VACCINES 2: Thirty years later

Macenta, Guinee Forestiere, where we arrived to work in 1993,  Polio was still rife.

In my last post I explained  how polio, a disease that was feared by my mothers generation, was rapidly bought under control in the western world by new vaccines which, as they were not patented, were able to be made rapidly available by multiple pharmaceutical companies. This is an interesting lesson for dealing with the current COVID-19 pandemic.  Are there any  other lessons that we can we learn from this story?

By the time that I first went to school, although there still were occasional cases, the threat of annual polio epidemics in the UK was already the memory of a previous generation.  Later in my final year at medical school (1984),the last case of polio in the UK caused by transmission of the wild virus was recorded. 

However despite the amazing generosity of Jonas Salk and Albert Sabin the problem worldwide was still a massive one. In 1988 there were still an estimated 350,000 cases of paralytic polio each year, with about 10% of the children dying. That was the year  that the WHO launched the Global Polio Eradication Initiative.  

Five years later, Andrea and I arrived in the hot and humid town of Macenta, Guinee Forestiere. It was forty years since  the discovery of the vaccine, yet tragically polio was still endemic. Each year I would see young children who had been either recently  paralysed or were living with the consequences of contractures. Often they were  crawling on their knees unable to use any  muscle strength that they had regained to walk. At the Centre Medical we worked together as a team; the physiotherapists taught exercises, the orthopaedic workshop made callipers and splints, and in the operating theatre we did tendon release procedures guided by the newly published WHO manual.

Thankfully prevention was also beginning,  polio vaccines were being distributed to  the fridges in the  new health centres that the Mission Philafricaine were building in collaboration with the Ministry of Health. For the first time the people of the region had access to  routine childhood vaccinations. In addition each year, on two special national vaccination days, every child under 5 in the country received a dose of oral polio vaccine. Healthcare workers passed from door to door with a polystyrene insulated cardboard vaccine carrier emablazoned with "KICK POLIO OUT OF AFRICA" No-one was exempt,my daughters must have recieved a total of 12 doses by their fifth birthday. Within a couple of years of the campaigns beginning I no longer saw newly paralysed children, but there were still plenty who needed help from the time before the vaccine. Similar campaigns were taking place everywhere with dramatic results, the graph below shows the global situation. 

In Macenta the  dramatic change was bought about by the arrival of the cold chain. In 1991, just prior to our arrival, there had been an epidemic of meningitis and the only way to get vaccines into the region had been in a truck from the capital alongside deliveries of frozen fish.These were being made by a family of Lebanese traders to a chain of depots selling fish to the local markets. Thanks to this unusual support lives were saved, but the need for the provision of a dedicated medical cold chain had become clear.

The WHO estimates that their polio campaign has lead to 80% of the worlds population now living  in polio free countries and that 18 million less children have been paralysed as a consequence.  There were only 22 cases of wild polio virus reported in 2017, a great success but we  not quite there yet, and it has taken 60 years.

Sadly despite the potential supply of large volumes of patent free vaccines it took 30  years before adequate supplies arrived in Guinea because of the lack of development of the healthcare systems in low and middle income countries, notably, cold chains. Thankfully cold chains are in place now even in remote places such as  Bardai, our current somewhat dryer home mid Sahara.

The Provincial hospital where we work  has  an excellent solar powered fridge supplied by UNICEF and we are able to supply polio vaccine to the most remote villages each year for the National Polio Vaccination Days. Due to the terrain it actually takes about a week to get around them all using the hospital ambulances. 

So with the current COVID-19 pandemic, we are fortunate that the necessary infrastructure is already in place, but where are the vaccines? So far 25 million doses have been given for the African population of 1.35 billion  whereas we in the UK have given 32 million doses for 68 million people, that is a 25 fold difference. This disparity represents  what the WHO has called a potential 'catastrophic moral failure' of inequality. We need to campaign for  our government and the World Trade Organisation to enable sharing the knowledge and technology so that a low cost vaccine  can be equitably and freely available throughout  the world. This is best done by a TRIPS (patents) waiver, which is supported by the majority of nations  but opposed by  pharmaceutical companies and rich western nations. If you want to show solidarity with your global neighbours click on  the BMS petition.

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