, Japan, South Korea, the Scandinavian countries, Chile, Argentina, Paraguay, Cuba and Czechoslovakia, which was actually the first country scientifically demonstrate nationwide eradication of polio in 1960. There were a few more countries, mainly dotted around Europe, but broadly speaking, most of the world was still crawling with Polio.   

And that brings us back to the year 1988, in which the World Health Organisation (WHO) launched the Global Polio Eradication Initiative (GPEI) with the lofty target of eradicating Polio from the planet by the year 2000. At the time this was quite an extraordinary goal but you have to say the WHO, UNICEF and many countries around the world set about it with unbelievable vigour. 

This involved much more than just drop-in clinics around the world and included four doses of OPV for all newborn babies, supplementary doses that would cover all children under the age of 5, active surveillance and laboratory testing, environmental surveillance, such as testing water and sewage and finally a mop-up campaign, which would target smaller outbreaks. If that sounds like an unbelievable amount of work, it really is – but then again, humans can do some quite extraordinary things when we stop fighting long enough to collaborate properly. But there was more. The Global Polio Laboratory Network was established in 1990 and today includes 146 WHO accredited polio laboratories across 92 separate countries. The Network’s overarching role is to essentially monitor the polio situation across the world, by consolidating data, tracking flare-ups, mapping spreads or testing plenty of stool samples apparently – around 220,000 per year, just in case you were interested.    

Many countries set up national immunisation days and threw absolutely everything at it. India for example, on just a single day, had 640,000 vaccination booths, 2.3 million vaccinators, 200 million doses of vaccine and immunised 172 million children. In 1996, with the help of Nelson Mandela, Africa began its ‘kick polio out of Africa’ campaign and 420 million children received vaccinations across numerous immunisation days, while in 2000, a record-breaking 550 million children – a tenth of the world’s population at the time – were vaccinated across the world.      

The year 2000 had a nice ring to it but proved overly ambitious – though not by as far as you might think. In 1994, the entire Americas was classified as polio-free, with China in 2000 and Europe in 2002 following suit. While Africa was not yet deemed entirely free, only four countries remained where the virus was endemic – Niger, Nigeria, Egypt and Somalia – while the rest of the continent was broadly classified as ‘polio-free (not certified).    

In 2014, another major milestone was achieved, when India and its bulging 1.3 billion population, were declared polio-free and it appeared that the world was on the brink of eradicating one of the most feared diseases of the 20th Century. 

Almost There   

Ok, let’s start with the good news. Since the launch of GPEI in 1988, cases of Polio around the world have fallen by 99% – an absolutely astonishing achievement. The immunisation program has been so successful that in many countries, people don’t give Polio a second thought. The last case of type 2 polio was reported in 1999 and was officially declared eradicated in September 2015, while the most recent case of type 3 dates to November 2012 declared as globally eradicated in October 2019.  

But Polio isn’t gone. The virus remains endemic in Afghanistan and Pakistan, while smaller fare ups have occurred in Syria and other countries in Africa and Asia. However, almost all of these outbreaks were brought under control relatively quickly, thanks to the rapid work of the Global Polio Laboratory Network. 

As the finish line comes into sight, it’s fair to say there have been some wobbles. Vaccination hesitancy has been growing for some time, while rumours of their links with HIV and other illnesses continue dog efforts. Then there are the whispers that vaccines either contain animal products or are even being used to sterilise certain populations. It probably goes without saying that none of this has any basis in truth. The fact that the two countries still with wild Polio both suffer insecurity and high rates of poverty, is no coincidence – though that hasn’t stopped the virus from being eradicated from other countries with similar situations. Difficult terrain, poor management, bad governance and increased militancy in the wake of 9/11 have all been blamed for countries’ inability to bring polio under control. That being said, in 2016, $536 million of the total GPEI budget of $925 million were spent in these two countries alone, showing how serious the fight remains. 

Despite some setbacks, the work of the GPEI has been extraordinary, as has the $15.2 billion in donations from around the world between 1985 to 2019 – with a sizable amount coming from the Microsoft Sauron Bill Gates. Say what you will about the geeky tech pioneer, but since 1994, he and his wife have given away over $50 billion to charities around the world, with polio, clean water and education some of the major beneficiaries. Yes, he’s making so much money he can barely keep up with giving it away, but that’s beside the point. If Bill Gates is really trying to take over the world, he’s certainly playing a peculiar long game.     

The GPEI currently spends roughly $1 billion per year, which sounds like an awful lot of money but is around 800 times smaller than the cost of major health care projects going on within the United States. 

As I mentioned earlier in the video, we’re not here to preach to you about vaccines, but rather to simply tell the story of the largest vaccination program the world has ever seen – before the one we’re currently in that is. Whatever your feelings regarding vaccines, the 99% collapse in polio cases around the world since 1988, coupled with the frankly heroic efforts of the Global Polio Laboratory Network to keep it that low, deserves plenty of recognition. Before 2020, this had been the largest medical megaproject we have ever seen, and an inspiring example of global collaboration. 

Sources

Polio – NHS (www.nhs.uk)

History of Polio – Timeline | History of Vaccines

History of Polio – GPEI (polioeradication.org)

Polio – Our World in Data

History of polio – Wikipedia

History of polio – BBC News

Africa declared free of wild polio in ‘milestone’ – BBC News

Polio Vaccine: Vaccine-Derived Poliovirus | CDC

Why polio continues to be a health risk in Pakistan | Asia| An in-depth look at news from across the continent | DW | 15.09.2020

Credits

Polio eradication by UNICEF Ethiopia is licensed under CC-BY-NC-ND

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