Polio deaths

In previous posts I’ve discussed the ways that diseases tend to persist in war-torn regions in ways that they don’t in other places.  For example, vivax malaria persists along the region separating North and South Korea, and Myanmar continues to have malaria even after neighboring nations such as Thailand and China have been relatively successful at controlling malaria.  I would suggest that the reason for this relation between disease and war has a lot to do with the conditions in which people that live in war zones must live.  When people flee an area where war has begun and cram into refugee camps, it’s predictable that there will be crowd- and hygiene-related disease.  Expect problems with intestinal and diarrheal diseases such as cholera.  Furthermore, while dodging bullets it’s probably hard to worry too much about drugs and bugs.  Public health efforts fall to the wayside.  

Frankly, if people would just stop acting like jackasses we would probably have a lot less trouble in our world.  But that’s probably too much to ask for.

Today I’d like to specifically talk about poliomyelitis (polio).  Polio is a viral disease and it spreads extremely easily via fecal and oral transmission.  Many who become infected with the virus never exhibit symptoms; however children under 5 are disproportionately affected.  Symptoms can vary widely, with the worst being paralysis and even death when the muscles necessary for breathing cease to function.  There is no cure for the disease.

Polio was historically a major problem even in Western nations such as the U.S.  By the late 1800s it was recognized as a severe and perhaps growing threat and in the 1950s a successful vaccine was created.  Since then a LOT of progress has been made in the control and even eradication of polio.  Today it really isn’t much of a problem for most of the world.  Or is it?

1963 poster from the U.S., courtesy of CDC and Mary Hilpertshauser

According to the World Health Organization, the only remaining nations with endemic polio are Nigeria, Afghanistan, and Pakistan.  These are places that frequently make the major news for reasons other than disease and probably aren’t on your radar when planning a family vacation (I apologize in advance if I’ve offended people in the tourism industry in any of these places).  But remember that most (around 90%) people are asymptomatic and that we have a highly mobile global population.  So you may not be worried about your kids getting polio while hanging out on a beach in Nigeria, but that doesn’t mean that it can’t wind up in your neighborhood (though most U.S. schools require you to get a vaccine before attending).

Anyway, the reason that I’m writing about polio today is that it keeps popping up in the news, most recently with regard to Nigeria.  Nigeria has been having some trouble lately.  For example, the radical religious group Boko Haram has been terrorizing a good chunk of the country now for several years.  The words Boko Haram can be roughly translated from Hausa to English as “Western education is forbidden”.  These guys REALLY don’t like “modern” Western science, which can be a real problem for people who like to save lives by practicing that modern Western science.  If you haven’t heard of them, keep your ears open because I think you’re going to be seeing their name a lot in the future.  

To get back to the polio story, several religious leaders in Nigeria have warned their followers against becoming vaccinated against polio.  Some have claimed that it will make you infertile while others claim that it will actually infect you with the virus (though I suppose if you’re a Boko Haram follower then viruses don’t exist in the first place).

Obviously this is a public health problem, but things have recently taken a drastic turn for the worse.  In the last week it appears that health care workers who administer the vaccine are actually being targeted by gunmen.  At least 9 were killed last Friday.  While no group has claimed these attacks, they resemble previous attacks that have been attributed to Boko Haram.  Perhaps even more disturbing is that these killings come just a couple of months after similar killings in Pakistan, which also targeted polio vaccinators.  In Pakistan, the Taliban has suggested that health care workers are working with, or actually are, CIA operatives.  (And while this may seem crazy, remember that the CIA did pay a Pakistani doctor to help in the capture of Osama bin Laden).

Clearly this is a pretty terrible situation.  Several organizations have hoped to actually eradicate polio, but clearly this won’t happen if the virus is allowed to persist in human populations.  (The potential for nonhuman hosts might also be an issue here, but getting it out of human populations is a noble cause anyway).  

Furthermore, what does this mean for future public health efforts in this region?  I suppose we can continue to bring outsiders in to vaccinate, but in my opinion it is always better to have local people maintaining public health efforts.  And when the news of this type of violence spreads through regions where it is occurring, I can’t help but think that it will in some ways shape the future of public health in those regions.  The children who are growing up now, who are just beginning to form ideas about what they will do when they are older, are now facing a world where being a medical provider can be a very dangerous thing.  Not everyone who goes into medical practice or public health does so because they have a passionate desire to practice medicine.  Some do it because it’s a relatively OK job and the added benefit of it helping others out gives it a sugar coating.  I worry that, for this type of person, a career giving vaccinations to local people will no longer be on the radar as a future potential occupation.  This could be a tragedy for public health, meaning that it would also be a tragedy for global health.