THEOMACHY: War of the Gods

Pakistan’s Polio Curse… Why can Pakistan not escape the Polio menace?

A poster for the Polio Eradication Initiative, Pakistan In 1952, Polio was the American disease. Roughly a century later, it is the Pakistani disease. Of course, this has nothing to do with the idea that in either epoch, the polio virus has evolved to disfavor the American phenotype and attach itself onto a Pakistani phenotype. It is nothing of this sort. A quick search for the global Polio epidemiology will give a WHO (World Health Organization) detail on the current polio situation. The following are lines copied word for word from the official WHO website

Endemic transmission of wild poliovirus is continuing in areas of Afghanistan and Pakistan. Failure to stop polio in these last remaining areas could result in global resurgence of the disease.

It would seem that the tendency for mishap in the world of pharmaceuticals runs rampant given that the formula for saving lives requires an equivalent exchange of deaths. In 1952 when Jonas Salk was constructing one of the largest labs for polio research, the crippling virus had struck around fifty-nine thousand people. The character of polio virus comes across as singularly malicious when one observes that it chooses children over adults for its victims. But it did cripple adults too, and some of considerable influence. One such man was Frederick Delano Roosevelt who served as the 32nd president of the United States of America. In his younger years he was infected with polio and was perpetually paralyzed from the waist down. But he contributed greatly to controlling the infection situation. He could relate, he could also understand that his condition was fairly better than the ravages the virus was otherwise capable of. In his time, there were around twenty-seven thousand cases of polio and most victims would succumb to the infection within a few days. The Iron Lungs, a NPV (negative pressure ventilators) is a respirator used in assisted breathing. Polio often paralyzes the lungs and the damaged respiratory muscles are many a times the cause of mortality.

A poster for the growing need of Iron Lungs to meet the rising cases of polio infectees FDR, as Frederick Roosevelt was lovingly initialed, spearheaded alongside his Wall Street lawyer, Basil O’Connor a widespread anti-polio campaign which recruited celebrities for a country-wide appeal for donation of one dime per person, a program he called ‘the March of Dimes’, that aimed to rescue children from infantile paralysis. Eventually ‘the March of Dimes’ became an established foundation which later funded Jonas Salk’s polio vaccine.

A poster for Roosevelt’s infantile paralysis awareness campaign During Salk’s time three polio strains had already been identified. But this discovery had not been without blood, sweat, and tears. Many an academics had been disgraced in their quest to find that panacea that would rescue subsequent generations from the debilitating impact of Polio. One such unfortunate researcher was Maurice Brodie. He had established a control group of monkeys who received his treatment and reported an 88% survival rate. The treatment involved subjecting polio infested monkey spinal cords to a fixed ratio of formaldehyde to induce antibody production. This was a novel use of formaldehyde, a chemical compound that is now universally acknowledged as a potent tissue fixative in research laboratories for storage of isolated organs. However, he had been targeted by anti-polio elites and labeled a killer. His research career was swiftly culled and he was marginalized by the pharmaceutical companies. Although eventually having found a minor position, he died at the age of thirty-six. Too young for a capable scientist! His fatal flaw? His experiments had caused the death of a twenty-year old man. But Maurice Brodie is one such example. The COVID-19 pandemic opened the eyes of people across the globe, both lay and knowledgeable alike, on how the search for a cure results in fatalities. There was debate regarding the moral subjectivism in medical science, but the penultimate decision was that whatever the outcome, the vaccine was the only prevention against an exponential coronavirus infection. When Jonas Salk incorporated Brodie’s invaluable findings regarding formaldehyde into his own research, he was lauded as the Asclepius of modern medicine. But Salk followed a long line of researchers and he was certainly not the last, for his vaccine was immediately followed by yet another, the Oral Polio Vaccine (OPV) by Albert Sabin.

Albert Sabin (L) and Jonas Salk (R) Jonas Salk’s vaccine was the culmination of years and years of research effort of not only his, but of all those before him. It was the work of earlier researchers who had identified that the polio killers were three different serotypes and it was yet earlier researchers who figured that the brain and spinal cord are not the only reservoirs of the viral load, it can readily grow in skin and fat cells too. The virus also does not attack the nervous system directly, it does so via the digestive tract thereby establishing an oral route of infection. When these series of works were consolidated by Salk under his own genius, the result was the wondrous vaccine that has since saved so many lives. It has a greater safety index too considering that it introduces a dead virus to induce a weak immunity.

Elvis Presley was one of Hollywood’s A-listers who was recruited early on as the promotional front man for FDR’s March of the Dimes foundation

Elvis Presley receiving his shot of the Salk vaccine as a part of the vaccine awareness campaign Later Albert Sabin created the Sabin Vaccine. A physician by the name of Albert Milzer had been vehement in his claims to denounce Salk’s vaccine. In a paper to the American Public Health Association he stated that overtreatment of the virus with formalin rendered the vaccine titers ineffective and ‘potentially’ had toxic effect on the recipient. An introductory course on organic chemistry would teach one the technique of understanding and drawing resonance structures and electrophilic and nucleophilic substitution. One of two electrons of oxygen that form a double bond with carbon moves to form a lone pair on oxygen thereby giving the element a negative formal charge thus becoming able to accept the hydrogen on nucleic acid of the viral particle. This would be a consequence of the interaction on paper, but real-life experiments had proved that the products of formylation are Schiffs Base and thus do not react with native DNA. However, allegations had been made and a shadow had been cast over Salk’s vaccine. Sabin was thus introduced as a competitor to Salk. His vaccine offered something that its predecessor and competitor did not; ease of administration and greater patient acceptance. Sabin’s vaccine was oral, it was painless, and the virus was attenuated thus inducing a greater immunization. It was a contrast to Salk’s injectable, killed viral vaccine. Sabin is also the vaccine that is administered in lower income countries namely Pakistan and Afghanistan for it mounts a greater immunity. Despite the global addressal of the polio issue, it’s a persistent menace to the health and well-being of developing countries.

The Sabin polio molecule taken from PDB (Protein Data Bank) Pakistan is certainly not without talented researchers. Many physicians and chemists were at the front of developing a treatment for the local covid crisis. When hospital requisition lists were filled with demands for ventilators and most clinics were running short on respirators, local engineers developed ventilators for instant use. Research labs of teaching hospitals lengthened their work hours to try to develop a chemical that could prolong life of victims. So many doctors and nurses died for the cause. Medical colleges updated their curriculum with a concentration on the SARS-COV that had hitherto been a mere paragraph in pathology textbooks and largely ignored by pharmacologists.

A female health worker in Pakistan marking an infant ‘vaccinated’ during her routine immunization tour But there are many problems where Pakistan’s vaccine research on debilitating infections is concerned. A critical example is the prevalent polio issue of the country. The prime reason for its recurrent infection is the lack of interest from researchers. Pakistani scientists have largely distanced themselves from the virus that continues to threaten the local population. There is a fear of subjecting patients to an untested chemical that could cause harm. For this reason funding on engineering and chemical study of polio is almost minimal and thus laboratories continue to focus on more ‘popular’ microbes such as staphylococcus, and the current SARS-COV. It is indeed, a vicious circle. Although earlier immunization campaigns had succeeded in bringing viral numbers to a minimum with a near-eradication of polio from 2017–2021, 14 cases of the infection have once again been reported in the country in 2022 with one case of wild polio virus type 1. The vaccine used in the local setup is the Sabin vaccine that requires stringent storage conditions; refrigeration at 2–8 degrees Celsius and photo-protection at all times. But how much of these conditions are met remains to be investigated for unfortunately during long days of door-to-door vaccine campaigns, the chemical integrity is undoubtedly compromised. Pakistan has a complex climate system and weather patterns differ drastically between regions. Temperature conditions in Hunza will not be the same in Chitral so vaccine stored in containers of ice would be altered, likewise humidity in Hyderabad will not be the same as in the nearby regions of Karachi and may cause denaturation of RNA molecule. There is also the chance of the attenuated virus being compromised during transportation and travel to the point that when it is orally administered, it is completely digested by gastric acids. Although newer generation of medical practitioners are working hard to train the staff engaged in these campaigns, human errors in unsupervised conditions are always possible. There is also the growing ebb of anti-vaxxers who campaign rigorously and present an unscientific bias to the lay community at large. Although early vaccine trials had resulted in some cases of autism and deaths, modern day vaccines are certified and safe for human use. But such is not an easy task to explain to the common man who is adamant on dissension. Since the past couple of years, efforts have been made to educate the public regarding the necessity for childhood vaccinations, reproductive and sexual health of women, and the development of children. More women are being targeted as critical recipients of such awareness campaigns to advocate for better health at home. The Pakistan Polio Eradication Initiative (PEI), that had trained around 285,000 frontline polio workers vaccinated a targeted 40 million children but in 2020 these were interrupted (though not brought to a close) by the sudden outbreak of coronavirus. Despite these commendable efforts Pakistan still has a long way to go in eradication of the polio virus for it is in a compounded effort from all sides (governmental, local, individual, academic) that we can launch a uniform attack on this crippling ailment.