Polio eradication program faces hard choices as endgame strategy falters
sciencemag.org
sciencemag.org
Here's the economic case for eradication:
http://polioeradication.org/wp-content/uploads/2016/07/Econo...
It is obvious in my mind. Vigilance is the only reason it's so close to eradication. Not completing the eradication risks enormous consequences. Not if, but when. The cost of eradication is thought to be in the billions of dollars. A pittance compared other government spending around the world.
I say just get it done so we dont have to deal with it any more. Unfortunately the plan seems to have some problems.
I'll cover man-made resurgence. There are copies of it in all major countries' virology labs. Furthermore, it can be synthetised from scratch since 2002, see NYT.
NYT: https://www.nytimes.com/2002/07/12/us/traces-of-terror-the-s...
If we could find 1% of that to re-purpose...
So the downside of not spending the effort to eradicate it is that someone's child will get it. I'd hate to think that some Billionaire like Larry Ellison would get to pick another mega yacht, rather than doing this.
We know we can eliminate it, which is more than we can say for most diseases. Pumping cash into other disease treatments doesn’t have that same guarantee.
I know nothing about polio, but is this demonstrably true, is polio seen to be mutating, and it is considered a real risk by scientists that a strain could emerge that is invulnerable to vaccines?
https://en.ird.fr/the-media-centre/scientific-newssheets/464...
A big killer of children is diarrhea. 800,000 die each year and treating it cheap and preventing it is just access to clean water. You can get a huge bang for your buck by spending money on it.
And as a result, an entire community can have access to clean water.
> And as a result, an entire community can have access to clean water.
Well, no. All communities have water sources. Where digging a well is cheap, the community will have one or more.
The problem digging a well solves is that there wasn't enough water. That's not the problem a community with endemic diarrhea has. Their problem is that they're not keeping their water clean. The new well is unlikely to be different.
So a community could significantly benefit from moving from surface water to a well or a shallow well to a deep well.
And that’s not to mention other techniques that can create a safer water supply. Many of them are quite cheap.
I don't follow this area very closely, but I bet it's not natural and I suspect it's a genuine minority position.
So it seems like the injectable vaccine will be strictly preferable if the nOPV strategy fails. It's only disadvantage is that it does not prevent the recipient from spreading polio to others if they become infected, and it looks like that disadvantage may have been illusory anyway.
It's also worth paying attention to the precise distinction between vaccine-derived poliovirus, which is the problem this article was about, and VAPP. VDPD is basically equivalent to normal wild-type poliovirus in terms of its infectivity and effects, but only happens once the vaccine poliovirus has been circulating and mutating for a while and can be protected against via vaccination. VAPP is caused by vaccination and can affect the recipients or those around them, but unlike VDPD the people who suffer from it shouldn't pose any more danger to others than any other vaccine receipient.
That seems like it would make the oral vaccine even worse, compared to the injected vaccine. Again, I'm not sure why they think reintroducing traditional type-2 OPV is a good idea if the injected form that won't cause vaccine-derived outbreaks is so easily available. (Of course nOPV is expected to be better than the former OPV, but it's yet to be available.)
I'm not exactly sure why the WHO rushed to pull type 2 from the oral vaccine before there was sufficient supply of the inactivated vaccine to replace it, but I get the impression that they didn't expect it would be necessary because they thought that type 2 virus would rapidly disappear once they did so.
http://polioeradication.org/wp-content/uploads/2016/07/sop-p...
People will believe all sorts of stupidity, and if anything, as poor countries get richer and more communicative, they’ll invent conspiracies and other reasons to avoid vaccination.
How else could 10B save or massively improve tens/hundreds of millions of lives.
Otherwise, you’re arguing a rock is providing safety against tigers because there are no tigers around.
For instance, if they can spend $1 for $2 of benefit, they should probably do that before they spend $2 for $3 of benefit. This is kind of a slippery point, because they are often engaging in activities where the benefit is hard to measure, but their activities should still appear rational relative to their best measures of the benefits.
https://www.aljazeera.com/indepth/features/pakistan-polio-co...
But governments around the world care more about shaking big sticks at each other than eradicating polio.
Between 2004 and 2012, the number of polio cases in Pakistan closely mirrored the number of drone strikes. But from 2013 onward, polio cases increased while drone strikes fell.
This can be explained by the CIA's use of a fake immunization campaign in a failed attempt to obtain the DNA of Osama bin Laden's relatives prior to his assassination in 2011. This seemingly vindicated militants' suspicions that vaccination programs were a cover for espionage. Militants consequently intensified their disruption of immunization campaigns, resulting in an increase in polio cases in Pakistan, as well as in Afghanistan, Syria, and Iraq.
The slightly better publications like Ars Technica qualified this by saying that this only applied to wild-type polio viruses and did mention vaccine-derived polio, but they severely downplayed how much of a problem this was for the campaign to eradicate polio.
It's sorta disgusting to see someone on the other side of the world considering it to be a PR disaster instead of just doing damage control if you must but do effing go back to the trivalent vaccine known to be effective.
For example, think of seat belts... they save a ton of lives, but it is possible for a seat belt to kill someone; let's say the ratio is 1 death caused for every 1000 saved. Even though a seatbelt can kill you, it is still clearly worth it to use one, and will save a ton of lives if everyone uses them.
Now imagine a celebrity is killed by a seatbelt; rationally, everyone should understand that it is a rare event, and that it is still worth it to wear your seatbelt.
However, since the case is such high profile, many people will see it and mistake the anecdote for data and think seatbelts are dangerous.
This "bad PR" could kill thousands of people.
> The oral polio vaccine contained three types, or strains, of the virus (types one, two and three). The vaccine, given to young children, is dropped onto the tongue, where it then travels through the stomach and digestive system. The live viruses in the vaccine have been weakened, so that it can’t cause disease. However, in very rare cases, and only in populations where immunisation rates are low, the vaccine virus can mutate in the intestines and regain the ability to cause paralysis, resulting in VDPV. The most common of the three vaccine strains causing VDPV has been the type 2 strain.
> Although the person who received the vaccine does not develop polio, the reactivated polio vaccine leaves their body in faeces and can potentially infect others.
> This is not a risk with the injectable polio vaccine, such as the one given in the UK, as the virus has been inactivated and doesn’t enter the gut. However, this vaccine cannot be used alone in places at risk of polio and where immunity is low. Although it protects an individual from paralysis, it does not prevent the virus being transferred from person to person – an important benefit of the oral vaccine
Honestly what's surprising to me is that they're able to overcome that resistance at all. Imagine trying to distribute a vaccine in the US that is known to trigger outbreaks of the virus it's supposed to protect against. Regardless of the fact that things would be far worse without it, all the evidence in the world wouldn't be enough to convince many people.
Western risk assessment is warped by the fact that a great many people never have to weigh risky decisions because for the most part society is wealthy enough that we can just defer risk of physical harm at the expense of either time or money. Of course people will freak out when they're given a decision where there's a risk of physical harm in both options.
The anti vaccination movement has only survived because most of these diseases are so rare. If we see a return of diseases like polio the anti vaccination movement would disappear fast.