x Abu Dhabi, UAEMonday 24 July 2017

Days are numbered for much-feared polio virus

The discovery of a vaccine in 1954 delivered a crippling blow to polio. Now, say a dedicated band of health experts and philanthropists, it's time for the coup de grace. James Langton reports

For a generation of children in the West, freedom from fear came at the price of a small prick on the upper arm, a few brief tears and a scab that healed to a mottled scar about the size of a thumbnail.

That was half a century ago. On the streets of London and New York in 2013, it is a sight so rare now as to turn heads; a few unfortunate men and women in late middle age, stiff-legged from the caliper that grips a limb withered from the polio they caught in childhood.

In the dusty villages of Afghanistan and Pakistan, or the fetid slums of Nairobi, it is a different story.

Here the first signs of rising temperature in a toddler may be no more than a passing childhood fever. But it may be something much worse - a blinding headache accompanied by vomiting and stiffness in the neck.

As the disease progresses, an unlucky few will be left with legs crippled for life. In between 5 and 10 per cent of cases, the paralysis will spread to the muscles that allow them to breathe. Then death is inevitable.

There is no cure for polio. But in most of the world, vaccines, now easily dispensed in oral form, have banished a once-terrifying scourge of communities to nothing worse than a fading memory of a childhood bogeyman. Most of the world, but not all.

For 21st century medicine, the challenge is not to stop diseases such as polio but to wipe them from the face of the planet.

It can be done. As late as 1967, smallpox was still killing up to two million people a year, and blinding and disfiguring as many again.

By 1977, after an eradication campaign by the World Health Organisation, the last case of smallpox was recorded in a hospital cook in Somalia.

Three years later, scientists were able to declare the disease had been eradicated. It exists now only in two secure research laboratories in Russia and the US.

Now the end seems near for polio. According to the Global Polio Eradication Initiative, an organisation working with the WHO and funded in part through the generosity of men such as Bill Gates and countries including the UAE, polio could join smallpox in the graveyard of diseases by 2018.

It will be a long overdue epitaph for a disease that was a scourge of the 20th century.

Although poliomyelitis has been recorded since the time of the Pharaohs, it was only at the end of the 19th century that the disease began to take on epidemic proportions.

In the summer of 1916, polio paralysed 27,000 and killed 6,000 in the US. From then on, the arrival of summer, normally a time of relaxation and pleasure, came with a cloud of fear.

Another outbreak in North America and the UK killed 2,720. Three years later the death toll was more than 3,000, and more than 50,000 were left with some form of paralysis.

Incurable and seemingly unstoppable, polio's impact reached deep into society's collective consciousness. Rich and poor, no one seemed immune. Swimming pools and park drinking fountains became potential sources of infection by the water-borne virus.

The list of victims includes the actors Donald Sutherland and Johnny Weissmuller, who developed a physique that would land him the role of Tarzan after taking up swimming to fight the disease.

Francis Ford Coppola, the film director, spent a year quarantined in bed after contracting polio. Itzhak Perlman, the world-famous violinist, must play seated because his legs are too crippled to stand.

Neil Young, the rock musician, contracted polio in the summer of 1951. Jack Nicklaus, the legendary golfer, escaped with nothing worse than stiff joints, but his sister was left in a wheelchair for almost a year.

That the stricken were almost always small children only added to emotional trauma of the disease on society.

In Britain, even into the 1970s, it was common to see a collection box outside shops in the shape of life-sized boy, one leg in a brace, supported on a crutch.

In the US, the medical charity March of Dimes, founded in 1938 by the president Franklin D Roosevelt - whose own paralysis is generally attributed to polio - raised money with the image of small girl, legs crippled but rising from a wheelchair, with the slogan "Look! I can walk again."

While attempts to create an effective vaccine began in the 1930s, it was not until 1954 that Dr Jonas Salk, a researcher at the University of Pittsburgh, revealed he had produced a working vaccine ready for testing.

Mass inoculations followed and in April 1955, in an announcement broadcast live around the world, it was announced that the vaccine worked. It was reported that church bells across America sounded in celebration. Millions of lives had been spared.

Later that year, Bill Gates was born into a world all but liberated from the shadow of polio.

The Microsoft billionaire has spent about Dh1 billion a year through his Gates Foundation in support of the Global Polio Eradication Initiative. Created in 1988, the foundation has achieved astonishing success.

In a quarter of century, the number of children paralysed by polio each year has dropped from about 1,000 to a handful. Thanks to an international investment of US$8 billion (Dh29.38bn), more than 2.5 billion children have been immunised.

A map of the world in 1988 would have shown entire continents recorded as regions where polio was epidemic. They included all of Africa, much of South America, and Asia.

Today that list has shrunk to three countries, Pakistan, Afghanistan and Nigeria. But the disease stubbornly refuses to die.

In 1988, the WHO declared its intention to eradicate polio by the year 2000. Last year 250 cases were reported; a small number - unless it is your child who is infected.

In The National yesterday, Mr Gates wrote of "a world free from vaccine-preventable diseases, with the full benefits of immunisation reaching all people, regardless of who they are or where they live".

Eradicating polio, he said, "will be a milestone on our path in realising this vision". But the milestone is proving remarkably tough to reach in polio's last strongholds.

The involvement of Sheikh Mohammed bin Zayed, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the Armed Forces, and the choice of the capital for the world's first Global Vaccine Summit is also of significance.

Pakistan and Afghanistan are Islamic nations, while Nigeria has a large Muslim population. In the first two countries, Islamic militants have used force to prevent medical teams reaching children who need immunisation.

In Nigeria, old fears that the vaccine is part of a western conspiracy to sterilise the population cling on.

The involvement of moderate Islamic nations such as the UAE may hold the key to breaching these last strongholds of the disease.

Experts in the disease fear that if the pressure for eradication is not kept up, polio cases may once again creep up, spreading to neighbouring countries with new infections numbering in the tens of thousands.

The WHO estimates failure to destroy the disease by the 2018 could lead to as many as 200,000 new cases in 10 years.

In the meantime, the organisation estimates that today there are 10 million people walking who would otherwise be crippled, and 1.5 million children who have escaped an early grave.

For humanity, finally eradicating polio may seem a small step, but it will be a great leap forward.

jlangton@thenational.ae