Sunday, November 2, 2014

Uncertain Health in an Insecure World - 5

The Boogeyman

In Dr. Khaled Hosseini’s acclaimed first novel ‘The Kite Runner’, the protagonist's polio-afflicted family servant, Ali, had a “twisted and atrophied” right leg. The children of Wazir Akbar Khan neighborhood called him Babalu – The Boogeyman. Ali gamely navigated the dangerous streets of Kabul, until he died after limping onto a landmine in Hazarajat.

With the recent observance of the 100th anniversary of Dr. Jonas Salk’s birth and World Polio Week, it is worth noting that while hundreds of millions have been vaccinated world-wide over the last sixty years, polio remains endemic in Afghanistan, Pakistan and Nigeria. The World Health Organization (WHO) has declared a wild polio virus exporting emergency in several countries, including Pakistan, Afghanistan, Syria, Iraq, Cameroon and Equatorial Guinea.

Yes… polio myelitis… febrile crippler of young bodies, diabolical spawner of the iron lung, has made a terrible resurgence in the war torn and teeming cities of southwestern Asia and Africa.

Polio is a stigma – a national mark of Cain – symbolizing the breakdown of a society.

Worldwide, the widespread use of oral polio vaccine has reduced cases from >350,000 per year in 1988 to just 416 in 2013. With only one in 200 cases resulting in paralysis, and only 5-10% of those experiencing respiratory symptoms, polio is more of a lurking health threat than a deadly epidemic. 

In his Pulitzer Prize winning treatise ‘Guns, Germs and Steel’, Jared Diamond chronicled civilization’s ascent in the face of decimating plagues and contagions, including epidemic polio which was first documented in 1840.

The same disease that struck fear into the hearts of parents for generations until the 1950’s (see the photo of 1954 vaccinations in Canada), sparing neither the rich nor the poor, has since been essentially eradicated in the developed world. Type-2 polio has been absent since 1999.

Unlike the yearly influenza vaccines that must tack to the unpredictable shifts and drifts of hyaluronidase (H) and neuraminidase (N) mutations, there is no polio “season”. In fact, polio is one damn boring virus – the three polio virus types have not mutated since the days of Salk and Sabin.

But polio is not just another debilitating childhood disease. The recent resurgence of polio, a disease preventable through childhood vaccination, is an indictment of the public health systems of the worst afflicted countries.

More modern “great vaccinators” who boldly predict the availability of millions of anti-Ebola vaccine doses by 2015, must also privately cringe at the thought of millions of children at risk failing to be immunized against polio.

 Human rights workers and relief organizations alike are eternally frustrated by embargoes and threat lists that prevent the delivery of inexpensive vaccine doses into the hands of enemies of their polio-free states.

Regional strife is the greatest impediment to the global eradication of polio.

Polio, not poor Ali, is The Boogeyman for many of the world's children.

Let's stop polio from stalking The Square.

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