Posted on Oct 05, 2022
For our first meeting during Polio Awareness Month, fellow Rotarian Dr. Robert Tello brought us up to date on the history and current status of our understanding of the polio virus and the ongoing effort, led by Rotary, to eradicate polio.  He started by talking about the recent up-surge of paralytic polio around the world but especially in New York City.  Although there have been a small number of cases in Israel and London with only one in New York, there have been numerous non-paralytic cases, especially across central Africa.  Around New York, waste-water analysis has shown that the virus is present in the five-county area around the city, including Rockland County where only 60% of the children have been vaccinated against the virus. 
A brief history of polio in the United States in the first half of the 20th century highlighted the size of outbreaks in several cities in the US before the advent of the polio vaccines in the 1950s.  It was understood that an infection by the virus could lead to paralysis of muscles, especially the respiratory muscles (the diaphragm and the intercostal muscles in the rib cage) leading to the need for breathing assistance from iron lungs.  It was ultimately discovered that the polio virus is an enterovirus (similar to the virus that causes intestinal flu) and that there are three strains of the virus.  There are also two other non-polio enteroviruses that can cause paralysis.  The virus enters the body through the mouth and infects the intestinal tract.  In some instances, it can enter the bloodstream and ultimately infect the spinal cord, resulting in paralysis. Some 75% of those infected are asymptomatic; others have intestinal flu.  Only 1% to 5% of those infected contract meningitis (infection of the spinal cord) and only some 1 in 200 to 1 in 2000 of those who get infected actually get paralyzed.  It is now understood that some 30% of those who get infected can begin to suffer a post-polio syndrome, a range of polio symptoms that may appear some 10 to 40 years after the initial infection and recovery. 
The first vaccines were developed by Jonas Salk (an injectable vaccine, 1955) and Albert Sabin (oral administration, 1962).  These were said to “end polio’s threat”.  The Salk vaccine was based on dead virus from all three strains of the virus, so was widely applicable, but was not especially suitable for rapid, widespread use since the injection required more medical intervention.  The Sabin vaccine, based on partially weakened or attenuated live virus (and ultimately including all three strains), was widely applicable and, being oral, was more suitable for large scale mass vaccination in developing countries, but the live virus could (and occasionally does) mutate back to the virulent form and cause the disease.  Both vaccines can be distributed in trivalent (all three strains of the virus), bivalent (only two of the strains, mostly types 1 and 3), or monovalent (typically whichever strain is appearing in local epidemics) forms. 
With the advent of the vaccines, the number of cases of paralytic polio started to decline.  In 1985, Rotary created the Polio Plus initiative with the goal of global polio eradication.  This initiative included not only polio vaccination but also included other health-associated efforts including clean water, sewage, public health, education, and transport to health facilities.  This program was soon joined by other organizations including the Gates Foundation and the World Health Organization (WHO).  This organization was already in place and well organized as a basis for attacking the COVID pandemic when it appeared in 2020. 
Rotary is involved in this initiative both by paying for the vaccine and by arranging for the volunteers to administrate the vaccine.  The volunteers are the hard part especially since, in some areas (e.g., Syria and Pakistan), they put their lives at risk simply by trying to administrate the vaccine. 
The result has been a 99% reduction in the presence of wild infections (that is, infections that are not caused by mutation of the partially weakened virus).  There are currently only three countries in the world, Afghanistan, Pakistan and Mozambique, where the wild virus is still causing paralytic infections.  All the other currently active infections around the world have been caused by the mutation of the type 2 virus from the vaccines.  The polio virus (like the COVID virus) is an RNA virus in which, during reproduction of the virus in the intestinal tract, a change in the order of the nucleotide bases that make up the virus is a mutation that may make the virus more virile by making the spikes on the virus particle that attach to the human cell more able to make that attachment. These newly virile virus particles are shed in the stool of the infected individual so that an unvaccinated individual who comes in contact with the stool may become infected.  Since the vaccine-derived infections come from the type 2 variant, widespread vaccination campaigns now use oral bivalent vaccines using only types 1 and 3.  In the areas where the vaccine-derived type 2 infection is happening, a monovalent oral vaccine against only type 2 (where the virus cannot mutate) is being administered.  The current effort to vaccinate against COVID uses a bivalent vaccine that gives protection against the original  COVID virus (SARS-2) and the current two most common strains of the Omicron variant (BA.4 and BA.5). 
Rotary has now established a program, Rotary Polio Eradication 2022 – 2026, with the goal of raising some $50 million per year, to be matched 2 to 1 by the Gates Foundation.  This includes a Polio Plus Society for individuals who have committed to donate $100/yr through the website  Donation through that website results in the donation being credited to your local club. 
The presentation ended with a video of Jennifer Jones, president of Rotary International, about the current effort to eradicate polio. 
With respect to COVID vaccinations, can an un-vaccinated individual just start with the new bi-valent vaccine?  No.  The new vaccine is aimed at individuals over 65 or with other serious risks.  So other individuals should start with the basic vaccination series. 
Where did polio come from?  Are there still active natural reservoirs? Archeological evidence suggests that polio was already present in ancient Egypt.  It is not apparent that there are any current natural reservoirs. 
If you were vaccinated 50 years ago, is it still good?  We don’t know.  If you will travel to an area where polio is still active, get a booster. 
Are iron lungs still being used?  No.  There is now a wider range of available respiratory assistance means including C-Pap and ventilators. 
Why is there the outbreak in New York City?  The short answer is that there is a high percentage of unvaccinated people in the area.  The virus spreads very easily.  They are now involved in a widespread sewage surveillance to see where the virus is now found. 
Why is there so much resistance to vaccination in children?  Dr. Tello suggested that it is a widespread trust issue.  A significant part of the population doesn’t trust the government, doesn’t trust the large pharmaceutical companies, and doesn’t trust traditional medicine.  Some people have had a significant reaction to a previous vaccination and there have been a very few serious reactions to the vaccine. 
What sort of change has there been in the vaccination rate in the US?  Some parents are outspoken about not getting their kids vaccinated, not putting unknown stuff into their kid’s bodies.  If children get the disease, they easily transmit to adults who have somewhat weakened immunity from childhood vaccinations.  As a result, several diseases that appeared to have been wiped out (e.g., measles, whopping cough) are making a comeback. 
Why do we continue to use the weakened vaccine?  The short answer is that the injectable vaccine requires more health-care people so the oral vaccine is still the best for mass vaccinations.  Given the high transmissibility of the virus, we need to have some 90% - 95% of the population vaccinated to achieve herd immunity.  Comparing Mississippi with Colorado (Mississippi has the higher vaccination rate), it appears that state law is more convincing than education.