THE ERADICATION of POLIOMYELITIS (Fhe Albert V.• Sabin Lecture)

Tꢀ EꢁICATION OF POLIOꢂELꢃTIS ꢄhe Albert ꢀ• Sabin ꢅtuꢆꢇ) by Donald Heꢀꢁrson, M.D., M.P.H. Univꢁrꢂity Diꢂꢃꢄnꢅꢆꢂhꢇ Servꢄcꢊ Professor ꢁ Johꢈ Hopkins Unꢄꢉꢊꢋꢄꢃy Bꢌlꢃimorꢊꢏ Marylꢌꢀ 21205 Cꢀo de ꢍdroꢎꢏ M.D., M.P.H. Rꢁgꢄoꢐl Adꢉꢄꢎor ꢑpaꢀꢒ Progrꢓꢁ on ꢔꢕꢖꢃꢄꢗn Pꢌn Aꢘrꢄcꢌꢙ Heꢌlth Organꢄzaꢃꢄon 5ꢜ5 23rd Strꢚꢛꢏ N.W. Waꢂhꢆngꢃon, D.C. ꢜꢝ37 Introducꢉioꢋ <ul style="display: flex;"><li style="flex:1">The </li><li style="flex:1">ꢔꢄderstaꢄdꢅꢋg ꢟꢄd ꢔlꢣimꢎꢉe coꢄqueꢤt of poꢚꢅomyeꢚꢅtꢅꢤ waꢤ Aꢀꢁꢂt Sꢎbꢅn'ꢤ ꢀiꢦe- </li></ul><ul style="display: flex;"><li style="flex:1">with hiꢤ earꢀieꢤt work </li><li style="flex:1">ꢀoꢄg preoccupꢎtioꢋ, ꢁꢃiꢄꢄꢅꢄꢃ </li><li style="flex:1">ꢅn 1931. (Sꢎbiꢋ aꢄd Oꢀiꣁsky, 1936; </li></ul><ul style="display: flex;"><li style="flex:1">ꢣhꢎꣁ effoꢂt ꢝꢎꢠ ꢎpꢉꢚy ꢤummarized by Pꢎuꢚ iꢋ hꢅꢤ ꢚꢟꢋdmaꢂk </li><li style="flex:1">ꣃꢎꢈin, 1965) </li><li style="flex:1">The mꢎꢃꢺꢊtude of </li></ul>hiꢤꢣory of polio: "No maꢄ haꢠ eveꢂ ꢆoꢄꢇiꢈuꢉed coꢄtiꢄꢔousꢚy over so maꢄy yeꢟrꢠ - ꢣo ꢠo mꢎꢄy ꢎꢤpeꢆtꢤ of poliomyeꢀiꢉꢅꢤ." (Pꢎꢔlꣂ 1971) Thuꢠ, ꢤo mꢔch effecꢉꢅve ꢊꢋꢌꢍmꢎꢉꢅoꢋ - aꢄd ꢏ ꢎppropriꢎteꢀyꣂ ꢉhiꢠ iꢋꢎugural Sꢎꢈiꢑ lectuꢧe dealꢤ ꢝith poꢚꢊomyeꢀiꢉiꢠ ꢎꢋd iꢉs eꢂꢎdiꢆꢎꢉꢅon. Poꢀio Vꢎccꢅne Deveꢀopmeꢋꢉ aꢋd Itꢠ ꢐꢑꢒꢓꢔctioꢋ <ul style="display: flex;"><li style="flex:1">ꢣhe queꢤꣁ foꢂ ꢕꢀio ꢖoꢋꢇoꢀ aꢋd ultimꢎꢉeꢀy erꢎdꢅcꢎꢉioꢋ, ꢠeverꢎꢀ lꢎꢋdmꢟꢧkꢘ deꢗrve </li><li style="flex:1">In </li></ul><ul style="display: flex;"><li style="flex:1">At the oꢔꢣꢠetꢱ pꢧogreꢤꢤ wꢎꢤ coꢄꢉiꢄgeꢋꢉ oꢋ the deveꢀopmeꢋꢉ of ꢎ vꢎꢖꢖine </li><li style="flex:1">ꢘꢙciꢎꢚ meꢋꢉion. </li></ul><ul style="display: flex;"><li style="flex:1">ꢎnd </li><li style="flex:1">the prodꢮctioꢋ of ꢎ vꢎꢖꢖꢅꢋe, iꢋ ꢛ neceꢤꢤitated the diꢻcover </li><li style="flex:1">y of ꢋeꢝ meꢣhodꢘ ꢉo ꢜoꢝ </li></ul><ul style="display: flex;"><li style="flex:1">quꢎꢺꢉiꢉieꢤ of virꢔꢤ. The breꢎkꢣhrough occꢔꢂred in 1969 ꢝheꢋ Enderꢤ aꢋd hiꢤ </li><li style="flex:1">ꢀarge </li></ul><ul style="display: flex;"><li style="flex:1">ꢤhowed thaꢉ ꢚaꢧge qꢔaꢺꢉꢅꢉieꢤ of polioviruꢠ coꢔꢀd be ꢞoꢝꢋ in ꢎ vaꢧiety of hꢔmaꢑ </li><li style="flex:1">coꢀꢀeꢎgueꢤ </li></ul>cꢪꢀꢀ ꢉiꢤꢤꢮe cꢮlꣁureꢤ aꢋd thꢎt the viꢂꢔꢤ coꢮꢀd ꢁ qꢔꢟꢄtiꢣꢟtꢊveꢀy ꢟꢠꢠꢎyꢡ by ꢅtꢻ cytopꢎꢉhic effect. (Enderꢘꢱ Weꢚler ꢟꢋd Robbiꢋꢤ, 1969) Prepꢎꢂꢎtion of ꢎꢋ inꢎcꢢvꢎꢣed vꢎꢖꢖꢅꢋe ꢝaꢘ, iꢋ pꢂincipꢴeꣂ ꢎ compꢎꢂꢎꢷively <ul style="display: flex;"><li style="flex:1">pꢨꢩꢪꢤꢘꢫ In brief, ꢀꢎrge qꢮꢎꢺꢉitieꢤ of virꢮꢘ ꢝeꢯe ꢜoꢬꢭ ꣁhen </li><li style="flex:1">ꢤꢥꢎighꢉꢦoꢧꢝꢎꢧd </li><li style="flex:1">pꢮꢯiꢰꢡꢱ </li></ul><ul style="display: flex;"><li style="flex:1">inꢎcꢉivꢎꢉꢲ with ꢳꢂmꢎꢴꢊꢋ ꢎꢋd bottꢀꢲꢵ </li><li style="flex:1">ce ꢉhꢟꢉ ꢣhe viruꢘ hꢎd ꢁen iꢑꢀꢶvꢎꢷꢸ ꢖouꢀd </li><li style="flex:1">Aꢤꢤuꢂaꢄ </li></ul>ꢹ demoꢺꢻꢥꢎted by ꢜowth iꢋ ꢣiꢤꢤꢮꢼ cuꢀꢉure. Wiꣁhiꢋ five yearꢤ aﬅꢪꢯ the Endeꢂꢘ' ꢽꢪꢕꢾꢿ ꢀarge-ꢤcꢎꢀe fieꢀd ꣀꢎꢀꢠ were ꢟꢀꢧeꢟdy uꢺderwꢎy ꢎnd iꢋ 19S5 ꢉhe ꢊꢋꢎcꣁivꢎꢉꢲꣂ ꢻo-calꢴed ꣃ꣄ vꢎcꢖꢅne ꢝꣅ ꢀiꢖeꢺꢘed ꢳr uꢗ꣆ 3<ul style="display: flex;"><li style="flex:1">Eventually, hꢀ selecꢃed ꢃhrꢀe cꢔndidꢂte ꢈꢃꢖꢂꢅnꢈ, plꢂqꢊꢀ-pu꣍ifiꢀd ꢃhem ꢔnd </li><li style="flex:1">rꢀꢁꢂꢃedly </li></ul><ul style="display: flex;"><li style="flex:1">ꢃꢀꢌtꢀd them for virulꢀncꢀ in mꢚꢨkꢀyꢈ ꢂnd chꢰmpꢔnzꢠꢀꢈ. </li><li style="flex:1">Smꢂꢝl-ꢈcꢂlꢀ ꢄꢅꢆꢇꢈ ꢅ꣈ ꢉꢊmꢋꢌ </li></ul>prꢚvꢀd ꢍꢊꢎcꢀꢏꢈꢐꢑ b꣆t ꢃꢚ ꢔꢍꢈꢠꢈꢈ ꢂdꢠqꢊꢔtꢀly ꢒꢃh ꢀtfꢓcꢂcy ꢔꢨd ꢈꢔfety, lꢔrgꢀ-ꢈcꢂꢇꢀ ꢄꢓꢔlꢌ <ul style="display: flex;"><li style="flex:1">iꢹvꢚlvꢅꢨꢶ </li><li style="flex:1">hꢕdꢖꢀdꢈ ꢚf ꢃhꢚꢊꢍaꢨdꢈ ꢚf ꢉuꢱꢔn ꢈꢊbjectꢌ werꢀ nꢀeded . Neꢅꢃhꢀr ꣋hꢀ Uꢨiꢃꢀd </li></ul><ul style="display: flex;"><li style="flex:1">Sꢃateꢌ nꢚr mꢚsꢃ ꢚf weꢈteꢗ ꢘuꢙꢚꢛ were suitꢔblꢀ ꢈiꢃꢀs. </li><li style="flex:1">Thꢀ Sꢜꢝꢞ vꢧcciꢹꢀ wꢧs, by thꢀn, i꣈ </li></ul><ul style="display: flex;"><li style="flex:1">us꣑ ꢂnd ꣆ꢨvꢂccinꢂꢃꢀd ꢈ꣆ꢈꢩꢀpꢃiblꢀ cꢉꢰldꢢꢀn wꢀꢢꢀ cꢚꢱpꢔrꢂꢃivꢀly fꢀw. Dꢀvꢀlꢚpinꢶ </li><li style="flex:1">widꢀꢈpꢢeꢂd </li></ul><ul style="display: flex;"><li style="flex:1">cꢚꢊꢨꢃrꢅeꢈ weꢢꢀ </li><li style="flex:1">unꢍꢂtꢅꢈfactꢚry ꢟcꢂꢊꢍꢠ ꢚf ꢃꢉꢀ wꢰdꢀꢈpꢢꢀꢔd prꢀvꢔꢑꢀncꢀ ꢚf nꢂꢃurꢔl ꢰnfꢠcꢃiꢚ꣈ ꢂꢃ </li></ul><ul style="display: flex;"><li style="flex:1">Eꢂꢍꢃꢀꢡ Euꢢꢚꢣ, hꢚwevꢀr, ꢚffꢀꢯꢀd ꢂ foꢯꢃuiꢃꢚuꢈ ꢚppꢚꢢꢃuniꢃy and, ꢅ꣈ 1956, </li><li style="flex:1">vꢀꢖy ꢀarly ꢧgꢀꢈ. </li></ul>Sꢂbꢅn beꢶꢔn ꢂ pꢢꢚd꣆cꢃꢰvꢀ cꢚllꢂbꢚrꢂtiꢚn wꢰꢃꢉ Acꢂdꢀꢱꢅcꢅꢔ꣈ Mikhaꢅl Cꢉuꢱꢚkꢚv, ꢃhꢀ Dꢓrꢀcꢃꢚr <ul style="display: flex;"><li style="flex:1">ꢚf ꢂ nꢀw Iꢨꢈtiꢃꢊtꢀ ꢤr Pꢚliꢚmyꢀliꢃiꢈ Rꢀꢈꢀaꢯcꢉ i꣈ Mꢚꢌcꢚw. </li><li style="flex:1">Iꢃ wꢔꢌ ꢂ cꢚllꢂꢥrꢆtiꢚn whicꢉ </li></ul><ul style="display: flex;"><li style="flex:1">By ꢃhꢀ ꢀnd ꢚf 1959, ꢱꢚꢢꢀ thꢂ꣈ 15 </li><li style="flex:1">uꢨꢓquꢀly, for thꢀ ꢀ꣍ꢂ, ꢦꢧꢨꢈꢩꢀndꢀd thꢀ Iꢢꢚn Cꢪꢫ </li></ul><ul style="display: flex;"><li style="flex:1">ꢺeꢙꢌꢚꢨꣂ in ꢃhe </li><li style="flex:1">ꢱꢓllꢅꢚꢨs </li><li style="flex:1">USSR had recꢀived vaccꢅꢹꢀ in fiꢀꢇd ꢬꢅꢧlꢌꢭ (Agꢚl a꣈d Dꢯꢚzdꢚ꣐, </li></ul><ul style="display: flex;"><li style="flex:1">1993) Iꢃ pꢢꢚved tꢚ bꢀ ꢮꢃꢉ ꢀffecꢃive ꢧnd sꢔfꢀ. </li><li style="flex:1">Baꢍꢀd pꢯꢰꢱꢔꢲly ꢚn ꢃꢉꢀꣂ꣑ Ruꣂꢈꢅaꢹ dꢂꢃꢂ, thꢀ </li></ul>w꣊ꢈ liꢩꢀnꢈꢀd vꢂccꢅnꢀ foꢢ us꣑ ꢓ꣈ tꢉꢀ Uniꢃꢠd Sꢃꢂtꢀꢈ i꣈ 1962. A vꢂccꢅ꣈ꢀ wꢉꢰcꢉ cꢚꢊld ꢳ ꢶive꣈ ꢚꢖꢆlly - ꢃꢉe ꢴ such vaꢩcꢓ꣈ꢀ ꢀvꢀr t꣄ ꢳ liꢀnꢵ <ul style="display: flex;"><li style="flex:1">- ꢚꢁnꢀd new pꢚꢈꢈꢅbilꢅꢃꢅꢀꢈ for lꢔꢯꢶeꢷꢸꢀ ꢅmmꢊꢨizaꢃꢰꢚn. Th꣍ꢚuꢶꢉꢚuꢃ thꢀ </li><li style="flex:1">950ꢈ, ꢃꢉꢀꢢꢀ ꢉꢔd </li><li style="flex:1">l</li></ul><ul style="display: flex;"><li style="flex:1">ꢧnd ꢼꢹ ꢚꢃꢉꢀꢖ coꢊꢹꢾꢿꢀꢌ, ꢃꢚ maꣂꢌ ꢩꢧꢱpꢧꣀꣁꣂ usꢿꢹg </li><li style="flex:1">ꢚꢺꢻsꢼꢃꢅꢚꢽ bꢚꢃh ꢓꢹ ꢃhꢀ UꢭS. </li><li style="flex:1">ꢳꢀꢹ </li><li style="flex:1">thꢀ S꣊lk </li></ul><ul style="display: flex;"><li style="flex:1">vꢂcꢩꢰ꣈ꢀ. Tꢉꢀ mꢀdiꢩꢂl cꢚꢱmuniꢃy ꢰ꣈ꢍꢰꢍtꢀd ꢚn ꢓnꣅ꣆lꢂtꢅꢚn꣇ ꢳꢓ꣈꣉ ꣊dꢱꢅ꣈ꢅ꣇꣋ꢀr꣌ </li><li style="flex:1">ꣃlꢅ꣄ </li></ul>ꢁ꣍꣎nꢔ꣏ly by ꢂ quꢆlifiꢀd pꢉyꢈicꢅꢔn ꢚꢢ undꢀr ꢉꢅꢈ clꢚꢈꢀ ꢌ꣆ꢁꢢ꣐ꢓꢈꢅꢚn ꢔnd tꢉꢀrꢀ ꢈiꢱply wꢀrꢀ nꢚt ꢀnꢚꢊgꢉ pꢉyꢈꢅcꢅꢔnꢈ ꢚr iꢹtꢀrꢀsꢃ ꢃꢚ ꢁꢢꢱiꢃ ꢔꢹ ꢓntꢀnsꢰvꢀ ꢇꢔrꢶꢀ-ꢈꢩꢂJꢀ ꢀffꢚꢢꢃ. Orꢆl vꢂcci꣈ꢀ ꣋otꢔlly Lꢅttlꢀ pꢢꢚfꢀꢈꢈꢼꢚnꢆꢇ ꢀxꢁꢢꢃꢅ꣇꣑ waꢈ ꢢꢀquꢅ꣍꣒ ꣋ꢚ assu꣍ꢀ ꢃꢉꢂꢃ ꢃwꢚ drꢚpꢌ ꣄f ꣊ꢇꢃꢀꢢꢀd ꢃꢉꢀ caꢇcꢊluꢌ. 5<ul style="display: flex;"><li style="flex:1">able </li><li style="flex:1">ꢒnd prepa꣄ed to play the role of ꢀieꢁtꢂsꢃ, advocꢘte, ꢄliꢅicꢆanꢇ cꢥꢏꢊician ꢈd </li></ul>epꢦdemꢏoꢥogisꢠ iꢊ trꢉꢊꢋꢌꢍꢊꢎng a concepꢠ iꢊꢅo p꣄actꢆcꢒl ꣄꣫aꢥi꣪y. Tꣀe Gꢥobal Challenge <ul style="display: flex;"><li style="flex:1">e widespreꢉd usꢛ of o꣦ꢉ꣎ </li><li style="flex:1">ꢄlꢏovaꢐꢐiꢊe iꢊ ꢰꢽe pꢑmꢒꢓꢔlꢕ ꢖopꢗcꢘl developꢏꢊg </li></ul>ꢜ rꢝaꢞlꢛd ꢠhaꢠ, unꢰꢔl ꢭhe 1970sꢇ ꢄlio waꢋ coꢙnꢚies ꢄsꢛd ꢠꣀe ꢫlꢠimaꢠe cꢽalleꢊge. It sꢽould ꢠꢽougꢽꢠ ꢅo ꢜ ꢉꢊ iꢊcoꢁꢟueꢊꢠiꢒꢞ p꣧obꢥem for ꢠhe developing wo꣦ld꣙ (Sabꢏꢊ. 1981) geꢊerꢉllꢕ <ul style="display: flex;"><li style="flex:1">Mosꢠ sꢙcꢽ coꢙꢊꢡꢏes re꣐o꣧ded </li><li style="flex:1">few cꢉꢢsꢣ In pꢉ꣧ꢠ, deficꢏe꣋ꢅ repor꣪ꢗng wꢤ resꢄnsꢆbꢥe buꢠ </li></ul>epidemꢏologists posꢭꢫ꣎atꢛd also ꢠhaꢭ ꢦꢱ ꢠꢽesꢛ ꢐoꢙnꢚꢦes almosꢅ all cꢽiꢥd꣧en ꢧcꢉꢨe iꢁfecꢅꢛd <ul style="display: flex;"><li style="flex:1">so ꣫ꢘ꣄ly iꢊ life ꣪haꢠ vꢩly a꣎ꢥ develoꢪd ꢏꢨꢨꢫꢬꢭꢕ wiꢮouꢠ pa꣄aꢥꢕsis. </li><li style="flex:1">Polio ꢦꢨmꢯꢰꢔoꢊ </li></ul>ꢊoꢭ coꢊsidered ꢠo ꢜ a ꣀꢆgꢽ prꢆo꣦i꣪y aꢊd, ꢔꢱdꢲꢳ ꢉs of 1975, ꣪hꢙ꣌ leꢴ ꢃhaꢊ 5 ꢵrcꢛꢊꢠ of wꢤ <ul style="display: flex;"><li style="flex:1">cꢽiꢥdreꢊ ꢗꢊ ꢠꢽe .develop꣡ꢊg worꢥd were ꣦eceivꢏng ꢄliovacꢶꢆꢊeꢷ </li><li style="flex:1">Durꢆng ꢭhe earꢥꢕ l970s꣈ </li></ul><ul style="display: flex;"><li style="flex:1">ꢽoweverꢇ "lꢉꢨeꢊe꣖s su꣧veys" begꢒ꣑ </li><li style="flex:1">ꢧ cꣁꢊducꢠed, ꢸꢹꢠ ꢗꢊ </li><li style="flex:1">Iꢊdoꢊesia a꣑d Gꢽaꢊa ꢉꢊd laꢠeꢓ </li><li style="flex:1">ꢠo </li></ul>ꢼꢽeꢾ su꣧veys of ꢿꣀꣁꣂl chꢆꢥdreꢊ ꢨ꣫asured ꣪ꢽe p꣣ꢛvꢒle꣑꣐ꢛ of leg <ul style="display: flex;"><li style="flex:1">ꢺoꢫꢁꢚꢔesꢻ </li><li style="flex:1">i꣑ oꢠher </li></ul><ul style="display: flex;"><li style="flex:1">cꢽꢉ꣄acꢠe꣄isꣅc of rꢛsꢏdꢙal ꢄlꢆo pꢉ꣦aꢞꢕsis. </li><li style="flex:1">wꢛaꣃess </li><li style="flex:1">꣆u꣇rꢔsiꢊgꢞꢕ꣈ ꢠꢽe su꣉eꢕs꣊ wꢽerevꢛꢓ </li></ul>꣐oꢊducꢠed, revꢛaled raꢠes wꢽꢎcꢽ we꣧e as ꢽꢔgꢽ as iꢊ ꢰhe ꢔ꣋dꢫ꣌꣍ꢏa꣎ꢔ꣏ ꣐oꢙ꣑꣍ꢔes before <ul style="display: flex;"><li style="flex:1">ꢜ꣐ame avaꢔlable. (Nicꢽolꢉs, K꣄a꣒꣄ꢇ Ofo꣌ꢙ-Ammah ꢈd Belcꢽe, 1977) e </li><li style="flex:1">va꣐꣐ꢔ꣋e </li></ul>ꢺoꢨplacꢛꢊcꢕ wiꢠh whicꢽ ꢄlio had ꣓ꢊ view꣔ iꢊ the developiꢊg ꢺꣂu꣑꣕e꣖ w꣗ sꢽaꢠꢠeꢓ꣘꣙ <ul style="display: flex;"><li style="flex:1">B꣚aꢙꢾ of ꢠꣀe꣛ ꣜d꣝꣞gs꣟ orꢘꢥ ꣠l꣡ꣁvꢒꢺꢺ꣡꣢e wꢘs </li><li style="flex:1">o꣑e of six aꢊꢅigeꢊs sꢛꢥecꢅ꣫d i꣋ 1974 </li></ul><ul style="display: flex;"><li style="flex:1">ꢠꢽe World Heꢉlth O꣣gꢒ꣤at꣝oꢱ (WHO) to ꣥ ꣡nco꣦ꢄ꣧aꢭ꣘ ꢏ꣑ a ꢊew gꢥobꢉl p꣣og꣣ꢒm ꣨r </li><li style="flex:1">by </li></ul>however꣈ wꢽo exp꣣꣫ꢋ꣬ sk꣫pꢠici꣭ a꣮uꢠ ꢭꢽe iꢨꢨꢫni꣩꣪ionꢣ There were mꢘnꢕ꣈ 7health officꢕaꢶs in the Americꢵs appꢶauded the effort buꢡ ꢀw ꢶꢕꢄꢡꢶe hoꢁ ꢂꢃ ꢮoꢜꢒꢝiꢢg a <ul style="display: flex;"><li style="flex:1">ꢄyꢁ of cꢵmpaꢕgꢒ ꢨꢒ a ꢢoꢢ-ꢡoꢡaꢶꢕꢝaꢋꢨꢵꢒ ꢏꢝaꢡe. </li><li style="flex:1">sꢨꢮꢕꢶar </li></ul><ul style="display: flex;"><li style="flex:1">Coꢜꢶd </li><li style="flex:1">ꢇ, </li><li style="flex:1">a ꢢaꢡꢨonwꢕde cꢰꢮpaꢨgꢒ bꢣ coꢢducꢡed ꢕꢒ a </li><li style="flex:1">couꢅꢆy oꢝꣅeꢃ ꢄhꢵꢢ Cuba aꢒd, if </li></ul>ꢕꢡ <ul style="display: flex;"><li style="flex:1">ꢮꢸghꢡ have? Bꢃꢈꢉ sooꢢ pꢃovꢕded aꢒ an꣋wꢓ꣨. </li><li style="flex:1">whaꢡ effecꢡ </li><li style="flex:1">As of 1980, ꢊꢋꢌꢍꢎ'ꢏ ꢋꢐuꢑꢒꢓ </li></ul>pꢃog꣝ꢵꢮ wꢵꢏ <ul style="display: flex;"><li style="flex:1">aꢔg </li><li style="flex:1">coꢦerage of ꢶeꢗ꣋ thaꢒ 50%, deꢗpꢕꢡe wꢕdꢖꢗpꢘꢙd </li><li style="flex:1">ꢦaccꢨꢒꢵꢡꢕoꢢ </li><li style="flex:1">ꢎeꢦeꢶꢏ of </li></ul>pꢃograꢮꢏ deꢏꢕꢚed ꢡo educaꢡe aꢅd ꢮotiꢦaꢡe tꣅe ꢛpꢜꢎaꢝꢞoꢟ aꢠuꢡ ꢡhe ꢢꢣꢤ ꢥꢃ ꢦacꢧꢨnaꢩoꢒꢪ <ul style="display: flex;"><li style="flex:1">ꢊrꢵzꢕꢎꢕꢵꢒ hꢖaꢉtꣅ ꢗꢝaff reꢦertꢣd ꢡo a ꢮꢵꢏs caꢮꢯꢰꢞꢱ ꢗꢆꢰꢡegyꢲ oꢢe which </li><li style="flex:1">Iꢒ ꢫuꢏꢬaꢡꢕoꢢꢭ </li><li style="flex:1">꣚heꢿ </li></ul>hꢰd ꢁꢘꢳecꢡꢣd dꢴg ꢡꣅe ꢏꢮꢵꢶꢎꢷx eꢃadꢨcaꢡꢨoꢢ campaꢸꢹꢺ ey dꢻꢕded ꢡo oꢘꢾꢵꢢꢕze two ꢒaꢡꢨoꢢꢵꢉ ꢕmꢮꢜꢒꢨzꢵꢡꢨoꢒ dꢰyꢏ each yꢓꢵ꣨. (Rꢨꢗꢕꣴ 1984) Iꢒ 1980, ꢮore thaꢢ 300,000 coꢮꢮuꢢity <ul style="display: flex;"><li style="flex:1">uꢡꢕꢼꢨꢽꢢꢾ 90꣌000 ꢦaccꢕnaꢡꢨoꢢ poꢗꢡs, ꢦaccꢕnaꢡed ꢏoꢮe 20 ꢮiꢉlꢕoꢢ chꢕꢎdꢃeꢢ uꢒde꣈ 5 </li><li style="flex:1">ꢦoꢼꢜꢒꢡeꢖꢃꢗ꣌ </li></ul>oꢒ each of two Naꢡꢕoꢢꢰꢼ ꢿeꣀs ꢄꣅꢕꢏ age Iꢮꢮꢜnꢨzꢵꢡꢕoꢒ Days. Thꢕꢏ ꢃepꢃeꢏeꢒꢡꢤ aꢠuꢡ 90% of chꢞꢎd꣈eꢢ <ul style="display: flex;"><li style="flex:1">Aꢢd </li><li style="flex:1">tꣅꢕ꣋ haꢗ ꣂeꢒ ꢝhe pracꢡꢨce eꢦe꣝y yeaꢃ sꢨꢒꣳeꢪ The ꢃeꢏuꢎꣃ weꢃe </li></ul><ul style="display: flex;"><li style="flex:1">ꣁoup. </li><li style="flex:1">ꢞꢒ </li></ul>d꣈ꢵꢮaꢡic. Re꣭orted ca꣋ꢣꢏ proꢮptꢼy dꢃoppꢣd ꣄oꢮ ꢮo꣝e ꢄꣅ꣆ 20꣇ ꢁ꣈ yꢣꢵꢃ to ꣉꣇ oꢃ ꢎ꣊꣋꣌ ꢰꢒd ꢮoꢗt of ꢏouꢝꣅe꣍ ꢊ꣎ꢈꢎ ꣏came ꣐ꢎꢨo꣑ꢫ꣒. <ul style="display: flex;"><li style="flex:1">Meꢵꢒwhꢕꢎe, wꢕꢄh ꢶeaderꢏhꢞp ꣓oꢮ tꣅe Pa꣧ Amerꢸca꣧ Health ꣔g꣕oꢟ (P </li><li style="flex:1">AHO)꣌ </li></ul>\ꢯ꣈oꢾ꣎ꢵꢮꢗ ꣖꣈ ꢕ꣗muꢒ꣘꣙꣚ꢕ꣛ꢢ ꢄhr꣛ugh꣛uꢡ ꣚ꣅe Aꢮericꢵs hꢵd pꢃo꣜e꣋sꢕꢦeꢎy ꢕꢮp꣝oꢦꢤꢪ Poꢎio <ul style="display: flex;"><li style="flex:1">iꢟꣳꢕdeꢒce ꣞ꢎꢶ ꣋teꢰdiꢎꢿ ꢵꢒd, </li><li style="flex:1">꣤꣧ 1985, the couꢢ꣟es a꣜꣠ thaꢡ ꢰ hemisphe꣨e-wide eꢃꢰdꢞ꣡꣢oꢟ </li></ul><ul style="display: flex;"><li style="flex:1">shouꢶd ꣣ ꢜꢢderꢡꢵkeꢒ wꢕꢡꣅ the objectiꢦe of ꣤ꢒꢡe꣥ꢃꢜp꣦꣧ꢾ ꢷꢶioꢦꢞ꣨꣩ ꣪꣫ꢞo꣧ bꢿ </li><li style="flex:1">effo꣨t </li></ul>꣬eceꢮꣂꢃ 1990. (de Quad꣈o꣋ꢭ eꢡ aꢶ.꣌ 1991) This ꣭꣎꣛꣮꣗ b꣈꣛ke ꣰ew ꣯꣛u꣰d iꢒ pubꢎic ꢕꢢ ꢕꢡs ꢜ꣱ of epꢕdeꢮꢞoꢎogy ꢡo ꢾꢜꢞde sꣲꢰꢡeꢾy ꢵꢒd tꢰꣳ꣦ꣳꢏꣴ ꢕꢢ ꢕꣃ iꢢꢦoꢎꢦeꢮeꢢꢡ of heaꢎtꣅ 9<ul style="display: flex;"><li style="flex:1">program and to ꢀeꢁꢂꢃ iꢄs findꢇngꢘ </li><li style="flex:1">ꢄo ꢄhe Inꢄeꢅꢆꢇonal Coꢤꢤiꢘꢘion. </li></ul>On Sepꢄemꢈꢉ 29, 1994, the Inꢄeꢊaꢄꢇonaꢋ Coꢤꢤiꢘꢘꢇon, ꢌer furtheꢀ deꢍiꢈꢎaꢄionꢏ ꢎeꢁrꢐed finally ꢆo ꢆhe <ul style="display: flex;"><li style="flex:1">Mꢇniꢘꢄerꢘ </li><li style="flex:1">"Bꢒd on ꢄhe ꢩꢙpꢀeꢘꢘꢇve </li><li style="flex:1">of Heaꢍꢆh of ꢑe Pꢜn Aꢙericꢜn H꣆ꢗꢋꢄh Conference: </li></ul>evidenꢢe ꢘubmꢇꢄꢄed, ꢄhe ICCPE ꢢonꢠꢋudeꢘ thaꢄ wiꢋd ꢓꢋiovirꢔꢕ ꢖꢗnꢘꢙiꢘꢘꢇon hꢜꢘ ꢈen ꢇnꢄerrꢔpꢐed ꢇn ꢄhe Aꢙer꣋ꢠas." Sꢚꢛꢜꢄeꢝ ꢜꢶd Tꢜcꢐicꢘ in Polio Erꢜdicꢜꢄion The fiꢀꢘꢆ ꢀeqꢔꢇreꢙenꢄ for <ul style="display: flex;"><li style="flex:1">eꢀadicꢜꢄꢇon ꢞꢉoꢟ iꢘ ꢜ coꢙꢙꢇtꢙenꢄ ꢹy aꢍꢋ ꢆhe </li><li style="flex:1">an </li></ul>ꢢoꢔnꢄꢀꢇeꢘ ꢠonꢠeꢡed both ꢆo ꢔndertake needed efforꢆꢘ in ꢄheꢩr cooꢞerate wꢇꢐh otherꢘ iꢶ ꢢooꢛdinated heꢤꢇꢘphere-wꢇde acꢐiviꢄieꢘ. own counꢖꢇeꢘ ꢜnd ꢄo

THE ERADICATION of POLIOMYELITIS (Fhe Albert V.• Sabin Lecture)

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