Today is Jonas Salk’s 100th birthday
100 years ago today, Jonas Salk was born. As the creator of the inactivated polio vaccine, he not only changed the course of human history, he also ushered changed the field of public health forever. We can count the polio vaccines and the elimination of smallpox as probably the two great success of public health.
In its mildest form, polio causes a mild bout of diarrhea. In its worst form, the virus migrates to the spine, impedes development and causes debilitating long term paralysis. My grandfather was struck with the disease and had one of his legs stunted and weakened (though he managed to serve in WWII anyway as a Marine). A carpenter who worked for me a while back died due to long term respiratory complications from a childhood polio infection.
Polio is mostly foreign to anyone born in my generation. We were nearly all vaccinated, and the high levels of vaccination have destroyed opportunities for the virus to persist in the environment, protecting everyone, even those who don’t get the vaccine.
Unfortunately, though Salk’s achievements were great, medical care and attention to polio was hardly equitable and tainted by the racism of the time.
During the 1930s the systematic neglect of Black polio victims had become publicly visible and politically embarrassing. Most conspicuously, the polio rehabilitation center in Warm Springs, Ga, which Roosevelt, himself a polio survivor, had founded, accepted only White patients. This policy, reflecting the ubiquitous norm of race-segregated health facilities, was sustained by a persuasive scientific argument about polio itself. Blacks, medical experts insisted, were not susceptible to this disease, and therefore research and treatment efforts that focused on Black patients were neither medically necessary nor fiscally justified.[1]
It is likely true that African Americans experienced a lower burden of disease than white children. We now know that polio’s worst effect arise from the lack of acquired immunity to the disease. Repeated infections from infancy, most importantly during the first six months, when babies still have maternal antibodies to fight for them. Improvements to sanitation delayed exposure to the virus, so that children were not immune and thus more susceptible to the disease’s worst effects.
In short, polio is a disease of development, not underdevelopment. The horrible racism of the pre-civil rights medical system can’t be denied, but the observed disparities in disease incidence might have not been imagined given the disparities in sanitation and access to clean water.
Presently, we are fighting a battle to insure that all kids in Sub-Saharan Africa are vaccinated. However, there still exist pockets where the medical system so dysfunctional and the politics so chaotic, that vaccination rates are low and disease continues to flourish. In places like Afghanistan and Northern Nigeria, the hope of polio elimination is almost non-existent
1. Rogers N: Race and the Politics of Polio: Warm Springs, Tuskegee, and the March of Dimes. American Journal of Public Health 2007, 97(5):784.
The uproar over polio: Is it deserved?
Technically, we can eradicate polio, but a number of reported outbreaks around the world have called the possibility into question.
From a CNN article, which pretty much says anything I could say about the current situation:
The spread of polio constitutes an international public health emergency, the World Health Organization declared Monday.
“If unchecked, this situation could result in failure to eradicate globally one of the world’s most serious vaccine preventable diseases,” the WHO said in a statement.
At the end of 2013, 60% of polio cases resulted from the international spread of the virus, and “there was increasing evidence that adult travelers contributed to the spread,” according to the statement.
Warfare in Syria is compromising vaccination efforts and human movement, presumably by refugees, are spreading the disease to countries like Iraq and Cameroon. It’s obvious that the failure to eradicate polio is a political problem.
I’ve been asked about polio several times over the past four weeks. People appear to be somewhat panicked about the situation.
Every time, I have responded in the same manner. While the eradication of polio would provide a great publicity boost for public health groups, polio does not present a major threat to global human health. While a small percentage of children infected with polio will go on to develop debilitating paralysis, the disease rarely kills its host. Polio is hardly one of “the world’s most serious vaccine preventable diseases.” I can think of many others which are far more serious.
To complicate matters, the social and medical infrastructure to support people afflicted by the disease is quite well developed in Sub-Saharan African countries. It is common to see polio paralytics in African cities living relatively comfortable lives, despite the severity of their conditions.
I do not share the same level of panic surrounding the failure to eradicate polio. Malaria and diarrheal diseases kill far more children, cause far more human suffering and wreak far more damage to social and economic development in developing countries than polio ever did or ever will. To me, those two are “international health emergencies.”
Vaccines against polio exist and are quite effective at controlling disease worldwide at a relatively low price. While the argument can be made that the eradication of polio would allow that money to be used for other purposes within cash strapped health budgets, the futile push to eradicate polio is likely sapping health money from more immediate health concerns.
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