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Holding the Polio Vaccine Hostage

Since the development of the vaccine, perhaps the most effective public health measure we have yet devised, only one human disease has been completely eradicated from the world – smallpox. The last case was reported in Somalia in 1977. Eradication was the result of a deliberate and intense campaign, requiring almost complete vaccination of the population, especially in certain population dense areas. Countries such as India and Nigeria were among the last to achieve eradication. Some of the lessons learned were that very high compliance rates were needed and that even small communities could harbor the virus and prevent eradication.

Several decades later, at the beginning of the 21st century, we are on the verge of eradicating a second major human infectious disease, polio. Like smallpox, polio is a virus that has no major non-human host, so eradication is possible. The polio virus enters the anterior horn cells of the spinal cord, the lower motor neuron – cells that connect the brain to muscles. When those cells die muscles lose their connection causing weakness and atrophy. Vaccine campaigns have successfully eliminated polio from most countries, but the wild type of the virus remains endemic in Nigeria, India, Pakistan, and Afghanistan.

We have the potential, with one final push (which is being spearheaded by the World Health Organization – WHO) to eradicate wild type polio from the world, but these efforts are being hampered by politics and ideology.

In 2002 the WHO had hoped to eradicate polio from Nigeria by the end of that year, and the rest of the world by 2005. Now seven years later that goal has still not been reached. The problem is not lack of funding, will, or scientific knowledge, but rumor and ignorance. Certain Muslim clerics began preaching to their people not to take the polio vaccine. The reasons varied, but were all based in fear of the West. For example, a BBC article from 2002 reported:

I am sceptical and apprehensive about the polio campaign given the desperation and the rush of the sponsors, who are all from the West,” a young scholar, Muhammad bin Uthman, told the French news agency AFP.

Clerics spread fears that the AIDS virus was being spread (some even claimed deliberately) in the vaccine. Others cited the Pfizer drug scandal from 1996  when an untested drug (an antibiotic called Trovan) was used to treat bacterial meningitis and resulted in a reported 11 deaths and others injured. The WHO was eventually able to get passed many of these rumors, but the opportunity for eradication was lost and now the WHO is playing catch up.

Once again, however, politics and ideology are getting in the way of world-wide eradication of polio, this time in Pakistan and Afghanistan. Several factors are at work to frustrate eradication plans. Pakistan recently abolished its health ministry, so the WHO has to work directly with local leaders who may be less receptive to foreigners. The Taliban has long opposed vaccines. Time World reports:

In 2007, a doctor who spoke out against anti-vaccine propaganda was killed in Bajaur agency. The same year, he notes, Taliban fighters kidnapped a public health worker and held him captive until he promised to stop vaccinating children. Last August, Taliban gunmen captured and killed ten aid workers in Afghanistan, claiming they were spies. Such incidents keep health workers out of high-need conflict zones, often the very areas that are in need of care.

This distrust was greatly exacerbated in 2011 when the CIA used a vaccine clinic and its health staff to gather DNA from Osama bin Laden’s children and help locate Osama. This action confirmed the worst fears and rumors of the Taliban – that health workers are really spies working for the US government.

The Taliban has also announced recently that they will not allow the polio vaccine campaign in North Waziristan until the US stops its drone campaign. Estimates range from 280,000 to 350,000 affected children, who will not receive the oral polio vaccine because of the Taliban ban. They are essentially holding the public health, and world health, hostage as a political maneuver.

The CIA using health workers as spies has been universally condemned as reckless. Health workers in general and the vaccine program specifically must be kept apolitical and civilian. The Taliban is also committing a crime against humanity by using an essential health campaign as a political bargaining chip.

We have the ability to eradicate polio from the world and spare countless children from a crippling illness. Since 1988 polio cases have been reduce 99.8% by the WHOs eradication campaign, but endemic polio remains in the four countries named. The polio virus is highly contagious, and because of the potential of world travel if the world wide polio vaccine program is not kept up the virus can rapidly reestablish itself. We have the ability to eradicate this disease, to confine the polio virus to secured laboratories. We have the knowledge and resources – only ignorance and politics now stands in the way. Perhaps we need severe world wide pressure on the four remaining countries to stop their resistance and cooperate with the vaccine campaign. This is an issue of world health that should not be held hostage to any one group’s immediate desires or ideology.

Posted in: Vaccines

Leave a Comment (37) ↓

37 thoughts on “Holding the Polio Vaccine Hostage

  1. lilady says:

    Excellent article Dr. Novella. India’s last case of wild polio occurred in 2011 and in 2012 it was declared “polio free”:

    http://www.polioeradication.org/Infectedcountries/India.aspx

    There are still cases of wild polio, however in the countries you mentioned:

    http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

    We still are fighting anti-vaccine groups and individuals here, who claim that all cases acute flaccid paralysis is caused by the oral polio vaccine…when we have at hand the few number of AFP cases caused by the vaccine:

    http://apps.who.int/immunization_monitoring/en/diseases/poliomyelitis/afpextract.cfm

  2. cervantes says:

    Indeed it would be a catastrophe if polio were to get loose in areas where it has long been absent, and children are generally not vaccinated.

    We need to be clear about a couple of issues, I think. The Muslim clerics who opposed polio vaccination campaigns in Nigeria have either been persuaded or neutralized. As you say, the problem is now in Pakistan particularly (not so much Afghanistan). And the current position of the Taliban is not that polio vaccination is per se a plot. Rather, the incident with the CIA using vaccination (not polio, BTW, but still) as a ruse to try to collect OBL’s DNA created immense resentment. The current Taliban ban on polio vaccination in North Waziristan is avowedly a tactic to stop the drone attacks; they accept vaccination in principle. So at this point it’s not so much a problem of unscientific beliefs as it is of geopolitical conflict.

  3. ConspicuousCarl says:

    I agree that the CIA stunt was unethical and has harmed the doctors’ mission. Perhaps we can negotiate a compromise here. The WHO can deliver the polio vaccine in buckets of battery acid, and the Taliban can throw it on the kids.

  4. Janet Camp says:

    @CCarl

    Is that supposed to be funny–or even sarcastic? Ick.

  5. Zetetic says:

    The crazy continues…

    “WHO doctor in anti-polio campaign shot in Pakistan”

    http://seattletimes.nwsource.com/html/nationworld/2018703905_apaspakistanpolio.html

  6. ConspicuousCarl says:

    Janet,

    Maybe you don’t follow this stuff, but that’s the sort of thing the Taliban gets up to:
    http://www.foxnews.com/story/0,2933,451941,00.html

    The point is, as unethical as the CIA operation was from a medical point of view, it would be ridiculous for the Taliban to complain about it.

  7. cervantes says:

    OT but important. Why Disclosure Matters: Supplement Industry Woos Romney With $4.5 Million:

    “As Romney refuses to disclose his top supporters, USA Today has stitched together its own list of Romney’s bundlers based on FEC data and media reports. One group that emerged: supplement companies, which are struggling to stave off regulation for pills and diet products that have so far evaded FDA scrutiny. Top executives at such companies have donated over $4.5 million to Romney’s campaign or to Restore Our Future, a supporting PAC, and have hosted big-dollar fundraisers to back his campaign.

    Romney’s campaign told the paper that “People who support Mitt Romney do so because they support his pro-growth, pro-jobs agenda for the country,” its standard response to donor stories.”

    And CC, saying “The Taliban are worse so why are you complaining about the CIA” is a defense that even a four year old knows doesn’t work.

  8. ConspicuousCarl says:

    I didn’t say WE shouldn’t complain about it, I said the Taliban shouldn’t. Thanks for demonstrating your own inner 4-year-old.

  9. cervantes says:

    Well, I’m pretty sure the Taliban don’t care what you think they should do. So if you were actually talking to them, I wouldn’t have bothered.

    What makes you think my comment was immature?

  10. Composer99 says:

    ConspicuousCarl:

    Hypocrisy is always disagreeable but I fail to see how it is logically relevant to whether or not anyone, even the Taliban, can complain about CIA agents posing as vaccine administrators or US drone strikes in Pakistan.

    At any rate, apart from their other misdeeds, I am in full agreement with the OP that the Taliban ought not to hinder polio vaccination in Pakistan as a component of their violent political conflict with the US.

  11. lilady says:

    I’ve got a comment about polio in India and other countries, with several long links stuck in moderation.

  12. windriven says:

    Good grief. This discussion is about the eradication of a disease that over the centuries has crippled and killed untold numbers of human beings. Using polio vaccination as a political hostage for any reason is abhorrent.

    The CIA used subterfuge with vaccination as its cover to verify the location of an international terrorist responsible for the deaths of thousands of people, many of them his own coreligionists. Let’s all agree that the CIA used an inappropriate cover and I hope we can all agree that his death left the world a slightly better place.

    But let’s not wander too near the suggestion that the Taliban – those noble clerics who kill girls for attending school, who ban music, who destroy ancient artifacts, who operate police forces that ensure, among other things, that no glimpse of ankle can be seen under a fluttering burqa, who offer the choice of either believing in their flavor of god or dying – is remotely justified in holding Pakistani children hostage to their political tactics.

  13. cervantes says:

    The question is not whether they are justified or not. It’s merely an observation that they are doing it as a weapon in their conflict with the U.S., not because of religious or other ideological opposition to vaccination per se.

  14. WilliamLawrenceUtridge says:

    I’m extremely happy to see what amounts to the overlapping portion of my own personal “interest Venn diagram” – vaccination and criticisms of religion :)

    ConspicuousCarl, though I also find the Taliban’s ideals and methods repugnant, that doesn’t change the fact that the CIA’s plan puts doctors in danger and sets back medical interventions in countries that need it by several years. I think Western culture and the US in particular can set our ethical heights a little higher than “competing with the Taliban”.

  15. DevoutCatalyst says:

    What Windriven said. Plus, add Talibanic rhinoplasty and acid facials to the list of things here on earth done to women that are just plain disgusting.

  16. BugDoc says:

    The eradication of smallpox was accomplished because the clinicians did NOT have to vaccinate the entire population. The rash was so characteristic to be diagnostic. There was no animal reservoir or human latent infection. So toward the end of the effort, the WHO waited for a case to appear. Then they would swoop in to a village and vaccinate everyone. If an adjacent village had not had a case, they were left alone. This “ring vaccination” was obviously successful, but not everyone had to receive a vaccine in order for smallpox to be eradicated.
    That’s my understanding…I could be wrong.

  17. WLU-my person Venn diagram would be the overlap of anti-vax and religion, but that’s just me. :)

    This story has little stink and ethical lapses to spread around equally to many different and opposing parties.

  18. William…one off-topic point. I hope you’re aware enough to note that Dana Ullman just got banned again from Wikipedia for playing around with homeopathy.

  19. BillyJoe says:

    Am I wrong in thinking that India is now free of polio?

  20. lilady says:

    From my comment held in moderation since 10 AM

    Excellent article Dr. Novella. India’s last case of wild polio occurred in 2011 and in 2012 it was declared “polio free”:

    http://www.polioeradication.org/Infectedcountries/India.aspx

  21. lilady says:

    Second link from my comment held in moderation since 10 AM:

    There are still cases of wild polio, however in the countries you mentioned:

    http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

  22. lilady says:

    My third (and final) link from my comment held in moderation since 10 AM:

    We still are fighting anti-vaccine groups and individuals here, who claim that all cases acute flaccid paralysis is caused by the oral polio vaccine…when we have at hand the few number of AFP cases caused by the vaccine:

    http://apps.who.int/immunization_monitoring/en/diseases/poliomyelitis/afpextract.cfm

    I guess my links were too many and too long, sorry. :-)

  23. WilliamLawrenceUtridge says:

    Michael Simpson, what’s his new user name? If it’s DanaUllman, he hasn’t been re-blocked yet. If it’s a different account, he needs to close and redirect to a single one. Unless it’s Alice1818?

    Lilady, I think it’s 3 links or more (or profanity) and you get moderated. Weird that your first comment still hasn’t shown up yet.

  24. PJLandis says:

    I wonder if the press (I think the Guardian broke the story) should’ve published this story; they probably could’ve used it as leverage for a more interesting story, as I doubt the CIA wanted this type of press. Not that I would expect them not to, but they must’ve seen this fallout coming.

  25. Dana Ullman is impossibly moronic. I do find it funny asking him why he has to use modern science to treat his poor vision instead of something offered by homeopathy. :)

  26. Lilady – I don’t see your comment in the moderation list (or spam list, for that matter) Not sure what happened.

  27. lilady says:

    I see my comment is up now at 10:17 AM :-)

  28. Janet Camp says:

    Carl, I DO follow what the Taliban gets up to, but I do NOT follow Fox News! I still think the way you put your point was awful.

    —–
    @cervantes

    I’m not at all surprised that the supplement industry is contributing heavily to Romney. The industry is huge in Utah and is (I would assume) dominated by Mormons. Orrin Hatch is their man in Congress–if the t-party doesn’t do him in.

  29. windriven says:

    @cervantes

    “It’s merely an observation that they are doing it as a weapon in their conflict with the U.S.”

    I understand each of the words in the sentence above but when I put them together I’m not clever enough to deduce the point.

    Some group might say, “I will bomb a federal building in downtown Oklahoma City because I disagree with the tax policies of Barack Obama.” But the placing of a bomb and US tax policy are only related through the sociopathy of this group; there is no rational thought process that links the two.

    The Taliban is saying, in effect: “I don’t like American foreign policy therefore I will condemn a fraction of our children to disability and death.” That is not coherent. That is not sane.

  30. windriven says:

    @Janet Camp

    “I DO follow what the Taliban gets up to, but I do NOT follow Fox News!”

    1. I think Carl’s point was well made precisely because it highlights the disconnect between Taliban actions and civilized behavior. It is not Carl’s comment that is “ick” it is the gross behavior of scurrilous swine who would do those things that is “ick”.

    2. I’m embarrassed for you, not because of Fox per se but because you have apparently chosen to believe that right of center sources can never speak the truth. People – liberal or conservative – who let their labels do their thinking for them are pitiable.

  31. BillyJoe says:

    lilady: “India’s last case of wild polio occurred in 2011 and in 2012 it was declared “polio free””

    That was my understanding as well.
    There are only three countries that still not polio free.

  32. burrahobbit says:

    The Indian polio vaccination drive had to overcome issues similar to those in Afghanistan/Pakistan. I recall a case where in Northern India a muslim cleric banned vaccinations and there were rumours that the polio vaccine was designed to make muslim children sterile. The evil guys were not the CIA but India’s so called Hindu elite.

    Religion is a major public health menace. My father told me that in his childhood there was strong opposition to the small pox vaccine on religious grounds- the small pox disease was viewed as a visitation of the Gods. Todays anti science anti vaccine noise seems to be an echo of a similar attitude

  33. ConspicuousCarl says:

    It was a reposted AP story anyway, not something Fox invented.

  34. ufo-42 says:

    Maybe the taliban want to ensure there is a pool of polio infection handy for use as a bio-terror weapon against the US… all the more reason to do a bit of involuntary immunization if that is what it takes to eradicate this scourge.

  35. Dr. Virus says:

    Postings on the poliovirus vaccine brings tears to my eyes. My father contracted polio as a 14 year old child in the early 1930s. He needed two sticks and callipers most of his life, then he was confined to a wheelchair. He died young. This drove me to become a virologist. Although, in the end, I never researched poliovirus but I have made, I hope, valuable contributions to AIDS and papillomavirus research.

    This is truly a sad situation.

  36. Th1Th2 says:

    Well the sad story is Dorksi does not appear to have any more vaccine news to blog. Impressive, isn’t it?

    Cue the cheesy cricket sound.

  37. lilady says:

    Thingy: Are you barking up the wrong squirrel again? Woof woof, grrrrr…

    http://www.youtube.com/watch?v=lvw-9XEyPKk

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