My med student girlfriend points out that while this is a huge victory for public health, only polio virus type 2 is being declared eliminated. Types 1 and 3 are still endemic in pockets of the world, and are next to eliminate. Each type has a different capsid protein.
It's pretty amazing that for my parents who were born in the mid-20th century, polio was still a concern. When they were growing up, FDR had recently died of complications from the disease and they knew people who were debilitated by it. Within their lifetimes the vaccine literally changed the world, to the point where polio is not present in developed countries. Vaccines are one of the greatest triumphs of human ingenuity.
>WPV3 has not been detected globally since November 2012 (in Nigeria); the only remaining endemic WPV1 strains are now restricted to Pakistan and Afghanistan.
Fake or not though, the US is definitely responsible for destroying decades of work to get local people to trust these vaccination programs. Pretty much for nothing but PR-points in the form of revenge.
Be careful about relying too heavily on Hersh's article. It makes some pretty bold claims about a conspiracy of eyewatering proportions that have never really been backed up. There has been a lot harshly critical responses to it. [1]
Historically Hersh has been a successful investigate reporter but his LRB piece hasn't really been widely accepted: [2]
> Were it not for the byline of Mr. Hersh, a Pulitzer Prize-winning journalist who first gained notice more than 45 years ago for exposing the My Lai massacre in Vietnam, the story would likely have been readily dismissed and gained little attention.
Cool and thanks for the extra info, I'll check out those links.
You're right that the story comes off as incredibly one-sided, and some of the claims did indeed leave me with a feeling of "there's gotta be another side to this". On the other hand, many of the claims by themselves weren't that surprising either (of the type that makes people use the "I don't see why anyone is surprised"-non-dismissal).
But I'm always interested to try and balance that view somewhat.
That said, even without having read your links, I can't imagine any other interpretation of the events (as also corroborated by the US' PR themselves) that would not have caused the destruction of decades of building of trust in vaccination programs to the local populations. That part doesn't just come from Hersh, the US admitted as much themselves--well not the repercussions obviously, but that they did (ab)use the vaccination programs as cover for a conspiracy furthering US military interests.
As anyone remotely familiar with the difficulties for vaccination programs should know, that alone, well-substantiated rumours, are more than enough to ruin a local vaccination program entirely. I mean, obviously, the act of administering a vaccine to a person is not the hard part of these programs. It's the part to get them voluntarily choose to receive the vaccines.
Regardless of all the other bold claims and conspiracy surrounding the OBL operation, the US should have reconsidered thrice before involving the vaccination programs. The scales should have been abundantly clear:
One the one hand there's the possibility of a monumental achievement for the whole of mankind, the complete eradication of a terrible disease, saving who-knows how many lives, something that can without any reservations whatsoever be placed on the "good" side of just about anyone's moral compass. Those were the stakes, and they knew it.
And on the other hand, there's getting revenge on Osama Bin Laden, who didn't play a serious role any more in the wars the US is waging. Already when he was killed, the only reasonable reaction I could (sort of) understand was "yes of course it's just for PR and ego reasons alone. but eh, let them have it, maybe it'll provide some closure".
So yes, whoever made that call and went on with it, did it for extremely petty reasons. And yes it probably was not a single person that decided this, it was probably a rotten system stuck in a feedback loop of hate, like an ingrown toenail, that made it pretty hard for anyone involved not to go along with it. It's still petty, and they can still own it.
At this point I think it might be reasonable to simply pay people in that area to be vaccinated. We stopped vaccinating most of the world so the risks of an outbreak and in the long term existing vaccinations stop being as useful due to the disease mutating.
While it seems obvious that this probably didn't help, Atul Gawande's Better (which came out before the CIA business had been exposed) has a really interesting chapter about polio vaccinations in Pakistan which includes stories about parents hiding their children from the vaccination crews for various non-US-related reasons.
General distrust of authority leading to rumors about the "true purpose" of the shots. As a specific example, he meets a mother who hid her male infant from the authorities because of a rumor that the shots were designed by Hindus to sterilize Muslim boys.
Not to discredit what you are saying or how amazing the success of human ingenuity has been, FDR might not have had polio. Modern research seems to imply that he actually had Guillian-Barre Syndrome. The Roosevelt family wouldn't let them exhume his body, so we probably will never know. Either way, there was no cure in FDR's life and his treatment would largely have been the same. Just food for thought!
This is a clear win for "public health", leaving just one strain (WPV1) which is geographically constrained.
A question for those well-versed in the biomedical and ecological sciences: Could our attempts to eliminate viruses be a bad thing? I wonder about the ripple effects of ecosystems on each other. We do not brag about extinction of any other natural entity.
And, when eradication does not work, when we only hinder the growth of a virus, does the attempt to prevent infection (or any form of "mostly cleaned up" coverage) encourage the development of superviruses by selecting for the strongest in the set, in the same way bacteria do? If not, why?
Not really, no. The "niche" that pathologic microbes play is basically entirely negative. Any supposed benefits are certainly well drowned out by massive mortality and morbidity. Nobody cries for mass murderers.
To your second question, that can be a big problem. HIV is probably the best example. Patients receiving HAART can really hurt themselves if they skip a treatment; it gives the virus enough time to mutate and get ahead. Usually this works at the individual level because of the mutation rates in viruses - and their tendency to revert upon infection to a new host - but theoretically yes. Moral of the story? Always take all your drugs.
"And their tendency to revert upon infection to a new host" - Are you saying that viruses revert to some sort of "base version" when they transfer from host to host? I'd never heard of such a thing. How would that work?
Yes. Depends on the virus, but in the case of HIV infection, the patient can produce over 1 billion new virus particles a day. Given the size (10kb) and mutation rate (10-3 to 10-6, iirc) every single nucleotide is mutated every single day.
There's more to it than that (lookup "biological filter" for example), but the virus must mutate to avoid drugs, which usually means a fitness hit (lower replication, for example). Upon infection of a new host, the virus can quickly maximize fitness once again. Not a "base version" per se, but a more ideal, fit virus, without many/most of the escape mutations.
If that is the case, then would it be possible for someone who skipped a dose and development a resistant strain, to continue skipping doses until his virus looses its resistance?
New hosts don't take drugs that kill certain variants of the virus, so the version that does best in a drug free environment replicates quickest. That's usually different from the version that does best in the drugged environment.
How? Phage therapy — which, let's be real, isn't accepted anywhere outside of Russia, Georgia, and Poland(?) — would only help against bacterial pathogens. It's useless against other viruses.
Polio is species specific to humans (at least, the strains we are eliminating are), so the ecological impact is limited to the indirect effects that come from more, healthier humans.
I've read/heard some discussion about how humans suffer detriment now that we no longer have gut parasites living with us. Unfortuntely it's been rather thin on the ground, I suppose it's not a very glamourous area to study.
It's complicated, but the science is fairly well established that lack of parasitism has lead to increased incidence of allergies in developed nations. Small price to pay.
Also keep in mind parasites and gut bacteria are far different to infectious diseases like polio and measles.
We are rapidly approaching an era of medical treatments where giving a treatment of "probiotics" to correct your newborn child's gut bacteria in order to prevent asthma much the way we give immunisations against diseases today. The hygiene hypothesis is getting some pretty compelling evidence and hopefully it will lead to us learning the "right" kind of things we should be exposing our children to in order to prevent these autoimmune conditions.
Autoimmune disorders are a large category - there's also some evidence that autism-spectrum disorders are caused by autoimmune responses in the mother.
I was thinking of the exact same thing. But I'm not sure it really applies, at least in the specific case of polio. Historically most people didn't have it, so we can't really be "missing" it. If we were talking about eradicating something relatively common and non-lethal, such as the common cold, that would be more comparable to the gut parasites.
For polio, the hypothesis is that it was very common before 1900. I quote from "From Emergence to Eradication: The Epidemiology of Poliomyelitis Deconstructed" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991634/
> In the pre-epidemic era, enteric infections were so ubiquitous that most infants were infected within 6–12 months, at a time when they had circulating antibodies passively derived from their nursing mothers. Although serum antibodies did not prevent enteric infection, they were sufficient to preclude viremia, thereby avoiding invasion of the central nervous system and paralysis. The result was the acquisition of active immunity under the cover of passive protection.
So the hypothesis is that historically most people did have it and were immune, and only the improved hygiene past 1900 led to epidemics. We can indeed ask whether some individuals are worse off now because they didn't contract it in their infancy. But we're also doing pretty much the same thing with the vaccinations. Maybe we'll see a rise in allergic reactions when polio 2 vaccines are phased out. I don't think that anybody would advise infecting babies to get the benefits back though :-)
I would argue that viruses have an obvious impact into our human ecosystems. Losing a father, a mother, a sister, a teacher, a doctor hurts not only the person, but us all. So I would only argue for the preservation of viruses in the wild if they, somehow, had an even larger provable impact in the long run.
Also keep in mind that we don't need to eliminate viruses entirely, we can keep some samples in labs. So we aren't losing that much in term of potential scientific knowledge and we can always reintroduce them if we feel like. This is much harder to do with, say, polar bears. Once they are gone, they are gone for good. So it is in our best interest to preserve them in the wild. At least, until we figure out cloning or cryogenics.
One comment. With bacteria, resistance is to specific (or multiple) antibiotics. This doesn't mean necessarily that the strongest bacteria in general terms get selected. For example MRSA tends to affect people who for some reason have weakened immune systems because healthy people do a decent job of fighting it off.
Good point. My use of the word "strongest" was definitely misleading, but I am not convinced it is always the case that there isn't a relatively low dimensional definition of "strong" in this sense.
I think (and if I'm wrong someone please correct me) that adaptations the bacteria evolve are specific features to specific pathways that they have for removing toxins (to a bacteria an antibiotic is a strong toxin).
For those not actually familiar with it, polio can spread into the spine and portions of the brain, killing neurons. This can cause paralysis and severe pain, and for some cases affect the ability to breathe. It was the original target of the March of Dimes, which helped provide support and (once available) vaccines.
Polio patients with breathing problems are where the "iron lung" was most widely used; it's basically a box or tube for the whole body except the head, with just enough seal and a timed low-level vacuum to allow the lungs to expand then contract when the low pressure is released.
Big win for public health. I'm sure the others won't be far behind.
In this same vein, go read the first sentence of the Wikipedia article on smallpox for a jolt of pride in human progress. "Smallpox WAS an infectious disease..."
It's interesting that they're already planning to remove the WPV2 component from vaccines, because it can (very rarely) lead to vaccine-associated paralytic polio. "With WPV2 transmission already having been successfully interrupted, the only type 2 poliovirus which still, on very rare occasions, causes paralysis is the type 2 serotype component in trivalent OPV. The continues use of this vaccine component is therefore inconsistent with the goal of eliminating all paralytic polio disease."
The US needs to start paying fines for this kind of behavior. Except of course we won't. But it makes me mad that this kind of thing happens and there's nothing that will be done to claim justice.
Bottom line is, mistakes were made, and getting your revenge on some old dude is not worth destroying decades of work trying to get a population to trust vaccination programs.
Um that's a bit of an extremely polarising conclusion to take away from elemenopy's comment.
"Questionable at best" tries to imply something entirely different than what was being said, which is that Hersh's claims were bold, not entirely backed up and subject to criticism. "Questionable in part", al right, but extending that to "questionable at best" sounds like you're pushing your own agenda here.
Maybe you just worded yourself too strongly, but if you decide to stick with that, please explain to everyone how the claims about what the US did to the vaccination programs in order to get to Bin Laden, made in Hersh's article, are either "questionable" or "worse".
Because as far as I've been able to check, Hersh's claims about the actions regarding vaccination programs part of the story (which is just a small part--but the part we are discussing here) are not being criticized by anyone in particular, except by those painting with the very broad brush that the entire story is questionable. Like you are doing.
"The US that put up fake vaccination centers in the pursuit of an already-minimized threat?"
In fairness, they gave out actual vaccines not fake vaccines so it wasn't a "fake vaccination program." I was a real vaccination program that also did a bit of assassination of international terrorists on the side.
So, on balance it was a very positive program for the community.
That still wouldn't be a problem if the local authorities trusted the vaccines - all it would mean is that they would receive it from somewhere else, Russia or China and administer it themselves.
I'm not super on board with the idea that the death rate is much of a worthwhile metric for determining how warlike we are as a people. It smells shockingly similar to counting lines of code.
It kind of depends on your definition of "war" and how you attribute causes of death, but in general, deaths due to warfare have been declining since the development of nuclear weapons and globalization.
Wikipedia seems to say that there is not a single idea of what countries are superpowers.
Some say that the US is currently (and since the end of the cold war) the world's only superpower. Some would say that the term "superpower" is not applicable any more.
Wikipedia also gives a list of "potential superpowers", being "the countries (or political entities) most cited as having the potential of achieving superpower status in the 21st century" :
" China
India
European Union
Russia
Brazil"
> We shouldn't do A, because even though A is okay, it will likely lead to B, then C, then D, which is definitely bad.
I don't think this is a valid form of reasoning by itself. The onus is on you to show that the A > B > C > D causality chain is inevitable. Simply mentioning the phrase "slippery slope" doesn't constitute such an argument and can be dismissed without thought.
It's pretty amazing that for my parents who were born in the mid-20th century, polio was still a concern. When they were growing up, FDR had recently died of complications from the disease and they knew people who were debilitated by it. Within their lifetimes the vaccine literally changed the world, to the point where polio is not present in developed countries. Vaccines are one of the greatest triumphs of human ingenuity.