Whatever the outbreak, lack of vaccines is always the problem

What have Ian Dury, Arthur C Clarke, Frida Kahlo, the Emperor Claudius, Neil Young and Francis Ford Coppola all got in common? All were born before 1955 and all suffered from poliomyelitis.

Poliomyelitis is caused by an enterovirus.  It travels in faeces and enters the body when the victim contacts contaminated water. Most cases result in a mild illness, but in one in a hundred victims the virus invades the nervous system, and things get serious. Meningitis follows, with high temperatures and progressive paralysis of the muscles of the legs, upper body, and even the neck. About half of these cases will be left with some form of permanent paralysis leaving them disabled and often immobile. No wonder it was so feared, and the arrival of vaccines after 1955 was greeted with such joy.

Vaccination has been one of humanity’s few undoubted achievements alongside things like tools and fire. Former terrors such as tuberculosis, measles, smallpox, rabies, yellow fever and so many others have either been confined to history or brought under control. Polio is a real poster child for the technique: the 1988 WHO vaccination programme has virtually eradicated the disease everywhere except for Pakistan and Afghanistan. Here resistance to vaccination is strong, for various historical reasons.

But in 2018 there came news of an alarming uptick of polio cases in parts of the Asia Pacific region. Writing for the Australian ABC news Olivia Willis and her co writers tell the story of how polio got a foothold in Papua New Guinea, Indonesia and neighbouring countries. Polio was eliminated in the Asia-Pacific. Then it suddenly came back – ABC News. It’s coming down again, due to the .efforts of governments and health workers. However, the causes are alarming.

For field workers, the best vaccine has always been the good old fashioned Oral Polio Vaccine, which uses an attenuated form of the virus.  It’s cheap, reliable, and effective in breaking the chain of infections. The trouble is that on rare occasions, the attenuated virus can escape, start to spread, and mutate until it is ready to strike again. That is what happened in Papua.

Anti-vaxxers will pounce on this with glee. We can imagine the spiteful joys on their websites: “VACCINES SPREAD DISEASE” and the somewhat paradoxical “Vaccination programmes don’t work.” Doubtless they will omit the crucial vindication that the vaccination rate in Papua was only 66% of the population. In polio-free Europe it is over 90%. That, combined with poor sanitation and public health in certain regions was why the outbreak occurred.

This has profound implications for the number one problem currently assailing the world, called Covid-19 in case you haven’t heard of it. Governments, scientists and doctors agree on one thing.

The only way out of this sorry social, economic and medical mess is the rapid production and distribution of as many vaccines as possible. Anti-vaxxers are having a field day denigrating ,casting doubt and spreading misinformation, much as they have been doing ever since the eighteenth century. The malign consequences of their efforts were shown by the upsurge in diseases like measles after the Andrew Wakefield scandal.  The evolution of the delta variant of Sars-Cov-2, which causes Covid-19, was a direct consequence of the virus running amok in unprotected populations. We have to stand firm on vaccines, because something much worse is waiting.

For about 60 years bacteria have been held in check by antibiotics. However, levels of bacterial resistance to antibiotics are now increasing fast. Already ancient killers like TB are making a comeback. New forms of MRSA in hospitals could make safe surgery impossible.  According to the charity Antibiotic Research UK this problem is already causing 700,000 unnecessary deaths a year and by 2050 this figure will reach 10,000,000. The consequences of two or more antibiotic resistant diseases appearing at once would make the effects of a single coronavirus seem small indeed.

About Antibiotic Resistance | Resistant Bacteria | Antibiotic Research UK

Despite heroic efforts to develop new antibiotics, bacteria will always evolve new resistance. The only long term answer is to develop a massive and sustained programme of vaccination. A recent review article in Nature outlines some promising lines of research the role of vaccines in combatting antimicrobial resistance | Nature Reviews Microbiology. As our experience of Covid-19 shows, the sooner that vaccines are developed and used, the smaller is the toll of death and misery.

To surrender to the anti-vaxxers even on one case like polio will hamper the efforts of researchers and health workers everywhere. The consequences in suffering and death will be enormous. But to adopt a policy of universal vaccinations offers the hope of a future where we still have hospitals, and diseases like polio and TB are no more than ancestors’ tales.

#covid-19 #polio #antimicrobialresistance #antibiotics #vaccine #immunisation #sars-cov-2 publichealth

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