Book Review: Polio – Paralysed by Politics?

Ayesha Khan from the Collective for Social Science Research, Pakistan, reviews Paralysed with Fear: The Story of Polio by Gareth Williams

Electron micrograph of the poliovirus. Photo credt: Centers for Disease Control and Prevention Public Health Image Library

Electron micrograph of the poliovirus. Photo credt: Centers for Disease Control and Prevention Public Health Image Library

The story of polio almost ended with historical success – its global elimination was to match that of smallpox years earlier. But today it is re-emerging as a potential threat again, so much so that the Gates Foundation has declared this an emergency and estimated that full eradication may cost as much a $1 billion dollars a year.

Gareth Williams, in his new book Paralysed with Fear: The Story of Polio, offers an insightful history of this debilitating and frightening disease, which was only tamed by the development of an effective vaccine in the 1950s. With tragic consequences in Scandinavia, Russia and the US, polio epidemics began to grow from the 1930s just when rates of cholera and tuberculosis were coming under control.

A key lesson to be learnt from the story of polio is similar to the efforts to develop cures for cancer, so eloquently captured by Siddharta Mukherjee in The Emperor of All Maladies, published in 2011. Finding cures cost money. This may seem a simple truth, but without enormous financial, and political, backing, breakthroughs in research don’t happen, or if they do nobody hears about them. US President Franklin D Roosevelt, himself a survivor of polio, founded the National Foundation of Infantile Paralysis (NFIP) in 1937. It launched a campaign based on fear, a call to save the public from the dreaded “Crippler” that emerged seasonally in various communities across the US. (In 1949 alone, America reported 42,000 cases and 2,720 deaths.)

NFIP fund-raising efforts were endorsed by famous stars such as Humphrey Bogart, and in its first year over $1.8 million were raised by its “March of Dimes” campaign that appealed to the American public to donate money for research into a polio cure and establishment of care facilities for recovering and paralysed patients. Ultimately it was the NFIP that funded Jonas Salk who delivered the first vaccine to the American public.

Williams writes in an accessible and vivid style, drawing together historical, political, and scientific material to tell a tale that is almost over. His research is meticulous and he is unafraid to reveal the darker side of medical research. For example, it was a young Swedish researcher during 1911 who discovered that polio could be transmitted through the gut, but his work was suppressed because the powerful Rockefeller Institute at the time was heavily invested in the theory of olfactory transmission. A full 25 years later, his theory was confirmed by American researchers and Albert Sabin began to think about the possibility of an oral vaccine.

The story of polio features a cast of characters in relentless competition against one another to find the cure, who were not averse to back-stabbing and undermining one another publicly in order to gain publicity and, ultimately, funding to pursue their work. Even the ethics of scientific research and practice were subjected to the manipulation of institutions and scientists eager to remain center stage. The famous rivalry between Jonas Salk and Albert Sabin, the inventor of the oral polio vaccine that eventually superseded Salk’s, lasted until their deaths in the 1990s. Sabin’s tombstone reads “SABIN. Developer of the vaccine that made possible the global eradication of poliomyelitis.” After undercutting one another in every possible venue, including scientific conferences, for decades, Sabin had to have the last word, which was in fact almost true. Not to be forgotten, though is Hilary Koprowski of the Wistar Institute, who developed a rival oral vaccine that was used to vaccinate thousands of children in Africa, and who later had to endure untrue allegations that his vaccine was linked to the spread of HIV/AIDs during the 1990s.

The reader is left unsatisfied by the end of the book, however, because only the last pages of it are devoted to the contemporary history of eradication, such as the Global Polio Eradication Initiative (GPEI) whose aim in 1988 was to eradicate polio by 2000. Polio remains endemic, around 250 cases reported in 2012, in Nigeria, Pakistan, and Afghanistan, making success almost within grasp.

Ultimately the story of why polio remains endemic in these countries is a political page-turner of another sort, not a medical one. A combination of political conflict and religious extremism in all three countries has halted the road to eradication. In Pakistan, for example, community health workers in the northwest have been killed by the Taliban for the alleged crime of using polio vaccines to spread sterility among the people as part of a western plot. The fact that a polio campaign doctor, hired by a US-based NGO, was used by the CIA to help identify the location of Osama bin Laden only made matters worse for government immunization efforts. The Taliban have also issued edicts that it is against Islam for women to work for wages and move about in public places, something over one hundred thousand women health workers across the country do daily. Today administering polio vaccinations has become an issue of national security in Pakistan.

None of the three countries still affected by polio have managed to bring violent religious extremism under control. Until they do so, no amount of funding will eliminate polio.

Paralysed with Fear: The Story of Polio by Gareth Williams is published by Palgrave Macmillan, ISBN: 978-1-137-29975-8

Ayesha Khan is Senior Researcher at the Collective for Social Science Research in Karachi, Pakistan. She has conducted a number of studies on health issues, health policy, and women. Her email is ayesha.khan@researchcollective.org.

The author declares no conflict of interest.

Books reviewed in Speaking of Medicine are independent of the book’s publisher. Reviewers do not receive a fee but are allowed to keep the review copy of the book.

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