Our spines have buckled under illogical external pressure. The country is, or soon will be, in a chaos on account of irrational ‘orders’ on polio drops at airports. There are already reports in the press of growing corruption in issuance of medical certificates for polio. Medical personnel are reportedly demanding bribe for the service. There is said to be ‘shortage’ of the approved paper on which to write the certificates. Soon we shall have ‘shortage’ of the vaccine itself.
Bogus certificates shown at check-ins are likely to match the number of passports. The pervasive corruption will flourish at all levels. We went through this experience long ago when a certificate of vaccination against Typhoid-A, Typhoid-B and Cholera (TABC) was a compulsory requirement. Fake certificates outnumbered genuine ones even in those relatively pious days. Since then we have grown impervious to feelings of guilt, shame and embarrassment.
The ‘order’ stems from sheer ignorance of the epidemiology of poliomyelitis. It was issued presumably without consulting any expert in the field. Let us consider a few facts about polio
Poliomyelitis in the Third World is a disease of infancy and very early childhood, hence the name “Infantile Paralysis”. Small doses of the virus in contaminated water are swallowed repeatedly as the years go by. Each dose acts as a Natural Vaccine inducing natural immunity in the individual. Those who have lived the first 10-12 years of their lives in Pakistan have acquired robust natural immunity. Such natural immunity, like the oral form of polio vaccine, immunizes not only the body’s internal tissues, it also immunizes the lining of the gut.
The immune bowel becomes an impenetrable defence barrier for the individual as well as for the community. Further doses of the virus are destroyed in the bowel instead of being released into the environment. The injectable vaccine protects the concerned individual, but he can still pass the virus in his stool and endanger the community.
Polio is an infectious disease but not a contagious one. Unlike smallpox, measles and chickenpox, it is not contracted by physical contact with a victim of active polio infection.
Polio has no nonhuman reservoir, except one or two rare species of monkeys. Depletion of its human reservoir can eradicate the virus. To that extent it resembles smallpox. It can be eradicated through mass oral vaccination.
Typhus and plague (Black Death) were once the banes of humanity. Malaria continues to claim thousands of lives every year. Each one of these is transmitted by an intermediary host. The hosts in these cases are the body louse, the common flea and one species of mosquito respectively. These diseases cannot be eradicated without eradicating the intermediary hosts; that is virtually an impracticable proposition. Polio, like smallpox, has no intermediary host and can, therefore, be eradicated through induction of herd immunity.
Microbiologically ‘clean’ drinking water is an exception rather than a rule in the Third World countries. Contamination with human faeces occurs in countless ways. Oral vaccination is cheaper and more easily implemented, than ensuring ‘clean’ water for one and all. Many other diseases, besides polio, are also transmitted through contaminated water. The twin drives — polio vaccination and supplying clean water — therefore must proceed simultaneously.
There is no immunity to the virus at birth. Swallowing large doses of the virus may pass from the gut into the bloodstream and cause paralysis of one or many skeletal muscles.
Polio is crippling but seldom fatal. It may rarely infect the brain and its covering membranes (meningoencephalitis) or the brain centres that control swallowing and breathing. Such cases, called bulbar polio, are almost always fatal.
I saw only two cases of polio in adults during the 15 years of my clinical career in the UK. For unknown reasons neither of the two had been vaccinated in infancy. They contracted the virus during their residence in East Africa.
Now let us look at another deadly health hazard — Rabies. Rabies, unlike polio, never cripples; it always kills. Scores, if not hundreds, of people die of Rabies every year in the country. It is doubtful if any case of fatal polio has been recorded in the country in the past few years. We humans readily slaughter one another but would not shoot a dog.
Our municipal authorities still get the funds for stocking strychnine, buying mince and paying a permanent dog killer a handsome monthly salary. This is one of the many great legacies of the British Raj. The mince goes into the official’s kitchen and the dog killer works as his domestic servant. We proved these facts in the 1980s when I taunted the then governor, Lt. Gen. Fazle Haq, after one of his friends died of Rabies in my ward.
Polio is eradicable and we must strive to eradicate it. It is, however, essential that we keep our perspective right and our priorities rational.
Forgive me for ending with rather a crude example that might bruise the sensitivity of some readers. What will you say about a government order that requires all veterinary surgeons in the country to artificially inseminate all the cows in every dairy farm including those who are 3-4 months pregnant. The world will laugh at us. Worse still will be a demand from UNO, WHO and the many cash-guzzling NGOs that a long-acting contraceptive injection must be given to all female travellers, including the senile and the pregnant. The indifferent attitude of the media and the medical community in this regard is saddening and pathetic.