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Polio’s ‘end game’

“Guess what?” announced my daughter-in-law Tesh recently. “Now that Kin has had his first shots, we can bring him out and go places as a family. He doesn’t have to stay indoors all day!”

It was clearly a milestone in their so-far brief history as a family of three. My grandson Anakin had just passed his first “monthsary” and, with the first of a series of vaccinations against common childhood diseases, he now had a measure of protection against illnesses that, just decades ago, routinely took the life of vulnerable newborns.

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I have a family history with these diseases. Family lore has it that my maternal grandmother had to bury her first two sons almost on the same day: She had just returned from the funeral of her first-born when she was told that her second-born, just a few days old, had likewise succumbed as a result of a cholera epidemic. My own mother had to endure the loss of her first-born just before the war, in the wilds of Koronadal in Cotabato. Some years later, her fourth surviving child, another boy, was stricken with cholera. I can still remember a photo of this boy (whom my parents named “Ilde” after my paternal grandfather Ildefonso) in long nightwear lying on his bier, as if he were just sleeping.

Fortunately for the rest of us nine surviving children, we were either incredibly lucky or, certainly part of that luck, childhood immunization had become not just available but also common.

As Dr. Tony Nelson of the Chinese University of Hong Kong told a media seminar recently held in conjunction with the Fifth Asian Vaccine Conference held in Hanoi, the world now takes for granted the protection granted by vaccines, which have guarded children against the most common and deadliest diseases in the last few decades.

Every mother now carries her immunization booklet on which to record her child’s vaccine shots or doses during the monthly visit to the pediatrician, during which the child’s weight, growth and developmental progress are tracked.

The visits and shots have become so routine that, as Dr. Nelson put it, the world often forgets “the child who didn’t die” as a result of vaccination. We expect vaccines to work.

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But sometimes, they don’t, or are made available too late to save a child.

Bruce Langoulant, a layman who heads an Asia-Pacific organization on meningitis, “earned” his expertise and experience from the story of his daughter, Ashley, who was stricken with pneumococcal meningitis when she was just six months old in 1989. At that time, the pneumococcal vaccine was a few months from official release and basically, said Langoulant, “we were sitting ducks.” Now 19, Ashley has survived cerebral palsy and epilepsy, and converted her parents into “champions” of vaccination not just in their native Australia but also in the rest of the region.

Langoulant works not just to promote vaccine use, but also to educate parents about their importance, and to encourage doctors to communicate better and more compassionately with their patients. A doctor’s patient, he said, is “not just the one lying on a hospital bed, but the family around the bed and outside the room.” Li Jin Chan, a journalist-turned-advocate/activist on vaccines in Malaysia, reminded the journalists present: “People will forget what you say or do, but not how you made them feel.”

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At present, the hottest news on the vaccine front is what people are calling the “end game” to finally eradicate polio. After smallpox, of which no case has been reported in decades, polio is next on the line for eradication, which means, variously, the “extinction of the disease pathogen,” the “elimination of the occurrence of a given disease, even in the absence of all preventive measures,” and “control of an infection to the point at which transmission ceased within a specified area.”

Polio was declared “globally eradicated” in 1975-1976, according to Dr. T. Jacob John, an Indian virologist, and “this was just in the nick of time.” Because, given the outbreak of HIV/AIDS in the late 1980s and early 1990s, the incidence of polio would have just exploded among vulnerable populations.

The last infection of the wild polio virus in the Philippines was reported in 1993, said Dr. Eric Tayag of the Department of Health. This is why, he said, while polio can be said to have been “eliminated” in the country, it has not yet been declared “eradicated.”

Today, three countries are the focus of the global polio eradication campaign: Pakistan (where 306 cases were reported last year), Afghanistan (28) and Nigeria (six). Polio has also sporadically appeared in Somalia, Equatorial Guinea, Cameroon and Iraq, but it is not considered “endemic.”

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Still, even in a country like the Philippines, health authorities need to ramp up their antipolio measures. Apart from antipolio vaccines being part of the common “menu” of childhood vaccinations, there needs to be as well a “shift” of methods—from the more common use of the oral polio vaccine, which carries the rare risk of paralysis in one of every 2.7 million children receiving a first dose, to the use of the inactivated polio vaccine which, administered by injection, carries no risk of paralysis.

The “big switch” in polio eradication, explained Dr. Tayag, is that, from the use of the “trivalent” vaccine, health authorities would transition to the “bivalent” vaccine which would “boost immunity to wild poliovirus to hasten their eradication.”

“We need to create buzz,” declared Dr. Tayag, to convince parents to bring their children to get another polio shot. Here’s hoping he can dance his way to the hearts and consciousness of Filipino parents!

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TAGS: cholera, health, meningitis, polio, vaccinations
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