Polio campaign: was stoppage less dangerous than the vaccine?

If Pakistan really wants to be polio-free, it's more important to spend much more on clean water supply, sanitation.

The Taliban may have hijacked the polio eradication campaign for all the wrong reasons, but that still does not make the programme a desirable one.

The government and other institutions continue with the authoritarian patronage mentality, not feeling it necessary to inform and educate people first so as to enable them to make informed choices. There is an assumption that the powers-that-be always know better, reflecting contempt for the illiterate or less-educated masses — just as government hospital doctors do not bother to explain to patients the nature of their problem, often not even providing the name of the disease they are affected by.

The government has either not kept up with developments surrounding the polio vaccine, or it has chosen not to divulge inconvenient information to the public. Should it not have told us that the oral polio vaccine itself, for example, has also become a carrier of polio? Should we not have been told which vaccine is being used in Pakistan? Is it the newer, ‘inactivated’ risk-free vaccine, which the US and other industrialised countries started using after abandoning the previous one? Or is it based on the original vaccine made from a live poliovirus which carries the risk of transmitting polio — but is still used in Third World countries because it is much cheaper, even though there continue to be outbreaks?

It was the late Dr Maurice Hilleman, developer of Merck’s vaccine programme, who discovered that the new virus had come about via the polio vaccine he had developed. Given that this vaccine is now the leading cause of polio paralysis, it makes one wonder about the real reason this campaign is being thrust on us, complete with threats of not allowing Pakistanis to travel abroad — or even blockade us — if we fail to carry out the programme.

This is certainly a matter for the professionals, and yet, the medical community continues to be inexplicably quiet on the issue. The electronic media needs to look beyond the senseless killings into the vaccine itself.

A dangerously erroneous impression that prevails is that the oral vaccine alone prevents polio, mainly because the government disseminates little of relevance and would be caught out in its neglect of health infrastructure if it preceded polio campaigns with an information blitz about how polio is caused.

It is important to drive home the message clearly and unambiguously that polio arises from unhygienic conditions. There is only one cause to polio and that is infection through the poliovirus, which infects humans and humans alone. It is extremely contagious and spreads easily from person to person. Specifically, it mostly spreads through contact with the faeces of the infected person, which can be through unwashed hands or inadequately cleaned utensils or clothing or other surfaces touched.

To a lesser extent, it can also spread through infected saliva or respiratory secretions. It is not restricted to any season and in Pakistan’s warm climate and widespread unsanitary conditions, thrives more easily. Infected persons can, therefore, also infect outsiders as they come into contact with them, who otherwise practise very hygienic habits.

It is important to be aware that the live poliovirus enters the intestinal tract and mucus in the nose and throat of infected persons for one to two weeks, or in the faeces for up to two months, according to the Global Vaccine Institute. This makes the rest of the household extremely susceptible, children and adults alike.

If Pakistan really wants to be polio-free, it is more important for governments to spend much, much more on clean water supply and household sanitation, specifically on toilets that are easy to maintain — at least two in every home; one for the men, and the other for women and children. In the bargain, this would help eradicate a whole lot of other water-borne diseases that also affect us.

Without cleanliness, the oral polio vaccine can do very little good. In fact, in a previous round, 78 per cent of Pakistani children, who contracted polio, turned out to be the very ones who had been vaccinated earlier. The Centres for Disease Control (CDC) confirms that it is possible for children to develop polio from the vaccine itself. According to the World Health Organisation (WHO), despite the large percentage of prescribed vaccinations carried out, Pakistan had the highest number of polio cases in a decade.

What is worse, the virus in the vaccine can mutate into deadlier versions. Seemingly, the wild virus is being replaced by the vaccine-derived one, which causes paralysis. Earlier this year, an international meeting was organised by WHO in collaboration with the US Centres for Disease Control and Prevention (CDCP) and the Japanese ministry of health on this matter. Why haven’t we heard the outcome of this?

Meanwhile, those who want to be kept informed and updated for their own protection could sign up with the free online advocacy portal of the National Vaccine Information Centre (NVIC), USA, the world’s leading source on vaccines and infectious diseases. The founder of the NVIC had long ago said that “with mounting evidence that cross-species transfer of viruses can occur, the United States should no longer be using animal tissues to produce vaccines”. Incidentally, NVIC has throughout advocated for informed consent to vaccination, something that our own government or international backers seem to feel differently about.

The fact remains that vaccines don’t work for everyone invariably; they may work for some, but also fail others disastrously. And yet, the authorities were ready to penalise parents in some way or the other if they refused to let their children be vaccinated. Now, they can divert attention and blame it on the Taliban instead. Vaccines by the millions make a lot of money for pharmaceutical companies producing them, but polio is too high an individual or national price to pay for profits.

Published in The Express Tribune, January 24^th, 2013.