Ending Polio: Why Doesn’t The World Trust Vaccines?

Eradicating a disease is one of those milestones in human history which amount to a wonderful vindication of human capacity for innovation and ingenuity in the service of the common good. Of course only (and I use the word cautiously as it remains a shockingly impressive achievement) one human disease (Smallpox) has ever been entirely eradicated.

Several other diseases are though thought to be close to eradication, most notably polio. 2012 saw under 250 new cases of polio, whilst the disease is thought to be endemic only in Nigeria, Pakistan and Afghanistan, with reports of recent cases in Syria. Polio infections have decreased 99% since 1988. Or, to use an equally mind-blowing figure, 10 million people today are walking who would otherwise be paralysed by the disease.

Jonas Salk and Albert Sabin must take much of the credit for this commendable and rapid progress. Whilst much of America and Europe suffered through polio epidemics in the fifties and sixties, they developed the vaccines which have come so close to confining the disease to history. In the UK and elsewhere, controversies about vaccines’ efficacy still occasionally emerge, generally with very little scientific cause but much media bombast.  If any vaccine has proven itself beyond question, however, the polio vaccine must have done so by sheer force of results.

Sadly though in the past year several ordinary people distributing polio vaccines in Pakistan, and nine women doing likewise in Nigeria, have been murdered by religious fundamentalist militants. Similar attacks have occurred in Afghanistan in recent years. The justifications given by the perpetrators in the above examples point towards some variation on the theory vaccines are methods of control by Western governments, either rendering the subject infertile or actually giving them some vicious disease.

Often these attacks are carried out by violent religious extremist militias. Religious concerns and brutal militia control are not the only factors, however, in certain population’s reluctance to embrace vaccination in spite of its huge successes elsewhere. Nearly all mainstream religious thought has no problem with vaccination. This year even the Taliban has ended its “war on vaccines,” declaring there is “nothing unislamic” about vaccines. Quite a move when you consider the rather broad and implausible list of activities the Taliban has previously declared “unislamic.”

Perhaps it’s surprising this declaration has not led to a significant decrease in attacks upon vaccination workers. It is much less surprising though if the declaration has failed to change the attitudes of ordinary people to vaccination. After all few living with the realities of the Taliban are likely to see their leadership as paragons of religious virtue.  Although the loss of lives faced by vaccination workers is tragic, as important as stopping such reprehensible and pointless murders is convincing ordinary people to take the vaccine and give it to their children.

Whilst few people are so unbalanced and ill-intentioned to actually murder someone administering a vaccine, many more will politely decline because they believe the vaccine does more harm than good, or has most probably been designed by disreputable overseas bodies for underhand purposes.

The areas in which polio remains extant are often remote, lacking in educational services and access to information. Education though does not equate exactly to an acceptance of vaccines and Western medicine. Significant numbers of educated, intelligent people in the developing world genuinely believe viruses like AIDS were created for purposes of population control, racial dominance or for some other nefarious end in laboratories of developed nations. One can only speculate grimly how many lives have been, and will be, lost to various diseases around the world owing to suspicions of malign intent and effect in Western-developed medicine.

With the UK’s recent history of vaccine paranoia surrounding the MMR inoculation, it should not be hard for us to understand how such fears arise, spread and come to dominate over rational and scientific but dry and difficult discourse. What may be harder to comprehend is the idea diseases are not unfortunate consequences of biology, but a trans-national conspiracy with complex and seemingly monstrous aims.

Consider though the recent history of many developing nations in Africa, Asia and Latin America. Even after the direct control of colonialism was relinquished, European and North American nations spent much of the 20th century orchestrating coups, instigating factional wars and directing political and economic activities in these countries in pursuit of their own ends with little concern about the impact on the lives of local populations. From the perspective of those who have lived through these machinations and their consequences, it may seem much less implausible that these offers of medical assistance may be less than straightforward.

Causes for this lack of trust are then long-term and hugely complex, but one does not have to look far for a contemporary example of how issues of developed nations’ foreign policy and trust in vaccines intersect. Reports have suggested information crucial to Osama Bin Laden’s assassination came to light following a fake polio vaccination campaign. It has to be questioned if further associating vaccinations with mistrusted and often outrightly hated military forces was really necessary or worthwhile.  There were many casualties over the ten years plus it took to find and kill this one man, and it is very likely we may add children dying of diseases they were not vaccinated against to that total.

Many of the steps towards greater uptake of vaccines will involve practical issues of resources, distribution, access and education. More broadly though, a more open and less narrowly selfish foreign policy by both private and public bodies in developed nations, which still largely produce, market and export vaccines, could have an extremely beneficial long-term impact on global health. Heightening global trust in vaccines will be a long and difficult process which can not be separated from more holistic efforts to develop a global political and economic system in which the ordinary citizens of developing nations can rightly trust.