The polio vaccine 50 years later: This year could be polio's last gasp

In 1999, Timothy Jones, MD, a family physician and deputy state epidemiologist for the Tennessee Dept. of Health in Nashville, left his family and went to Yemen. He went to provide polio vaccinations to children in this Middle Eastern nation that is one of the poorest in the Arab world.

"It was a very, very difficult country to work in," he remembered. "But it was a great opportunity to be a part of one of the most historic achievements of public health."

His work was part of an overarching march toward the global eradication of polio. In many ways, the prize is now closer than ever.

Since 1988, the year the World Health Assembly pledged to eradicate polio, the number of countries in which the disease is endemic plunged from 125 to six. And this month, just as the world marks the 50th anniversary of the announcement that the Salk vaccine worked, experts say global eradication could be accomplished by 2005's end. "We have a pretty good chance this year to do it," said Oliver Rosenbauer, World Health Organization spokesman.

The final steps, however, may be the most difficult.

Several prior deadlines for eradication have been missed, and, although 784 cases were recorded in 2003, the lowest ever, that number went up to 1,263 in 2004. This increase has been primarily driven by Nigeria. There, rumors that the vaccine could damage fertility and was being used to spread AIDS led to a boycott. In turn, the boycott led to the re-emergence of the disease there that spread to 14 other African nations in which polio had previously been eliminated.

Public health experts warn that this experience is a sign of things to come if vaccination rates are not maintained around the world until the disease is truly eliminated.

"If efforts falter, it will come back and come back with a vengeance," said Harry Hull, MD, state epidemiologist for the Minnesota Dept. of Health and former director of the WHO's Global Polio Initiative.

And the countries that continue to struggle the most in this fight generally have the fewest resources. In India, for example, one of polio's remaining strongholds, challenges result from the sheer numbers who need to be vaccinated, combined with a woefully insufficient health infrastructure.

"There are not enough trained professionals," said Venugopal Bellum, MD, MPH, a second-year resident at Eastern Virginia Medical School who is originally from India and worked on eradication there in 1997 and 1998. "When we were giving the vaccine, there weren't enough gloves, and maintaining the cold chain was difficult. Some vaccine had to be thrown away."

Funding is also an issue. According to WHO, another $75 million is needed this year. So far, significant donations have come from Sweden, Canada and the European Commission.

"Funding is always a crisis," said Carol Pandak, EdD, manager of Rotary International's Polio Plus Program, a partner in the initiative. "But governments are seeing this as doable and want to be part of eradicating it."

And experts maintain that giving up now is not an option. Otherwise, they say, the $3.1 billion already spent on this goal, which is expected to be recouped when countries such as the United States can stop vaccinating, would have been spent for nothing.

Experts also warn that if polio exists anywhere in the world, there is always a chance that it can return here. The last cases in 1979, for example, were linked to travel among the Amish who had not received the vaccine. This meant the virus jumped from Turkey to the Netherlands to Canada, eventually infecting 15 Amish and non-Amish in Wisconsin, Iowa, Pennsylvania and Missouri.

"If a disease exists in the world, we need to worry about it as if it's in our backyard -- ready to spread at any moment," Dr. Jones said. "We could have our hands full very quickly."