When I was in grade school, I remember looking at pictures of Franklin Delano Roosevelt and wondering why someone so powerful was confined to a wheelchair. If he was the president of the United States -- the top dog in the strongest nation in the world -- why couldn't he walk? Why didn't he use all the resources at his disposal to cure the thing that had crippled him?
That thing, it turned out, was polio. And curing it was more difficult than my nine year-old self could have imagined. First recognized in 1840, polio is a viral disease that can affect the motor neurons, causing devastating muscle weakness and paralysis. Known for paralyzing primarily infants and children, poliovirus is spread via fecal-oral transmission and first enters the body through the mouth, where it then begins its mission to infect the host's cells.
The tricky thing about viruses is that they have the ability to transform the DNA of the host cells they infect. Once they have inserted themselves into the host genome, they replicate and mutate. The rate of mutation makes it especially difficult to treat the virus once it has infiltrated the host and is why prevention of polio is much easier than curing an already activated virus. After much trial and error, preventative vaccines were successfully developed in the 1950s and quickly became used to confer immunity to the disease. In a public health triumph, polio was eradicated in the United States in 1979. Today, for most living in the western hemisphere, polio has become all but a distant memory. Yet while vaccinating children against polio in a country like the U.S. was relatively simple, other less fortunate countries faced and still face larger challenges. For one, the polio vaccine must be kept cold at all times, and countries lacking widespread electricity cannot provide the refrigeration required for the vaccines. Frustratingly, some third-world countries have not achieved polio-free status, despite vaccines being extremely effective and costing only around twelve cents a pop.
Enter Rukhsar Khatoon, a four year-old girl from a small village in the Indian state of West Bengal. Rukhsar has polio, and will likely present with polio symptoms for the rest of her life, unless a cure is found. What sets Rukhsar apart from other polio victims, however, is that she is the last: the last recorded case of polio in India. Since her diagnosis three years ago, India has not documented a single other case of the disease, and on March 27th, the World Health Organization (WHO) will formally announce the end of polio in not just India, but the entire region of Southeast Asia. This announcement will signal the end of a tumultuous era for India when it was considered to be the epicenter of the disease. In 1988, at the time when a global effort was launched to end polio, over 200,000 children were diagnosed with the virus every year in India alone. With India officially free of the disease, it seems that hopes are high that the remaining affected countries will follow suit. Boasting over 1.2 billion people, India is the second most populous country in the world. The three countries that have not eradicated polio also have sizable populations -- Pakistan, Afghanistan and Nigeria. But India and Rukhsar are proof and motivation for these nations that polio can and will be overcome.
There are three steps that India took to rid itself of polio and these are steps that can feasibly change the future for Pakistan, Afghanistan and Nigeria. First and foremost, funding: This might seem obvious, but without the funds for the vaccines to be procured and distributed, there can be little hope of success. Secondly, innovation is crucial. Remote villages probably aren't going to have access to electricity -- so the refrigerators must be powered with other sources, like kerosene oil. Thirdly, educate about the necessity of the vaccine. In India, rumors spread in some Muslim communities that the vaccine made women infertile and that it was a government ploy to curb the population. The vaccine can't do any good if no one wants to receive it. If the correct measures are taken, though, it is plausible that WHO will soon be announcing the end of polio as we know it.
Recently, in school, I learned about polio again. This time the focus wasn't on President Roosevelt, but rather the virus itself and the effects it can have on the human body. What struck me most about the lesson was the curious treatment for polio patients called the iron lung. When my professor first described the mechanism, I assumed that patients merely slept inside the lung, or alternatively, had several sessions inside it a week. I was floored when I discovered that polio patients actually spent years inside this bizarre machine that breathed for them once their normal muscle function deteriorated. I googled it and was even more shocked to realize this ancient looking contraption is still in practice. Although more rare than it once was, iron lungs are used in extreme cases to treat surviving victims of polio. These patients have no chance of regaining the ability to autonomously breathe because there is no cure for active polio, even though the disease is mostly obsolete. Seeing modern-day pictures of patients confined to the iron lung lends perspective to the fact that even as the world celebrates polio being eradicated in India, many people continue to live with the disease, with access to only limited therapy options. Half of India's 21 million physically disabled, including little Rukhsar, are disabled because of polio. As we look towards the future with renewed hope for worldwide immunization, we should not forget those who suffer without a cure.