The problems of polio eradication.

Abstract

Leslie Roberts's otherwise outstanding article on the quixotic effort to eradicate polio (“Polio: the final assault?”, News Focus, 26 Mar., p. 1960) incorrectly implies that the World Health Organization (WHO) is discovering new difficulties in wiping out the disease. In fact, WHO was warned of precisely these problems several years ago and ignored the advice. As early as 1997, picornavirologists had serious concerns about the eradication program. V. R. Racaniello and I argued against marketing polio vaccination to poor countries as an “eradication” campaign ([1][1]). Among other issues, we pointed to the likelihood of outbreaks stemming from back-mutation in the Sabin vaccine, the danger of bioterrorism, the implausibility of maintaining adequate disease surveillance posteradication, and the impossibility of accounting for laboratory stocks. At the time, WHO officials dismissed these concerns ([2][2]). The same officials are now learning that they have indeed entered a quagmire, but the cost of their slow learning—in both dollars and political capital—has been enormous. Given sufficient bullying and cash, it might still be possible to force poor countries into compliance and eradicate poliomyelitis, but will it be worth the price? Although the headline-grabbing “race for the last child” has noble intentions, its leaders still show an appalling disregard for context. WHO's own statistics ([3][3]) suggest that the “last child” vaccinated may enjoy only a few short polio-free months before dying of malaria, tuberculosis, or HIV/AIDS. On a lighter note, I was amused to see the “Polio Pointers for 1951” image accompanying the article (p. 1961) without a photo credit. It appears to have been lifted, with only slight modification (the erasure of my grandmother's scrawled note), from a Web site I created in 1996 ([4][4]). The original leaflet is in the public domain, but I believe that my scan of it is the only digitized version available. 1. 1.[↵][5]1. A. W. Dove, 2. V. R. Racaniello , Science 277, 779 (1997). [OpenUrl][6][Abstract/FREE Full Text][7] 2. 2.[↵][8]1. H. F. Hull, 2. R. B. Aylward , Science 277, 780 (1997). [OpenUrl][9][Abstract/FREE Full Text][10] 3. 3.[↵][11]World Health Report 2003 (World Health Organization, Geneva, 2003) (available [www.who.int/whr/2003/en/][12]. 4. 4.[↵][13]See the Polio Information Center Online at . [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #xref-ref-1-1 View reference 1. in text [6]: {openurl}?query=rft.jtitle%253DScience%26rft.stitle%253DScience%26rft.aulast%253DDove%26rft.auinit1%253DA.%2BW.%26rft.volume%253D277%26rft.issue%253D5327%26rft.spage%253D779%26rft.epage%253D780%26rft.atitle%253DThe%2BPolio%2BEradication%2BEffort%253A%2BShould%2BVaccine%2BEradication%2BBe%2BNext%253F%26rft_id%253Dinfo%253Adoi%252F10.1126%252Fscience.277.5327.779%26rft_id%253Dinfo%253Apmid%252F9273700%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEyOiIyNzcvNTMyNy83NzkiO3M6NDoiYXRvbSI7czoyNToiL3NjaS8zMDQvNTY3OS8xOTAzLjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9 [8]: #xref-ref-2-1 View reference 2. in text [9]: {openurl}?query=rft.jtitle%253DScience%26rft.stitle%253DScience%26rft.aulast%253DHull%26rft.auinit1%253DH.%2BF.%26rft.volume%253D277%26rft.issue%253D5327%26rft.spage%253D780%26rft.epage%253D780%26rft.atitle%253DEnding%2BPolio%2BImmunization%26rft_id%253Dinfo%253Adoi%252F10.1126%252Fscience.277.5327.780%26rft_id%253Dinfo%253Apmid%252F9273701%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [10]: /lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEyOiIyNzcvNTMyNy83ODAiO3M6NDoiYXRvbSI7czoyNToiL3NjaS8zMDQvNTY3OS8xOTAzLjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9 [11]: #xref-ref-3-1 View reference 3. in text [12]: http://www.who.int/whr/2003/en/ [13]: #xref-ref-4-1 View reference 4. in text