Pushing their small motorcycle through the dank shade of a rubber tree forest, over tree roots and unrideable terrain, Dang Huy Hoang and Nguyen Dinh were pleased to have beaten the clock.
It was late morning, just as the noonday heat was becoming unbearable, and the two men knew their hunt was done. On their way out of the forest, a 30,000-acre rubber plantation in Vietnam’s Vung Tau province, they met a group of provincial health officials eager to know how the hunting went.
Since dawn, Dang and Nguyen, a paramedic and a nurse, respectively, had been looking for children under 5, plantation workers’ kids whose homes are in the nearest village. The two were trying, through the children, to kill off one of history’s most feared and loathsome living things.
The two men are part of a remarkable global campaign to finally and completely rid the world of polio. It is a struggle that has enlisted millions of health workers and volunteers in each of the world’s 215 nations.
Much of the impetus and money that has gone into quashing polio has come from Evanston-based Rotary International, an organization many equate more with civic boosterism than grass-roots humanitarianism.
The campaign’s aim is to hunt for the last few microscopic bits of surviving wild polio virus throughout the world. Scientists will winnow until they find polio’s last human victim, trap the virus after it passes out of the victim’s body and, they hope, eventually incinerate it.
Thus a deadly virus that through history has killed and crippled millions of people, especially children, will be erased from the face of Earth.
Americans and Western Europeans sometimes seem to think polio already has disappeared. But only the rich, industrialized nations were the true beneficiaries of polio vaccines developed in the United States in the 1950s and early 1960s.
By the 1970s, the U.S. and Western Europe were polio-free. But only 5 percent of all Third World children were immunized by then, and polio continued to cut down millions.
In the 1980s, a coalition of international agencies launched a plan to finally make the vaccines available to all children.
U.S. interest in the plan has always been strong. So long as polio remains endemic anywhere in the world, all American children need to continue to be immunized, costing $350 million a year.
Polio is vulnerable to extinction because it resides solely in humans. Flu viruses, for example, thrive and mutate in the intestines of many animals besides humans, making flu an impossible target for elimination.
If most people in the world are made immune with concerted vaccination drives, the polio virus will have no haven left.
Only a few viruses that afflict humans are candidates for such medical destruction. One already has been obliterated. The last smallpox virus was traced to one man in a sun-baked African village in 1977, after an immunization campaign lasting little more than 10 years.
In the campaign to beat polio, Third World nations go looking for money for vaccine and training at Rotary International’s headquarters in downtown Evanston. Rotary is the global service club for 1.2 million business and professional people, members of 27,000 local chapters in 150 nations. In 1988, as the plan to destroy polio came together, Rotary raised $400 million to help it along.
The Rotary money has bought vaccines to immunize more than 1 billion children. It has been a handy stick that Rotary has used to keep squabbling at a minimum among agencies, governments and experts as they struggle toward the goal.
There are 2 million to 3 million children playing and walking normally today who would have been severely disabled if the campaign had not been started 10 years ago.
Impressive as that is, experts believe the last, wild polio virus will be trapped somewhere in Africa just three to five years from now.
The undertaking has led bloodlusting warriors in some of today’s most violent conflicts to temporarily lay down their arms. Fighters in Peru, the Philippines, Sri Lanka, Sudan and the former Soviet republics, some of whom might gladly slay the children of their enemies, have agreed to truces to see that their own children receive the protective vaccine.
“The people who started this (polio eradication) were dreamers and visionaries,” said Harry Hull. He is an American who directs the vaccines and immunizations programs for the United Nations’ Geneva-based World Health Organization (WHO), which has organized the assault on polio.
“When you look for things that are truly a global, cooperative effort,” Hull said, “this is one of the few. Every country in the world is involved.
“It is overwhelming to think you can get everybody united to one task, to work together for some common good.”
Dang and Nguyen’s search for children in the Vietnamese rubber tree forest shows how far the global polio effort has reached, from WHO’s Swiss headquarters to this little corner of Cu Bi commune.
Twice a year for four years, Vietnam has held national immunization drives. The day before Dang and Nguyen made their search in the rubber tree forest, families had brought 90 percent of the commune’s 1,280 under-5 children to designated immunization centers.
“We have a list of children who live too far to go to the immunization centers,” Dang said.
The list contained perhaps three dozen names. Each had been neatly checked off. Dang and Nguyen had found every child and had administered vaccine they carried with them.
“In our part of the commune, this round of immunization is completed,” Dang said. “We have immunized 100 percent of the children.”
During each immunization drive, Vietnam, a nation of 74 million, has mustered 30,000 health workers and 200,000 volunteers to immunize 10 million children. The drives will continue until the polio disappears.
The country went from 557 reported polio cases in 1992 to 43 cases in 1996.
Landing the knockout blow, however, has been a problem.
That’s because ethnic Vietnamese children living in Cambodia tend to get overlooked in Cambodian immunization programs. Likewise, ethnic Cambodian children living in Vietnam seem to get missed in Vietnamese immunization drives–a problem that has occurred in other countries as well.
In this case, both groups travel back and forth between the two countries. Invariably, unvaccinated children pick up the polio virus, becoming portable reservoirs of the disease and spilling it into the general population.
The wild virus so far has been able to elude eradication, particularly in southern Vietnam’s Mekong River delta region.
As a result, the Polio Rehabilitation Center, a residential school for polio-stricken children in Ho Chi Minh City, is still a very busy place.
The government-operated school is a two-story building behind walls occupying a noisy intersection. There are 150 children who reside at the center, ranging from 4 to 18 years old. Their daily struggle to cope with and triumph over their disease echoes tales of heartache and bittersweet redemption once familiar in the U.S. before polio vaccines.
“When the children come here for the first time, it usually is the first time they’ve been away from their village, left here alone without parents or family,” said Pham Thi Thanh, a physical therapist at the center.
“In the village, parents and local health officials sometimes don’t know what to do with these children. Most have never gone to school. The only way the children can move about is to crawl on the floor, so they usually are very dirty, and some are very sick.
“When they come here, it is common for them to cry for a week. They won’t eat, won’t do anything.”
Redemption begins when Pham and other physical therapists begin to work with them one on one. The children start exercising muscles in their arms and backs to compensate for the loss of use of their legs.
As time goes on, with braces and crutches, they stand on their own for the first time since polio withered their limbs.
“They go to school and begin to have friends, sometimes for the first time in their lives,” Pham said. “Here they end up having many friends who look like they do, have the same problems as they do. They can walk. They can write. It is very liberating.
“The numbers who need this place have been declining since 1992. We think soon there will be no more children with polio, at all.”
Polio probably has survived through human history. It is passed through poor or careless hygiene, moving from hand to hand to mouth via interpersonal contact.
Until modern times, scientists believed polio was a relatively minor disease. Oddly, polio became deadlier with the advent of basic public health measures such as clean water and sewage removal that corralled pathogenic killers such as typhoid, cholera and plague.
Once you are exposed to polio, even if you suffer no symptoms, you are immune for life. In older times, polio virus was so prevalent that most people picked up immunity to it when they were still nursing infants.
Mothers had immunity from their own infancy and passed it on to their infants while breastfeeding them.
As effective sewage systems were built up in late 19th Century industrialized nations, polio suddenly was not so prevalent in the environment.
Children often would not be exposed to it until they were 5 years old or older, no longer nursing. Without their mother’s immunity, they were vulnerable whenever the polio virus did appear, usually during the hottest summer months, when the virus spread most readily.
Most would suffer only symptoms of a feverish summer cold that soon went away. But in about one in 200 cases, the polio virus passed into the spinal cord, killing nerve cells that activate muscles.
It would so inhibit the ability to breathe in some that they would die. In those who survived, usually nerves regulating their legs died, resulting in lifelong paralysis.
The lucky 199 who suffered only a mild case then enjoyed lifelong immunity.
The first severe polio epidemic in this country broke out in 1916, and thereafter summer polio season was a nightmare for parents and children alike.
In some cases, people reached adulthood having never been exposed, and then caught polio. The most famous adult polio victim in history was stricken in 1921, 39-year-old Franklin Delano Roosevelt, who became paralyzed for life. Twelve years later, he became president of the United States.
The schoolchildren’s crusade to find a polio vaccine, the March of Dimes, in fact was started by friends who rallied around Roosevelt.
It was March of Dimes-funded research that led directly to the announcement on April 12, 1955, of Dr. Jonas Salk’s development of a safe and effective polio vaccine made of killed polio virus.
The same funding led to the 1961 introduction of a vaccine made of living but severely weakened polio virus, developed by Dr. Albert Sabin.
Sabin and Salk, often bitter antagonists, each harbored the dream that his vaccine would be used to ultimately eradicate polio worldwide.
Their vaccines soon made polio a public health footnote in the wealthy industrialized nations. And, out of sight, out of mind, few cared that it was still a rampant destroyer in the Third World.
In 1979, Rotary International took on a limited project, raising $760,000 to immunize every child in the Philippines. It was a showcase project to help celebrate in 1980 the 75th anniversary of Rotary’s founding by a group of businessmen in Chicago.
In 1982, Rotary planners began looking for ways to immunize every child in the world for polio by the year 2000, eradicating the disease by 2005, Rotary’s 100th anniversary.
The service organization linked up with Washington, D.C.-based Pan American Health Organization (PAHO).
“In 1984,” said Ciro de Quadros, PAHO’s immunization expert, “we realized many countries in South America already had interrupted polio transmission. We thought we could get every country with an all-out campaign.”
Vowing to snuff out polio in the Americas by 1990, PAHO enlisted the World Bank, UNICEF, the U.S. Agency for International Development and Rotary to join in with technical assistance and money.
“We had a good, concrete, simple strategy that worked,” De Quadros said. “We were going to immunize all children under age 5 twice a year with national immunization days. We had strong political commitment and good collaboration between national governments, international health agencies and volunteers.”
They decided to use the Sabin vaccine because it can be administered by anybody who can aim a dropper bottle at an infant’s open mouth and squeeze off two drops.
The Salk vaccine has to be administered with a hypodermic needle, and few Third World nations have enough trained manpower for such a task.
It also helps that the Sabin vaccine, 20 times cheaper than the Salk version, has a “herd immunity” effect. The live, weakened virus can get picked up through bad hygiene just as the wild virus and thus extend its protection to unvaccinated individuals.
The virus in its natural state, in immunological terms, is “wild,” as opposed to the “vaccine virus,” manufactured from severely weakened wild virus. The vaccine triggers the human immune system but is not strong enough to attack the central nervous system and cause lasting damage.
The human intestine is the only long-term safe haven for the wild virus. Mass immunizations are designed to deny the virus the sanctuary of any new human hosts.
Huge numbers of people have to be used in mass immunizations just to protect the living vaccine, which must be kept chilled from the moment of manufacture.
If it isn’t, it loses its potency within hours. In a process called the “cold chain,” vaccines are stored on ice until immunization days. Then, tens of thousands of people are needed to break it down and pack it with dry ice into small, shoulder bag-size portable containers.
The bags are delivered to the thousands of vaccination sites around the country for actual administration to the children. If the cold chain breaks, the vaccine deteriorates and the entire campaign fails.
The vast manpower needed to maintain the cold chain and administer vaccine is the biggest expense of eradication. Because each nation provides its own manpower, they cover 90 to 95 percent of the expense.
Once the massive national immunizations begin quelling the wild virus, surveillance experts watch for any sign of a renewed appearance of the virus.
The slightest suspicion of the virus is enough to trigger a door-to-door “mop-up,” immunizing everybody in the vicinity.
In rural Peru in 1991, repeated mass immunizations, mop-ups and surveillance eventually led health workers to the doorstep of 2-year-old Luis Fermin Tenorio.
At the time, Peruvian health authorities already had heavily saturated the nation with several national immunization drives. But it never reached Tenorio’s small village, Pichinaki, 250 miles east of Lima, because of the Shining Path guerrilla war waged in the area.
When Tenorio’s illness was confirmed as polio, Peruvian Rotarians got the Shining Path to agree to a truce, allowing a countrywide mop-up immunization that reached 2 million children in one week.
Since then, not one single case of endemic wild virus polio has turned up anywhere in North or South America, creating the globe’s first polio-free hemisphere.
Long before then, however, success in the Latin America strategy had become so evident that De Quadros and others lobbied to eradicate polio worldwide.
“The World Health Organization at that time was not real keen on the idea,” De Quadros said. “But between 1985 and 1988, progress in the Americas was spectacular. We had already showed that the disease could be eradicated in a very wide area.”
In 1988, WHO formally committed to eradicating worldwide by the year 2000.
It was an act that echoed a similar WHO commitment made on Jan. 1, 1967, to rid the world of the smallpox virus within 10 years. On Sept. 26, 1977, a WHO team headed by De Quadros tracked and trapped the last wild smallpox virus in Somalia.
In 10 years, the incidence of smallpox went from 15 million new cases a year to zero. Smallpox eradication to date has saved the world $20 billion in health care costs.
As long as polio thrives anywhere in the world, it is possible for it to reappear in polio-free nations.
In 1978, for example, a polio-infected visitor entered the Netherlands. The virus passed into a Dutch religious sect that refuses all immunizations on religious grounds. An explosive epidemic ensued within the commune, with more than 100 members contracting polio.
Before anybody realized what was occurring, infected sect members visited one of their communes in Canada. Eleven Canadian sect members ended up paralyzed.
In 1993, it happened again in the Netherlands, killing one person and leaving 41 paralyzed there, migrating to Canada, as well.
The eradication enterprise naturally has been plagued by disagreements arising from competing agendas of the hundreds of government, UN and international organizations involved.
Many credit Rotary for not allowing such bickering to slow the momentum. When experts argued about the best way to proceed or who was to take credit for what, Rotary’s threat to withdraw funding has kept everybody focused.
“If we don’t do it now, we may never again have the chance to get rid of this disease,” said William Sergeant, chairman of Rotary’s polio eradication program. “If we fail, we’ll lose this network of expertise and the determination to get the job done.”
With three years left on the deadline, money is flying out of Rotary’s front door in Evanston faster than ever.
Last year, it purchased vaccines for 300 million children. This year, it will buy enough for 500 million.
As momentum builds toward the year 2000, the project’s successes are becoming more frequent and more impressive.
In 1990, China had 23 percent of the world’s polio cases. In 1993, it began its first national immunizations, and by 1995, the disease was virtually gone from the world’s most populous nation.
Attention then switched to the Indian subcontinent. Early in 1996, India held its first national immunization day, delivering vaccine to 115 million children in one day.
Workers, including 150,000 Indian Rotary members and volunteers they rounded up, delivered vaccine by foot, cars and camels to 500,000 vaccination posts around the country.
“In 1994, about two-thirds of the world’s polio cases were found in the Indian subcontinent,” said WHO’s Harry Hull.
“We’re quite optimistic that polio (in India) is going to disappear relatively quickly,” Hull said.
Where the most work needs to be done, however, is Africa. Thus far, barely half the children there have been immunized, and 12,000 new cases are reported each year.
That is about to change.
South African President Nelson Mandela last year lobbied other African leaders to support eradication. Since then, every nation on the continent has fallen into line, eager to get the job done.
WHO is drawing up lists of laboratories around the world that are holding samples of the live wild virus. The goal is to bring all the samples together to one or two laboratories so it can be burned.
Already, all the world’s remaining live smallpox virus is stored in Moscow and Atlanta’s Centers for Disease Control and Prevention.
Health officials are scheduled to burn up the smallpox virus in 1999, but security and intelligence experts argue to save it. They fear someone might have saved stocks of it secretly for future germ warfare, and keeping actual virus would be prudent for detection systems or making new vaccines.
The same debate almost certainly will take place over the last polio virus if it is finally cornered and captured. Ciro de Quadros is confident polio will be destroyed.
“It will happen,” De Quadros said. “Too many people, too much money and too much planning has gone into this. We’re so close now, everybody is committed to doing whatever it takes to finish (polio) off.
“Then, measles will be the next targeted disease.”
