Rotary Foundation with Ray Brown
by Lorine Parks
Ray Brown gave us a Rotary Foundation-focused course in Polio 101, in which we also learned fascinating facts about immunology. Don’t look now, but you are a member of a herd.
First, how our organization works: Paul Harris begat Rotary, which begat the Rotary Foundation, which begat Polio Plus, and many other humanitarian programs.
Next, Ray took us carefully through the facts. There are two kinds of polio: 99.5% of the cases attack the gastro-intestinal tract and make one only mildly ill; .05% of polio victims contract the kind of polio which attacks the central nervous system and kills or paralyzes either the lungs or the legs. Or both.
It is the polio myelitis strain with its central nervous system attacks which hit the United States with epidemic proportion in the first half of the twentieth century. In that era, summer was a dreaded time for children. Although they could enjoy the long days of play, summer was also known as “polio season.” Children aged five are under are the most susceptible to paralytic poliomyelitis, whose common name is infantile paralysis.
Adults get it too: in 1921 Franklin D. Roosevelt contracted polio at age 39. Ray showed us pictures of a ward room full of iron lung machines at Rancho Los Amigos Hospital. The scourge is all too familiar to Downey Rotarians.
Bill Harriman, our club president from 1929-30, was the Superintendant at Rancho in 1944 when a group of 32 patients was transferred from County General Hospital to Rancho Los Amigos for the treatment of poliomyelitis, and Rancho’s transition from the County Poor Farm to a premier medical center began. -
Polio is a disease resulting from bad sanitation. Where there is good water and hygiene, polio hasn’t much chance. But once it establishes itself in a population, it is very contagious and can be spread by contact with the stool of an infected person and droplets from a sneeze or cough. In fact, when a person is infected with polio, it is expected that polio transmission among susceptible household contacts will occur in nearly 100 percent of children and over 90 percent of adults.
There has never been a cure for polio once it is contacted, but there have been treatments for survivors and rehabilitation therapy
In 1955 the first of two of what Ray called “superstar virologists” appeared: Jonas Salk, with his injectable vaccine, made of safe dead polio virus. Safe because it contained a formalin-killed strain of the influenza virus that could not cause the disease but did induce antibodies able to ward off future viral attacks. But this IPV (Inactive Polio Vaccine) (the “I” could also stand for Injectable) cost about 80 cents a dose in 2016 dollars and it took trained technicians to administer it.
Remember the sugar cube soaked in vaccine? Come 1961 and enter Dr. Albert Sabin, with his oral vaccine. It was good and cheap (twelve cents a dose), and easy for anyone untrained to administer. The bad news? The OPV (Oral Polio Vaccine) used an active form of the virus and some of the recipients could get the disease. Sabin and many scientists of the time believed that only a living virus would be able to guarantee immunity for an extended period.
By 1994 the World Health Organization declared that naturally occurring poliovirus had been eradicated from the Western Hemisphere owing to repeated mass immunization campaigns with the Sabin vaccine in Central and South America. Europe was certified polio-free in 2002.
Despite Sabin’s belief in live-virus’s efficacy, the risk for paralysis from the live-virus vaccine does exist, although it is slight. So in 1999 a federal advisory panel recommended that the United States return to Salk’s vaccine because it cannot accidentally cause polio.
Now, where does Rotary come in? After seeing how smallpox had been erased from the face of the earth, in 1985 Rotary formally decided to address polio. Rotary joined WHO, UNICEF (United Nations International Children’s Fund) and the Bill and Melinda Gates Foundation, to lead the fight.
Rotary, along with our partners, has reduced polio cases by 99.9 percent worldwide since our first pioneering project to vaccinate children in the Philippines in 1979. Rotary always supported The March of Dimes (now Easter Seals), which promotes research.
And in 1988 Rotary added the “Plus” to its Polio campaign. With polio on the run, the funding and organization now set in place could be used against other scourges of childhood: diphtheria, pertussus (whooping cough), and typhus. Measles alone can lead to blindness, encephalitis or death.
So which type of vaccine to use today? OPV or IPV? OPV – Oral Polio Vaccine – is what is chosen for large-scale campaigns, because it is cheap and easily administered. But the virus can be transmitted. IPV – Injected Polio Vaccine – means no danger of transmission. But it is still relatively expensive and can only be administered by trained personnel. Tell that to a field volunteer behind battle lines in Afghanistan.
Now is the time for creative thinking, outside the box. At this point in the program, Ray upgraded our medical education by enrolling us in Immunology 101, with its breakthrough concept of herd immunity. Basically, the more people who are immunized and protected, the less chance there is for the disease to spread amongst the members of the community.
It turns out, that not everyone in the population needs to be injected and immunized, to eradicate polio. Herd immunity, also called herd effect, or community immunity, is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection. Chains of infection are likely to be disrupted, which stops or slows the spread of disease.
Once a certain threshold has been reached, herd immunity gradually eliminates a disease from a population. This elimination, if achieved worldwide, may result in the permanent reduction in the number of infections to zero, called eradication.
This contradicts the idea that as long as a single child remains infected, children in all countries are at risk of contracting polio.
So if the less expensive oral vaccine method is used, there may be more cases reported in the short run but the entire disease may be eradicated much quicker. Not all the herd has to become immune. If enough, a critical number, are, then the disease will quickly die out, in only a few generations.
This method was used for the eradication of smallpox in 1977 and for the regional elimination of other diseases. Herd immunity does not apply to all diseases, just those that are contagious, meaning that they can be transmitted from one individual to another. Tetanus, for example, is infectious but not contagious, so herd immunity does not apply.
But the maintenance of herd immunity is dependent upon the majority of individuals in the community being vaccinated. This is key.
Now politics begins to interfere with the natural process. Opposition to vaccination has posed a challenge to herd immunity, allowing preventable diseases to persist in or return to communities that have inadequate vaccination rates.
Some tribal chiefs in Afghanistan, or Africa, for example, have refused to allow polio workers into their territory, fearing they are disguised CIA spies, or that the vaccine is a means of ethnic extermination, by causing sterility (that is only a rumor – it doesn’t).
There are the occasional new outbreaks: the island republic Madagascar in the Indian Ocean, Laos in Asia and Guinea in equatorial Africa. A few cases may be reported in Nigeria. Complications come in the politics, geography, and culture of the area affected. So the polio story, though nearly completed, is still keeping its supporters in suspense till the very end.
Ray held his audience spellbound. Although his talk continued for ten minutes after the iron-clad deadline of 1:30, no one moved to leave until he finished. And then there were spirited questions.
The accomplishment is phenomenal. Two point five billion inoculations have been given in over 200 countries. Polio cases have decreased by over 99% since 1988, from an estimated 350,000 cases a year in more than 125 endemic countries, to 74 reported cases in 2015.