THE GEORGETOWN UNDERGRADUATE JOURNAL OF HEALTH SCIENCES 7(1), 2013 The Case against Polio Eradication Samuel Kareff Program in Science, Technology, and International Affairs, Georgetown University, Washington, D.C. Abstract The poliomyelitis (polio) viruses have been a detriment to the global population since first gaining notoriety in the nineteenth century. In the wake of polio epidemics since then, much progress has been made worldwide to eradicate the viruses. An astounding 99% of the globe is now fully vaccinated against them. Despite these massive efforts, there remains one last percent, famously characterized as the “final inch,” of the world that is still subject to the pathogens (Bernstein et al., 2009). The question that remains is whether or not the worldwide eradication effort can ever succeed. If not, should a control program be implemented instead to mitigate the effects of polio? This paper approaches this question with case studies of Cuba, India, and the Congolese Republics. It concludes that the eradication campaign cannot succeed in annihilating the polio viruses due to the following: 1) the future burden of finances on the international community, 2) the possibility for polio to erupt from just a single case of vaccine-derived poliovirus, 3) historical evidence based on the smallpox campaign and other polio country case studies, 4) the declining amount of support and enthusiasm for the current campaign, and 5) the implications this global health fight has on arenas such as trade, bioterrorism/national security, and collective memory. The international health community must re-evaluate its strategy to combat polio in order to fully and properly address this lethal problem. Keywords: polio, eradication, Cuba, India, Republic of Congo, Democratic Republic of Congo Introduction program. Eradication optimists maintain that eradication is within reach and that polio will Polio eradication has been widely debated since the undoubtedly be vanquished within the next few World Health Assembly formally launched its years—just as had been done with smallpox in the campaign in 1988. In subsequent years, various last few decades. Several persuasive cases have regions in the world achieved polio-free status, with been argued at the international, national, and even the Americas doing so in 1994, followed by the municipal levels supporting the cause. A notable Western Pacific in 2000 and Europe in 2002 (Global example includes Dr. Margaret Chan’s “The Case Polio Eradication Initiative, 2011). In 2011, 23 for Completing Polio Eradication” plea published in years after it was first targeted, polio remained an 2007 (Chan, 2007). epidemic in only sub-Saharan Africa and South On the other hand, eradication pessimists question Asia. Specifically, four endemic states of how practical polio eradication actually is. Many Afghanistan, India, Nigeria, and Pakistan currently refer to the repeated delaying of eradication as an exist, though an additional four states have gained unreliable timetable with some doubting that “re-transmission” status, namely, Angola, Chad, eradication is a plausible goal at all. They then Democratic Republic of Congo (DRC), and Sudan assert that a control campaign would be (ibid). (Note: at the time of this writing in April exponentially more efficient in controlling the 2011, these were the only endemic states. India deadly effects of polio. A greater examination into achieved zero cases of polio in 2012. Nigeria has both sides’ arguments is necessary before begun a retransmission of polio.) Regardless, these determining whom holds greater validity. classifications represent substantial decreases from What is certain about the polio eradication debate their peaks in 1988. is that it is an international problem that remains on Although one might assume that all states are in the forefront of diplomacy and foreign affairs. With favor of eradication, this is not the case. globalization prompting an increasingly easy Controversies have arisen within the past decade transmission of polio across borders, governments at regarding the continuation of the global eradication all echelons need to focus on this key issue. The 26 THE GEORGETOWN UNDERGRADUATE JOURNAL OF HEALTH SCIENCES 7(1), 2013 global polio eradication campaign sits at the primary infection. Despite this small rate of intersection of science, technology, and international progression, the viruses’ lethal effects obviously affairs; it is precisely for this reason that it must be represent a major public health concern (SAPPSS, examined carefully, especially considering the 2011). current and future consequences that the disease Fortunately, vaccinations have existed for roughly provokes. This paper analyzes all of the above from 50 years to battle the contraction of polio. Two a global health perspective, utilizing country case types exist to protect against the viruses: 1) oral studies as well as some basic medical facts and poliovirus vaccine (OPV), a two-droplet mixture of history of the disease. highly weakened viruses administered orally and 2) inactivated poliovirus vaccine (IPV), an injection The Science behind the Virus containing dead viral samples administered directly into the bloodstream (both contain all three WPVs). Despite their proximity to universal eradication, The advantages of one form of the vaccine versus polioviruses continue to threaten the global the other depend primarily on the country in which population (Kareff, 2010). Spreading as an they are distributed. For instance, countries like infectious disease through water contaminated with India prefer the OPV as it is much easier to human fecal matter, poliomyelitis is prone to distribute than the IPV injection and can be extensive and brisk outbreaks (Bernstein et al., produced between eight and twelve cents per dosage 2009). Polio usually affects children under five (Gregg 1984; Global Polio Eradication Initiative, years of age due to their weak immune systems. 2011). Conversely, states such as the U.S. lean However, children of all ages are susceptible to the toward the IPV as the risk of contracting polio from disease without a vaccine (ibid). Although the viral the inactivated viruses in the vaccine is much lower infection is most commonly referred to in its (Roberts & Enserink, 2004). Though neither is singular form, “polio,” there is more than one virus perfect—the WHO recommends three doses to grant that acts as a causative agent. In fact, three types of immunity—the polio vaccines are one of the main wild poliovirus (WPVs) exist worldwide. reasons that this disease’s prevalence has decreased Additionally, eighteen other viruses are often significantly over the past century (McKenzine, mistaken as polio due to similar symptoms and 2011). pathways of infection(Sabin, 1991). Although approximately 90 percent of infected persons will Factual Background: the Current Eradication appear asymptomatic, the remaining percentage can Campaign and its Origins exhibit symptoms ranging from a slight walking disability to complete paralysis or death (Global The distinction between control, elimination, and Polio Eradication Initiative, 2011). eradication of a disease is necessary to understand Like many other viruses, the polioviruses usually the current global campaign completely. Disease enter the host (in this case, humans) via the oral control occurs when the rate of contraction exists at route and migrate to the gastrointestinal tract where a level below that which would be expected if any they propagate. This is the point at which polio form of resources were dedicated toward its typically becomes asymptomatic, as the virus management (Barrett, 2004). Successful control relocates itself into the bloodstream as a dormant campaigns thus rely on high rates of surveillance, infection. In about 5 percent of cases, however, the proper diagnosis, and adequate infrastructure to virus actually enters the host’s bloodstream as an facilitate these activities (Gregg, 1984). Control infectious version and continues multiplying. Flu- campaigns are limited to certain geographical areas. like symptoms including headaches, fever, and Some diseases that are currently controlled include general malaise typically accompany this phase of cholera in various African countries (Dowdle, 1999). the viruses’ pathogenesis. Finally, in about 1 Conversely, disease elimination results when the percent of cases, polio enters its final and most temporary incidence of a disease reaches zero damaging phase by infecting the central nervous (ibid).Measles is an example of a disease that has system. Invading motor neurons, polio can cause been eliminated in several areas around the world. paraplegia or total paralysis. Most alarmingly, this Elimination is not the same as eradication, however, process can happen within a few hours following as there is always a possibility for the disease to 27 THE GEORGETOWN UNDERGRADUATE JOURNAL OF HEALTH SCIENCES 7(1), 2013 arise if a host were to somehow contract it. Finally, official launch, the smallpox campaign laid a vital disease eradication occurs when the rate of incidence framework for other diseases’ eradication programs. of a disease permanently reaches zero (ibid). Only For example, the program refined the classification smallpox and rinderpest have been fully eradicated and performance of epidemiologic surveillance by globally. One might consider the objective for all ensuring that all healthcare providers knew and international health campaigns as somewhere