Coronavirus vaccine's arrival recalls the 1950s battle to stop polio - Stars and Stripes
Coronavirus vaccine's arrival recalls the 1950s battle to stop polio - Stars and Stripes |
| Coronavirus vaccine's arrival recalls the 1950s battle to stop polio - Stars and Stripes Posted: 16 Dec 2020 08:48 AM PST  Stars and Stripes is making stories on the coronavirus pandemic available free of charge. See other free reports here. Sign up for our daily coronavirus newsletter here. Please support our journalism with a subscription. TAMPA, Fla. (Tribune News Service) — History was made in Tampa Bay Monday as the first dose of coronavirus vaccine was given locally to a nurse at Tampa General Hospital. It was a long-awaited moment of hope for many, even those whose shots are months away. As we wait we can learn from Tampa Bay's vaccine past, starting with the polio vaccine. These lifesaving vaccinations emerged in the 1950s as researchers crusaded to stop a virus that attacked the nervous system. While the populations most vulnerable to the coronavirus skew older, poliomyelitis was largely identified as a children's disease, said Naomi Rogers, a professor of the history of medicine at Yale University. Younger children were most likely to experience paralysis and other severe symptoms later. "Children may have been the most vulnerable, but that didn't mean other people couldn't get polio," she said. This year, multiple companies have raced to create a coronavirus vaccine. Back then, public health experts in the United States were focused on developing and distributing Dr. Jonas Salk's vaccine to fight polio, Rogers said. Salk started working on the polio vaccine in the late 1940s. He had developed and tested a version that he felt comfortable with by 1953. In 1954, clinical trials involved roughly two million American children, including second graders in Dade, Broward and Palm Beach counties. Tampa eagerly welcomed the Salk vaccine in April 1955. "We are greatly relieved," James E. Wall Jr., general chairman for Hillsborough County's polio vaccine program, told The Tampa Times then. "We are tickled pink." Nearly 12,000 first and second grade students in Hillsborough County signed up to get the vaccine. The county health department administered a course of three shots to children whose parents consented to participate in the voluntary program. Teams of local volunteer doctors and nurses — along with 300 homeroom mothers — were recruited to facilitate the mass vaccinations in schools. There were problems with some of the early polio vaccines, Rogers said. Roughly 200,000 people received a batch developed by the Cutter Laboratories in California that had been improperly prepared. Thousands fell ill from the defective doses. Ten children died. Several hundred others were paralyzed. "There were no more vaccines until they investigated what had happened and identified that it was a particular batch that had been inappropriately monitored," Rogers said. "They fixed that. And then, within a month or so, they really started the vaccine program." Meanwhile, an anti-vaccine movement was already brewing in South Florida. Duon Miller, an Ohio cosmetics manufacturer, started Polio Prevention Inc. in Coral Gables. According to the Miami News, Miller's company provided "moral and financial support throughout the country to individuals and organizations who spread fear about the polio vaccine." The Tampa Daily Times reported sightings of Miller's anti-polio vaccine pamphlets stuffed inside local mailboxes. Some Tampa residents said they were handed the papers by strangers on the street. Miller was arrested in Miami in 1954 on federal criminal charges of mail fraud and placed on probation for two years. His campaigning could be aggressive: The Dimon family of North Miami received a phone call from Polio Prevention Inc. after the local news published a story about their daughter's polio hospitalization. Soon after, they were sent five pamphlets from the group. "They had titles like 'Murder, Inc.,' 'The Truth About Polio,' and 'Stop This Voodooism,'" the mother told a reporter in 1955. "It was particularly horrible to receive them when we were upset and really worried about death." "The shampoo manufacturer, who claims polio is caused by soft drinks, is accused of sending cards containing language of 'libelous, scurrilous and defamatory nature' in his fight against vaccinations," wrote The Journal Herald, a newspaper in Miller's hometown of Dayton, Ohio. "One of the cards he is charged with circulating states, 'thousands of little white coffins will be used to bury victims of Salk's heinous and fraudulent vaccine.'" Health authorities stood by their vaccine. Polio cases dropped. And for the most part, the general population trusted it, said Michael Teng, an associate dean at the Morsani College of Medicine and an associate professor at USF. "Vaccines were more respected back then because you could actually see people who had really suffered from the polio virus, who were walking around on crutches because the polio virus had destroyed their nerve cells," Teng said. The immunization efforts continued into the 1960s. After the initial campaign to get doses in schoolchildren, there was a lag in immunizations, Rogers said. The next push from health officials was to vaccinate not just the most vulnerable youngsters, but also teens and adults. For the vaccine to work best, mass vaccination was necessary. "Elvis Presley very publicly rolled up his sleeve and got the shot," Teng said. "It actually was pretty successful. People were really, really good about getting the polio vaccine." "In the 50s and early 60s, it was really a high point of medical American science," Rogers said. "It would have been extraordinarily unpopular for a celebrity to come out against science." Trials for the new liquid Cox vaccine, named for bacteriologist Herald R. Cox, emerged in South Florida in 1960, the Boston Globe reported. More than 500,000 Dade County residents downed the oral vaccine, a cherry-colored liquid containing a weakened live polio virus. Over 2 1/2 million live virus vaccines had already been given out in Central and South America, but at that point it had only been used in limited United States studies. The story called the test "the nation's first attempt to wipe out polio on a community-wide basis." The program was approved in 1961. By May 1962, officials praised the vaccine trial in Dade County, saying the Cox oral vaccine was "highly encouraging." Another oral vaccine, named for researcher Albert Sabin, was also approved. Health officials encouraged those who got the Salk Vaccine in the 1950s to sip down two Sabin vaccines of the 60s as a booster, wrote the Tampa Times. In addition to elementary-aged tots, the treatment was given to University of South Florida students, civilians and airmen at MacDill Air Force Base. "No citizen of Hillsborough County under 40 should have any excuse for not being protected against polio," said Dr. James O. Bond, director of the Bureau of Preventable Diseases of the Florida State Board of Health, in 1962. The year 1969 broke records, the St. Petersburg Times reported, with no polio deaths recorded nationwide. As the decade wound down, the polio vaccine had been joined by vaccines for measles, mumps and rubella, Rogers said. Those vaccines are now part of routine childhood vaccines. Other immunizations came later, like the 1995 chicken pox vaccine. "By the end of the 60s, people were starting to say that there would be a vaccine for every disease," she said. "And that was the hope." (c)2020 the Tampa Bay Times (St. Petersburg, Fla.)  |
| How Covid-19 Drove New Polio Cases in Afghanistan - Smithsonian Magazine Posted: 01 Dec 2020 12:00 AM PST When Saidgul was around 6 months old this past March, his parents decided to take him to Herat, a city about 80 miles from their hometown in Shindand District in Herat Province in western Afghanistan. The road between the two towns is partially unpaved and can be treacherous, infested with Taliban checkpoints. In Herat, they hoped to get Saidgul vaccinated against polio, since clinics in their district had shut down without warning due to the Covid-19 pandemic. The nationwide lockdowns were yet to be announced, but Herat Province — which shares a bustling border with Iran, a country hit hard by the pandemic — was also reeling toward a crisis. "When we first came to the Herat 100-bed hospital, the main gate was shut because of coronavirus and they didn't let people enter," Saidgul's father, Anargul, told Undark. "We returned later but they told us they weren't letting anyone inside because of coronavirus." Unable to get his son vaccinated, Anargul, who like most Afghans goes only by one name, returned to Shindand with his family. But later, the parents noticed that Saidgul was not able to move his left leg. A few days after that, Anargul said, "We were at a party of a relative when we realized that he was not able to move his other leg either. Both his legs were limp." The family rushed Saidgul to a doctor, who suspected it was polio, or poliomyelitis, a dreaded disease that had been rumored to have returned to their region. The results confirmed it, said Abdulwahid Rahmany, a vaccination officer for the West Zone that covers Herat province. It was only the second case of polio to have emerged from Herat "in many years," he added. Polio vaccinations are largely targeted to very young children and are highly effective. In the past, polio cases mostly flared up in regions coping with military conflict and Taliban insurgency. Even so, in recent years, health officials had "managed to eradicate polio from many parts of Afghanistan," said Merjan Rasekh, head of public awareness for the Polio Eradication Program run by the Ministry of Public Health. But now, the Covid-19 pandemic is remapping polio across the country, creating pockets of cases where there recently were none. "We had to halt the polio campaign between February 2020 and August 2020 due to Covid-19 lockdowns," Rasekh said. "It created a big gap in the number of children we were able to reach compared to past years." Saidgul is among 54 new cases of polio in 2020, the highest number on record since the fall of the Taliban in 2001, Rasekh added. All the recent cases involve children between the ages of 3 months and 3 years, according to the ministry. According to the United Nations Children's Fund (UNICEF), the disruption in immunization due to the pandemic left a total of 50 million children without their polio vaccine in Afghanistan and Pakistan, the last two polio-endemic countries in the world. Rahmany's experience in Herat is emblematic of the problem. As families stay home in the epicenter of the Covid-19 pandemic in Afghanistan, he said the Taliban doesn't always let vaccination teams conduct door-to-door campaigns. "We kept the clinics open, but due to the lockdowns and quarantine and insecurity, parents were not able to bring their children for vaccinations," he said. "As a result," he added, "we only managed to reach 15 percent of our expected coverage." "In many ways," UNICEF notes on its website, "the map of polio mirrors the conflict in Afghanistan. The challenge to reach and vaccinate every child is as much diplomatic as it is operational and medical." Those diplomatic challenges include negotiating access to insecure communities that the Taliban control, as well as communicating with families who may be misinformed about the effects of vaccines. During the years of Taliban regime, national polio surveillance in Afghanistan didn't exist; as a result there is limited information on the prevalence of the disease from that time. But the existence of adults in the country who suffer from permanent paralysis — a possible outcome from polio contracted in childhood — may provide anecdotal evidence as to how widespread the disease may have been. "The polio situation has improved compared to, I remember 15 to 20 years ago, when it was very bad," said Alberto Cairo, head of orthopedic program for the International Committee of the Red Cross (ICRC) who has worked in Afghanistan for three decades. "I remember we used to receive quite many children with paralysis. It was very common back then." Coverage has since improved. "The vaccination program works," he continued, noting that there are very few children under the age of 3 who come into the orthopedic clinics these days. Before the Covid-19 pandemic, the few cases they used to see were largely from the southern and eastern parts of the country, where vaccination programs are hard to conduct due to ongoing conflict with the Taliban. In 2018, for instance, more than 840,000 children missed vaccination opportunities in six provinces in the south and east due to insecurity, according to the World Health Organization. As new battlegrounds formed around the country over the years, many regions became inaccessible to the health ministry and to government polio workers, making it harder to conduct immunization campaigns in the southern and eastern provinces. "Our target population is [to] cover 95 percent of children in every campaign," Rasekh said, referring to the country's 9.9 million children under 5 years old. "But we miss around 1 [million] to 2 million children in every round of polio vaccination — and this is a big number." Now, Covid-19 has drastically altered the landscape, allowing polio to spread to the north and west, in parts of the country that have not seen the disease in recent years. Of five recently reported cases, Rasekh said, "two cases were found to directly because of Covid-19." One was a 4-month-old girl from the northwest, he added, who was born during the lockdowns and could not be inoculated. In some cases, health workers eventually had to refocus their efforts from vaccinations to fighting the pandemic. "When Covid-19 started spreading in Afghanistan, we were asked by ministry leadership to support them in fighting the pandemic." Rasekh said. "Our polio workers engaged in fighting the coronavirus, particularly in two areas. One was the surveillance and contact tracing of cases, where we would find cases and report and refer them to the health system. And another was to work with them in communication and community awareness." "At the time, fighting Covid-19 was the priority for the Ministry of Public Health," Rasekh added, noting that nearly 4,000 polio workers across the country were referred to the ministry to help with the pandemic. And while Rasekh said immunization clinics stayed open throughout all the districts for parents to bring in their children for vaccinations — something Saidgul's family said was not the case in Shindand — government-imposed lockdowns, increased conflict with the Taliban, and an overall lack of awareness of the disease have prevented many children from getting the vaccine. Children who are vulnerable to polio may have lifelong complications if they contract the disease. The virus "affects the spinal cord," Cairo said, destroying the part that controls muscle. The muscles therefore become paralyzed because they are unable to receive the signals they need to move. "It doesn't affect sensation, they have full sensation," he said. "So if you touch the paralyzed leg, they feel pain like me and you. But they lose movement — sometimes it is only a little movement, just one muscle, and other times it is both legs and arms and the trunk also, so you can imagine it is very difficult." In eastern Afghanistan, a 6-month-old boy caught both polio and the coronavirus, according to Rasekh. While the baby managed to recover from Covid-19, polio left him paralyzed. "When you have the polio paralysis, it is forever," Cairo said. "There is no cure for it." People with polio paralysis require orthopedic treatment, but that, too, has been curbed due to the pandemic. In 2019, prior to Covid-19, the ICRC center in Kabul would treat about 4,450 orthopedic patients each month. While many were Afghans with various injuries suffered from the conflict with the Taliban, there were also victims of polio. Even after the lockdown, the center stayed open, but significantly reduced the number of monthly patients. "We are now operational, but still are not functioning in full capacity," Cairo said. According to data provided by ICRC, the Kabul clinic now sees some 2,500 patients per month. The Covid-19 crisis will affect polio victims in Afghanistan long after the pandemic subsides. The ICRC is concerned about the rising cases of polio, and its staff is expecting to see new patients arriving in the coming months, even years. When it comes to treatments for polio for young children "they really need to follow through," Cairo said. "For every patient, it is a big commitment and burden, even for the family." And the challenges of living with polio become even harder outside of urban centers where little help is available, he added. But there are some signs of hope. While Covid-19 is far from over, polio immunization campaigns in the country have resumed, starting with three provinces in the last week of July and extending to half of the country by August. "Being part of the Ministry's Covid-19 campaign helped us learn how to conduct the campaign more responsibly to avoid transmission of the disease," Rasekh said. Among other measures, workers wear masks and use sanitizers while in the field. Rasekh also said the experience of polio teams will be invaluable in the future dissemination of the Covid-19 vaccine when it is eventually released and reaches Afghanistan. The majority of vaccination campaigns in Afghanistan are conducted by female health care workers, who provide the ministry with better access to households in an otherwise deeply conservative society. "Women are welcome inside the homes where men would not be allowed — they can not only provide vaccines and talk to the families and mothers and create awareness, but also help survey if there are unreported cases," he said. Since most of the polio cases are still centered in the south and east, in insecure provinces that share border with Pakistan, the Afghan health ministry is working in collaboration with their Pakistani counterparts to ensure the disease is eradicated on both sides of the border. "There is a lot of cross-border movement between the two countries," Rasekh said, referring to the large number of Afghan refugees that emigrate to Pakistan, as well as the high number of people who return. The health ministries aim to "ensure that people of all ages who move across the borders should be vaccinated," he added. If polio is not eradicated in Afghanistan and Pakistan, the WHO estimates that it will spill into other countries, and that within a decade there will be 200,000 new cases every year globally. "One infected child can put at least 200 others at risk," Rasekh said. "So we cannot fight it without widespread vaccinations." This article was originally published on Undark. Read the original article.
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