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Medicine

Polio Eradication Program Faces Hard Choices as Endgame Strategy Falters (sciencemag.org) 119

Posted by msmash from the closer-look dept.
The "endgame" in the decadeslong campaign to eradicate polio suffered major setbacks in 2019. From a report: While the effort lost ground in Afghanistan and Pakistan, which recorded 116 cases of wild polio -- four times the number in 2018 -- an especially alarming situation developed in Africa. In 12 countries, 196 children were paralyzed not by the wild virus, but by a strain derived from a live vaccine that has regained its virulence and ability to spread. Fighting these flare-ups will mean difficult decisions in the coming year. The culprit in Africa is vaccine-derived polio virus type 2, and the fear is that it will jump continents and reseed outbreaks across the globe. A brand new vaccine is now being rushed through development to quash type 2 outbreaks. Mass production has already begun, even though the vaccine is still in clinical trials; it could be rolled out for emergency use as early as mid-2020. At the same time, the Global Polio Eradication Initiative (GPEI) is debating whether to combat the resurgent virus by re-enlisting a triple-whammy vaccine pulled from global use in 2016. That would be a controversial move, setting back the initiative several years, as well as a potential public relations disaster -- an admission that the carefully crafted endgame strategy has failed. "All options are on the table," says viro-logist Mark Pallansch of the U.S. Centers for Disease Control and Prevention, one of the five partner organizations in GPEI. "We are clearly in the most serious situation we have been in with the program," adds Roland Sutter, who recently stepped down as the director of polio research at the World Health Organization (WHO). The heart of the problem is the live oral polio vaccine (OPV), the workhorse of the eradication program -- the only polio vaccine powerful enough to stop viral circulation. Given as two drops into a child's mouth, OPV for decades contained a mix of three weakened polio viruses, one for each of the three wild serotypes that have long plagued humanity. All three serotypes in the vaccine have the potential to revert to more dangerous versions; that's why the endgame strategy calls for deploying OPV in massive campaigns to eradicate the wild virus, then ending its use entirely.
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Polio Eradication Program Faces Hard Choices as Endgame Strategy Falters More

Polio Eradication Program Faces Hard Choices as Endgame Strategy Falters

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  • This is the problem with live vaccines. (Score:5, Interesting)

    by WindBourne ( 631190 ) on Wednesday January 01, 2020 @08:03PM (#59577566) Journal
    Back in the 60s, we were ALL being inoculated with live attenuated small pox. However, at the time, something like 20-40 kids/ year died from the actual vaccine. Our parents KNEW that it was possible to be one of the 1 in a million that could die. Then it was finally stopped because it was felt that it was fully gone, and all of the deaths had been from the vaccine.

    I keep thinking that on something like this, we need to use dead virus/particles once the area is fairly cleaned up. The dead virus/particles is not as effective, and may actually allow the virus back. However, if one can be designed that is DECENT, it should do the work for most places and then for any place that has the live virus coming back, then re-do the live virus in a larger area of where it was.

    • Re:This is the problem with live vaccines. (Score:5, Informative)

      by puck01 ( 207782 ) on Wednesday January 01, 2020 @09:21PM (#59577708)

      In the US and as far as I know all western countries in which polio has been eradicated, only the IPV vaccine is used to prevent polio. IPV is not a live vaccine. In the US its been this way since I was in med school - so at leave over 20 years but probably longer. IPV is quite effective on the individual level if provided as recommended.

      The only places where the live polio vaccine is used is in poorer counties or countries with active disease. Its more effective from a population standpoint because one person can be vaccinate but the inoculated live virus will inevitably be passed to others which is typically a good thing. Many more people end up effectively vaccinated. Obliviously, its not a perfect strategy. The OPV vaccine is also much cheaper to provide.

    • They use live vaccines because it can be used orally.

    • Both variants of the vaccine are effective enough, both against wild and vaccine derived strains, that's not the problem. The problem is that in an insufficiently vaccinated population vaccine derived strains can propagate beyond one case and keep going. And attenuated polio vaccine is only used in hard to vaccinate populations to begin with, it's easy to administer, no needles or anything required just drops on the tongue. That doesn't work with inactivated vaccine. If you can you use inactivated vaccine a

    • Back in the 60s, we were ALL being inoculated with live attenuated small pox

      As I understand it:
      - Smallpox innoculation (artificial infection with full pathogenicity smallpox - in this case by the skin route) was the first smallpox live-virus immunization. It was common in some Muslim countries and used to a limited extent in England, brought home by a diplomat's wife. Infection via a skin lesion (rather than inhalation) produced a full-blown infection, fully contagious, but usually non-fatal case

  • So frustrating ... (Score:5, Informative)

    by 140Mandak262Jamuna ( 970587 ) on Wednesday January 01, 2020 @09:04PM (#59577676) Journal
    I got polio in 1966 in South India. 10 years after Salk. In the West there is no polio victim in my age group.

    But back in India, every school I went to had a couple of victims in each grade level. Some with one leg and others with both legs, some could walk and others could not. I was lucky, just one leg and I can walk.

    First time we got close to finishing it off, CIA used polio vaccine workers to hunt for Osama Bin Laden. Backlash against the vaccine workers in Pakistan later made it impossible to finish polio off its last strong hold in one Karachi slum. Then the Haj pilgrimage took it out of Pakistan and spread it to two other places, Nigeria and Indonesia.

    Now, this. In the larger context, polio is a lot more dangerous than Osama. I wish CIA had not used UN health workers as cover for its underground activities...

    • Re: (Score:2, Insightful)

      by Train0987 ( 1059246 )

      I wish Pakistan hadn't aided and hidden Osama.

      • Re:So frustrating ... (Score:4, Interesting)

        by 140Mandak262Jamuna ( 970587 ) on Wednesday January 01, 2020 @10:29PM (#59577830) Journal
        Yeah, Pakistan is messed up. Geopolitical games of Russia, Afghanistan, they are all bad. But polio virus is of a different scale altogether. Its biological, does not know national boundaries, it can spread and wreak havoc on very large scale. Between terrorists and polio I think polio is worse.

      • Re:So frustrating ... (Score:5, Insightful)

        by bloodhawk ( 813939 ) on Wednesday January 01, 2020 @10:49PM (#59577886)
        Yep, but that doesn't make the US Gov/CIA less of a bunch of cunts for abusing a basic humanitarian work in this way.
        • That's globalists for you. Their goal is so overpoweringly important and urgent, it overrides all other goals.

    • Re: (Score:2)

      by mccalli ( 323026 )
      I caught polio in 1973, in the UK. There are victims still in your age group, but very very few of us. I believe I am in the last 75 people to have full-paralysis polio in the UK, and I was lucky and had a full recovery with no ill effects.

      Hope you did fine.

    • Same here. I got furious with my government when I learned of that. Don't get me wrong; I hated OBL, but I'd much rather live in a world without polio than a world without him. And there's no excuse for putting aid workers in danger.

    • "I wish CIA had not used UN health workers as cover for its underground activities."
      Yeah, well I wish the PLO wasn't using ambulances today to shuttle weapons. Shrug. The world's a shitty place full of assholes.

  • People were were vaccinated, and who have no symptoms nor health problems, can transmit a form of the virus that came from their vaccination, to people with weakened immune systems who were not vaccinated?

    • Not with the dead virus. No. The original vaccination was live virus that was crippled but that was stopped many decades ago.

    • The vaccinated person shits out the modified virus, then it cycles through the population a couple of times due to bad sanitation and incomplete vaccination. While it's doing that it sometimes mutates back into a paralysis causing strain.

    • Re:So if I understand the situation (Score:4, Informative)

      by puck01 ( 207782 ) on Wednesday January 01, 2020 @11:02PM (#59577912)

      When the oral polio virus (OPV) vaccine is used this is true. The OPV vaccine isn't used in most countries. Its use it typically limited to poorer areas or areas with outbreaks. Its cheap to provide (can be given orally). Because the attenuated virus infects many people, one vaccine may vaccinate a large group of people.

      In western countries its pretty much never used as far as I know. In the US , for example, we only use the IPV vaccine for polio. It is not live.

      • It was used in the USA from 1963 to 2000 so it's the one I had as child. Wonder if my shed viruses killed any poor SOBs

  • This is only one of the reasons for it.

    I hate the pro vs anti-vax debate. It is filled with toxic morons on both sides. While I definitely advocate for vaccination, I will never advocate for it be be mandatory because no matter how much you live in fear you just simply do not have the right to force someone to roll the dice on risks like this. You cannot claim it for your protection, national security, or for any decent reason. You can only do it for selfish reasons.

    Vaccines have never been safe, no dru

    • Re: Vaccinations must remain choice. (Score:4, Insightful)

      by Way Smarter Than You ( 6157664 ) on Wednesday January 01, 2020 @10:24PM (#59577816)
      Because some ignorant religious butters and equally ignorant Hollywood morons are fearful, my family has to be at risk for horrible diseases? No. These morons live in the same society with the rest of us and one of our standards is everyone gets vaccinated. I have absolutely zero sympathy or understanding for ignorant morons who want to ill their own children and those of other people as well. No religious or other stupid exceptions, no excuses. If your kid is the 1 in a million who can't get vaccinated, ok that sucks, but everyone else should get it. Why make a stupid exception for this? Oh hey my religion say I can't drive under 55 and I need to part in blue spaces and on red curbs and in front of fire hydrants. I have that right because... god. Anti-vax is no less stupid a concept.

      • Re: (Score:2, Insightful)

        by SirAstral ( 1349985 )

        "These morons live in the same society with the rest of us"

        Yes, I have heard this rant before as well, right before people were abused and or oppressed.

        This is currently what China is saying to all the "Uyghurs"... "Welcome to Society".

        And for the record, you are just as ignorant and fearful as those you are hate on. Ignorance and Fear is the currently of all domination of others. When you move to force someone by law to do something then you are the same as those you hate.

        Or in short... you cannot say I

      • At increased risk, you're at risk regardless.

        If your kids are not promiscuous the risk of genital HPV infection could be less than the risk of adverse vaccine effects. Should they be forced to be vaccinated to protect your little sluts? Maybe, maybe not.

        In a liberal democracy there's always going to be a tendency to err more on the side of freedom and personal choice than community. You could try China instead.

        • "At increased risk, you're at risk regardless."

          I don't think "Way Smarter Than You" has the intellectual capacity to understand something like this. They have allowed their irrational fears to make them "Risk Adverse" he is an example of the "Ellsberg paradox".

          https://en.wikipedia.org/wiki/... [wikipedia.org]

          • You have no idea how hpv spreads or apparently what it even is. But sure I'm the ignorant child. You don't have to be promiscuous to get hpv. It can live in your system with no symptoms for a year. There is no test for men at all. It spreads very easily. Condoms are no guarantee of prevention.

            How much of that did you already know? None of it. And you call me ignorant,

            in fact, your virgin daughter can get hpv and the various cancers and such that can follow simply by having sex with her non vir

        • Re: Vaccinations must remain choice. (Score:5, Insightful)

          by Uberbah ( 647458 ) on Wednesday January 01, 2020 @11:18PM (#59577924)

          Should smallpox still be a thing because freedum and "choice"? Sounds more like you're being a dipshit for the sake of dipshittery.

          • They aren't the unvaccinated population which is stopping the eradication of measles/mumps, the third world is.

            If the whole world had first world levels of vaccination they would be gone already. Even if the whole first world was vaccinated, vaccine failure would still make you risk infection from the third world.

          • Smallpox IS a thing. There's no "should" about it.
            People get sick. People die. This is normal. You can't stop it. It is not worth forcing someone to subject their bodies to government control to stop one, two, or even one million diseases. There will be millions more diseases after that. You cannot fully eradicate disease unless you glass the whole planet.

      • Because some ignorant religious butters and equally ignorant Hollywood morons are fearful

        No, you fucking moron. Because someone doesn't want to do something to their body, and you don't get to fucking make them because you live in fear of how weak and unfit you are.

        Fuck you if you think you can force them via the government.
        The government forcing them is the same government that has experimented on its own citizens without their consent or knowledge. It continues to do so.
        The government forcing them is the same government that will suffer no repercussions for harming or killing its own citize

    • This post was very reasonable.

      Unfortunately I am afraid that for most of the population what you wrote will be dismissed as a stupid, crazed, irresponsible purveyor of fake science anti-Vaxxer whose kids should not be allowed to go to school and you should be personally liable for any disease repercussions in anyone you or your kids ever contacted. As far as they are concerned measles is death and death is measles and they will treat you the same as if you are trying to shoot up an elementary school with

      • "This post was very reasonable." -- thank you!

        Yea, I am well aware of the politicization of vaccinations and you are right that objectivity is no longer allowed.

        "They have been conditioned to be terrified for their kids"

        This is so on point. All the mandatory vaxxers are working on the same fear that the anti vaxxers are working on.

        "I have read of doctors trying to say what the post I am responding to said and they have nearly had their careers ruined."

        This is one of the many benefits of government or grou

    • Comment removed based on user account deletion

    • Re: (Score:2)

      by ediron2 ( 246908 )

      Serious irony, making this 'my uneducated opinion is equal to the knowledge of actual experts' as we celebrate Asimov's centennial. Hyperbole like calling the consensus views of thousands of immunologists 'downright evil'? 'Not efforts to silence or belittle antivax'? Y'all don't get to bring your half-baked political philosophies into a realm of science and ascribe what we do to motives you're just pulling out of your ass. Step off.

  • Yes, there are outbreaks due to human error, but when you factor in that there are over eight billion people on the planet, these numbers are reasonable. Overall, efforts to eradicate polio and other viruses using vaccines have apparently been very successful. Clearly some improvements must be made, and they will be made.

    • Re: (Score:2, Insightful)

      by SirAstral ( 1349985 )

      You can never say that loss of life or quality of life is reasonable on the behalf of others, only for yourself can say this.

      The overall results are obviously much better than going without vaccinations, but until we reach a 100% effectiveness rate with zero negative side-effects we can never allow ourselves to call it reasonable. For now, this is the best that we can do, but you might be mistaken that improvements will be made. Money is a major factor in things like this. And if the numbers are really r

      • Re: Scientists Are Not Perfect (Score:4, Insightful)

        by Way Smarter Than You ( 6157664 ) on Thursday January 02, 2020 @04:04AM (#59578186)
        Yup let's set a standard so high it can't ever be met (8 billion perfect vaccinations with no errors or glitches) so we can sound faux reasonable with our crazy anti-vax agenda.

        By that standard, no one can have any medical services, drugs, surgery, or even a broken limb set. Hey, let's extend this logic to other things! Yay!

        People die driving, swimming, exercising at the gym, having sex, and walking down the street. For everyone's safety let's ban all those things because we're not 100% safe doing them. Oh and paying my taxes makes me sick, too. So I shouldn't have to do that, either! Yaaay for shitty anti-vaxxer logic!
      • By your logic, because some people choke to death on regular food, starving your child to death should be within the limits of ""freedom" too.

  • Is the failure to eradicate polio thanks to the United States using a bogus polio vaccination scheme to hunt for Bin Laden?

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