6 ms·

The dream of polio eradication might need a rethink

37 points by lxm 4y ago

gp 4y ago
[flagged]
- e44858 4y ago
  “The U.S. case and most of the current outbreaks in Africa (which was declared a polio-free continent in 2020) are linked to vaccine-derived strains of the virus. These strains were originally part of oral polio vaccine. They were shed in human stool from those who'd been inoculated and mutated in the wild, regaining strength and becoming just as dangerous as the original virus.”
  - mschuster91 4y ago
    It would not have been an issue had more people been vaccinated.
    - hutzlibu 4y ago
      Not really, because it was the live virus from the cheap vaccine, that mutated and got dangerous again.
      - epgui 4y ago
        That doesn't change that the campaign could have been successful if more people were vaccinated, even with that defective vaccine. If 5 people get iatrogenically infected but the infection has nowhere to spread, what do you think happens? Casualties: 5. Polio: gone. (downvoters: I'm a biochemist)
        hutzlibu 4y ago
        Can you cite a researcher that says the problem has anything to do with people refusing the vaccine? They say very clearly it was the vaccine that was the problem. Those oral vaccines are very quick to deploy, but still, your solution would require that EVERY PERSON ON EARTH takes the vaccine at the same time and then goes into isolation. And the problem does not stop there. Or how would it work your way? You realise that the virus from the vaccine goes into the sewer and god knows where else and stays contagious? The only solution the researchers are saying is for everyone to get the expensive shot, which is not using a live virus.
        iudqnolq 4y ago
        Why do you think going into isolation would be needed? The whole point of the comment you're replying to is that contagious people aren't a problem if there's no one vulnerable for them to spread it to. (Also, that doesn't require everyone vaccinated, just a high percentage).
        hutzlibu 4y ago
        "(Also, that doesn't require everyone vaccinated, just a high percentage)" Yes, and that high percentage of vaccinated people was achieved. But ... Polio is still back. So how would be your plan to get everyone not vulnerable with the cheap (and dangerous) vaccine? (the vaccine does not give 100% protection btw.)
        partomniscient 4y ago
        One other thing to consider is even if its eradicated - it originally arose from pre-Polio building blocks of some sort, how do you prevent it from re-occurring 'from scratch'?
        iudqnolq 4y ago
        You keep trying to turn things into binary factors: it either is a high percent or it isn't, 100% protection or bust. That's not how this works. The percentage of people who need to be vaccinated is based on many factors, including the degree of protection the vaccine provides. There's no one number, it varies based on the totality of the circumstances. One valid interpretation of the setbacks we've encountered in eradicating polio is that number needs to be a bit higher. As you can see in this chart the level of vaccination, while high in many countries, could be higher. https://ourworldindata.org/grapher/polio-vaccine-coverage-of-one-year-olds https://ourworldindata.org/grapher/polio-vaccine-coverage-of...
      - JumpCrisscross 4y ago
        > it was the live virus from the cheap vaccine, that mutated and got dangerous again To the unvaccinated. We recently had New York’s water tested for poliovirus. Turns out we’re lousy with it [1], most recently by an unvaccinated traveller to Europe bringing it to Long Island [2]. It’s not a problem for the vaccinated because the moment the virus hits the blood it gets zonked. Still it replicates in the gut, which is why it’s in our sewage. (IPV is not sterilising.) [1] https://www.nytimes.com/2022/08/12/nyregion/polio-nyc-sewage.html https://www.nytimes.com/2022/08/12/nyregion/polio-nyc-sewage... [2] https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7133e2-H.pdf https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7133e2-H.pdf
        Izkata 4y ago
        For the majority, also not dangerous to the unvaccinated. Most of the time people use numbers for paralytic polio (death rate of like 20% IIRC) and just call it "polio", which is completely wrong and misleading. The actual numbers for polio in general: https://www.cdc.gov/polio/what-is-polio/index.htm https://www.cdc.gov/polio/what-is-polio/index.htm * 72% of infections are asymptomatic * 25% of infections are flu-like * 3% of infections result in something serious (not just paralysis) * Between 1 in 200 and 1 in 2000 infections (0.5% to 0.05%) result in paralytic polio (which includes weakness, not just fully paralyzed limbs) Polio is scary because of the visibility of the survivors in that 0.5%, but as a proportion of the population the vast majority of the population won't get that (and polio infects by ingestion, so on top of all this making it less visible, clean food and good hygiene can also prevent infection).
  - tunesmith 4y ago
    Honest question. What's the "therefore" after this statement? The article mentions there have been 15 cases this year. After hundreds of thousands in 1988. So I can't exactly accept "therefore, vaccines are the problem" with a straight face. What "therefore" was actually intended here?
    - jfengel 4y ago
      Unfortunately, there isn't a straightforward "therefore". The default would be "therefore, we have to accept that very small numbers of people will be harmed for the benefit of the vastly greater number". Only the most diehard utilitarian would love that. A better answer is "therefore, we need to radically alter the polio strategy, which will be expensive and difficult but would prevent those 15 cases, and maybe eventually eliminate it entirely. Oh, and we don't know how to do it". That makes the diehard utilitarians grumble, and everybody else cranky.
- echelon 4y ago
  The problem is the cheaper vaccine is live attenuated virus and is becoming infectious and spreading to new people.
- hutzlibu 4y ago
  Except that the reason for the comeback of Polio are not anti-vaxx people, but flaws of the original vaccine itself: "The U.S. case and most of the current outbreaks in Africa (which was declared a polio-free continent in 2020) are linked to vaccine-derived strains of the virus. These strains were originally part of oral polio vaccine" "Last year there were only 30 cases of wild polio detected while there were nearly 800 cases of vaccine-derived polio. Of the 15 cases reported in the first quarter of 2023, 14 are from strains of the virus that mutated from the oral polio vaccine used in lower-income nations."
  - epgui 4y ago
    > Except that the reason for the comeback of Polio are not anti-vaxx people, but flaws of the original vaccine itself No, it's both factors together. Without skyrocketing anti-vaxx prevalence, even the vaccine defects would have been self-limiting collateral. Anti-vaxx is what turned a linear problem into an exponentially growing problem.
    - hutzlibu 4y ago
      Ok, so can you cite a reasearcher who shares your opinion? We are talking about large scale campaigns that were thought to be succesful as they were widely deployed. But the virus simply mutated back to dangerous. solution: expensive and working vaccine problem: cost
      - xupybd 4y ago
        You've over simplified the problem. Yes infinite resources would solve this. However, the cost is astronomical. You require not just the vaccine but the infrastructure to support it in regions that are very far off this level of infrastructure. It will take generations of political stability in these nations to get there. That doesn't look likely anytime soon.
      - epgui 4y ago
        I’m sure you could go and cherry-pick someone who had the opposite opinion somewhere, but in reality this is not a very controversial position. It’s introductory textbook / basic reasoning material (if you consider “basic population dynamics” to be “basic”, that is). The only thing I can think of that would make what I said wrong would be if the mutation rate of the iatrogenic strain was many orders of magnitude higher than the wild strain, which does not appear to be the case. And even then, I’d say it would be a “maybe” at most.
- hvs 4y ago
  I'm not sure you read the article. Vaccine-derived cases of polio far outnumber cases of wild polio in the world now. Polio can be created in a lab with publicly available information. This virus WILL be with us forever. The discussion is how to handle that fact.
- rajin444 4y ago
  No liability for the Covid vaccines (yes, I’m aware there are options that in reality almost never pay out) was a huge mistake. How do you repair a breach of trust that severe, outside of massive propaganda campaigns? And that’s just one small part of how the Covid vaccinations were abysmal in terms of trust building. Blaming the “vaccine hesitant” instead of the politicians and media who lied (directly and indirectly)…further strengthens vaccine hesitancy.
  - saiya-jin 4y ago
    I dont know enough about liability part to comment on it, but most probably neither do you. Vaccine hesitant in general is already a term for those who reject science, so any rational discussion is unfortunately pointless. How you get there are just pure manipulated emotions of the worst kind, ie fear, and thats not a point any rational scientific argument can fight against and win. If you yourself cant conquer your basic fears, you will always be a puppet to anybody who can play with that, which in real world is tons of pretty bad actors. So there lies your way out, if you actually care about it.
    - hanselot 4y ago
      If science can be equated to: "Trust me bro, it works, the man on the TV said so.", perhaps I could buy that this is a good faith take, but those that still refuse to accept that they are suffering from the same blind ignorance is bliss bull** that drives all religions, I can tell you that with something where the opportunity cost is sterilization of the majority of the planet's population, perhaps you should be skeptical. You know, as the scientific method dictates? Perhaps you were too distracted by the fearmongering to notice the promises slip by your very eyes, as day by day the companies that forced this onto the planet changed the script. From 100% effective, and safe, to, what are we at now? I don't think you even know. Sunken Cost Fallacy is real, and one way or another at least 50% of the planet have it right now regarding the orwell juice. I wish you the best of luck with your 50th breakout case of, what are you calling it now, flu? (The same flu that was mysteriously extinct for 2 years)............................................................................................... Despite all the people pointing at AI and shouting, look over there be scurred, you will find that every person you demonized and belittled will be laughing when you come begging for unvaccinated blood. And to clue you in, no, I don't care if you brigade me to hell.
garbagecoder 4y ago
Wow that’s quite a fine at Rotary
- poulsbohemian 4y ago
  Well played. In all seriousness though, given the money and effort Rotary has put into this cause, this article has certainly given food for thought.
  - garbagecoder 4y ago
    It is, but even if your goal is technically unattainable, I think it's sorta the journey that matters to mix metaphors. Getting the number as low as possible matters and remembering the how scary something we take for granted as an out-of-date problem is good on all kinds of levels. It totally always warmed me up a bit to know that my local Rotarians who where I live anyway are not usually the sweetest types would make this their thing.
code51 4y ago
> In a perfect world, health experts say they'd like everyone would get the more expensive polio shot which is incapable of mutating into a dangerous, circulating virus. but then... > Mass immunization campaigns with the more expensive yet safer injectable vaccine, he says, are nearly impossible in some of these places. There simply isn't the infrastructure or trained medical staff to carry out such campaigns. So, let's try to understand this: if we throw a boatload of money onto this problem, is it possible to eradicate polio using that decent, more expensive vaccine? or... do we have a theoretical misunderstanding of viruses? If I'm not mistaken both IPV and OPV is applied to children in national immunization problems of developed countries. So there must be something still missing in IPV.
- makomk 4y ago
  As far as I know, OPV isn't used in childhood immunization programs in developed countries any more, but it used to be and I think every successful polio eradication program in countries where it's no longer endemic relied on it. There's also some evidence that the inactivated vaccine isn't so good at preventing polio from multiplying in people's guts and spreading to others. Is this a problem in practice? There's probably not any way to know for sure. Also, since polio spreads via the oral-fecal route it's obviously going to spread more effectively in developing countries with poor sewage treatment, so what works in the developed world may not work so well elsewhere anyway.
  - throwway120385 4y ago
    This would seem to suggest that it's not a problem with the vaccine but with the level of sanitation. The one big relevant difference here is that in developed countries we had flush toilets and sewer systems carrying effluent away from the populace, which may not be true in places that still have polio. So OPV could work but doesn't not because it's ineffective but because the polio-rich effluent produced by vaccinated people isn't being carried away from them effectively. So maybe the best way to eradicate polio is to build sewers and septic systems.
- di4na 4y ago
  The problem is that money would not be enough. Training people to the level they can inject it would still take incompressible time.
miguelazo 4y ago
Never forget: https://www.newscientist.com/article/2277145-cias-hunt-for-osama-bin-laden-fuelled-vaccine-hesitancy-in-pakistan/ https://www.newscientist.com/article/2277145-cias-hunt-for-o...
- xupybd 4y ago
  Yeah that "clever trick" has no doubt cost tens of thousands of lives. If not more.
  - saiya-jin 4y ago
    Thats secret services or state interests in general, they have a goal and rest is collateral damage. In some cases its neglible, in some other its massive and borderline genocide. Not that people in general care about it that much, those people dont have US or EU passports to cause much outrage. I am little bit afraid the best possible outcome would be some lesson for the future, but I dont think its even that. More like a lot of bragging about success part, and thats it. I guess human life in general has completely different value for average HN user like you and me, compared to some military or intelligence high rank.
phkahler 4y ago
Can we modify the oral vaccine (virus) to be more resistant to mutation? Specifically, I'm thinking there is a lot of redundancy in the codon table - mapping triplets to amino acids. If we increase the levenshtein distance between the vaccine-virus and the bad one without changing its protein structure it should reduce the likelihood of reverting back in the wild.
- btilly 4y ago
  We tried that. It reduced the frequency with which it happens, but not as much as we would like. https://www.science.org/content/article/first-polio-cases-linked-new-oral-vaccine-detected-africa https://www.science.org/content/article/first-polio-cases-li...
amluto 4y ago
I don’t understand how the current strategy can be expected to work. There are two vaccines: IPV and OPV. IPV does not cause outbreaks, but it does not induce sterilizing immunity [0]. So polio (harmless vaccine polio or dangerous polio, vaccine-derived or otherwise) can circulate in IPV-vaccinated populations. But the US hasn’t administered OPV since 2000 [1]. So polio can circulate in the US without causing symptoms! Anywhere with a sufficient population of people under 23 can be a reservoir of polio. I don’t understand how the overall strategy can be expected to eradicate polio. Even if the nOPV vaccine were perfect, any reintroduction of polio from any source (wild, old type 2 vaccine-derived, nOPV-derived) could circulate in the US and then be reintroduced elsewhere from here. I don’t get it. Presumably the US should start administering nOPV just to control its own outbreak. [0] https://pubmed.ncbi.nlm.nih.gov/22532797/ https://pubmed.ncbi.nlm.nih.gov/22532797/ [1] https://www.cdc.gov/vaccines/vpd/polio/index.html https://www.cdc.gov/vaccines/vpd/polio/index.html

37 points by lxm 4y ago

gp 4y ago

[flagged]

e44858 4y ago
“The U.S. case and most of the current outbreaks in Africa (which was declared a polio-free continent in 2020) are linked to vaccine-derived strains of the virus. These strains were originally part of oral polio vaccine. They were shed in human stool from those who'd been inoculated and mutated in the wild, regaining strength and becoming just as dangerous as the original virus.”
- mschuster91 4y ago
  It would not have been an issue had more people been vaccinated.
  - hutzlibu 4y ago
    Not really, because it was the live virus from the cheap vaccine, that mutated and got dangerous again.
    - epgui 4y ago
      That doesn't change that the campaign could have been successful if more people were vaccinated, even with that defective vaccine. If 5 people get iatrogenically infected but the infection has nowhere to spread, what do you think happens? Casualties: 5. Polio: gone. (downvoters: I'm a biochemist)
      - hutzlibu 4y ago
        Can you cite a researcher that says the problem has anything to do with people refusing the vaccine? They say very clearly it was the vaccine that was the problem. Those oral vaccines are very quick to deploy, but still, your solution would require that EVERY PERSON ON EARTH takes the vaccine at the same time and then goes into isolation. And the problem does not stop there. Or how would it work your way? You realise that the virus from the vaccine goes into the sewer and god knows where else and stays contagious? The only solution the researchers are saying is for everyone to get the expensive shot, which is not using a live virus.
        iudqnolq 4y ago
        Why do you think going into isolation would be needed? The whole point of the comment you're replying to is that contagious people aren't a problem if there's no one vulnerable for them to spread it to. (Also, that doesn't require everyone vaccinated, just a high percentage).
        hutzlibu 4y ago
        "(Also, that doesn't require everyone vaccinated, just a high percentage)" Yes, and that high percentage of vaccinated people was achieved. But ... Polio is still back. So how would be your plan to get everyone not vulnerable with the cheap (and dangerous) vaccine? (the vaccine does not give 100% protection btw.)
        partomniscient 4y ago
        One other thing to consider is even if its eradicated - it originally arose from pre-Polio building blocks of some sort, how do you prevent it from re-occurring 'from scratch'?
        iudqnolq 4y ago
        You keep trying to turn things into binary factors: it either is a high percent or it isn't, 100% protection or bust. That's not how this works. The percentage of people who need to be vaccinated is based on many factors, including the degree of protection the vaccine provides. There's no one number, it varies based on the totality of the circumstances. One valid interpretation of the setbacks we've encountered in eradicating polio is that number needs to be a bit higher. As you can see in this chart the level of vaccination, while high in many countries, could be higher. https://ourworldindata.org/grapher/polio-vaccine-coverage-of-one-year-olds https://ourworldindata.org/grapher/polio-vaccine-coverage-of...
    - JumpCrisscross 4y ago
      > it was the live virus from the cheap vaccine, that mutated and got dangerous again To the unvaccinated. We recently had New York’s water tested for poliovirus. Turns out we’re lousy with it [1], most recently by an unvaccinated traveller to Europe bringing it to Long Island [2]. It’s not a problem for the vaccinated because the moment the virus hits the blood it gets zonked. Still it replicates in the gut, which is why it’s in our sewage. (IPV is not sterilising.) [1] https://www.nytimes.com/2022/08/12/nyregion/polio-nyc-sewage.html https://www.nytimes.com/2022/08/12/nyregion/polio-nyc-sewage... [2] https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7133e2-H.pdf https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7133e2-H.pdf
      - Izkata 4y ago
        For the majority, also not dangerous to the unvaccinated. Most of the time people use numbers for paralytic polio (death rate of like 20% IIRC) and just call it "polio", which is completely wrong and misleading. The actual numbers for polio in general: https://www.cdc.gov/polio/what-is-polio/index.htm https://www.cdc.gov/polio/what-is-polio/index.htm * 72% of infections are asymptomatic * 25% of infections are flu-like * 3% of infections result in something serious (not just paralysis) * Between 1 in 200 and 1 in 2000 infections (0.5% to 0.05%) result in paralytic polio (which includes weakness, not just fully paralyzed limbs) Polio is scary because of the visibility of the survivors in that 0.5%, but as a proportion of the population the vast majority of the population won't get that (and polio infects by ingestion, so on top of all this making it less visible, clean food and good hygiene can also prevent infection).
- tunesmith 4y ago
  Honest question. What's the "therefore" after this statement? The article mentions there have been 15 cases this year. After hundreds of thousands in 1988. So I can't exactly accept "therefore, vaccines are the problem" with a straight face. What "therefore" was actually intended here?
  - jfengel 4y ago
    Unfortunately, there isn't a straightforward "therefore". The default would be "therefore, we have to accept that very small numbers of people will be harmed for the benefit of the vastly greater number". Only the most diehard utilitarian would love that. A better answer is "therefore, we need to radically alter the polio strategy, which will be expensive and difficult but would prevent those 15 cases, and maybe eventually eliminate it entirely. Oh, and we don't know how to do it". That makes the diehard utilitarians grumble, and everybody else cranky.
echelon 4y ago
The problem is the cheaper vaccine is live attenuated virus and is becoming infectious and spreading to new people.
hutzlibu 4y ago
Except that the reason for the comeback of Polio are not anti-vaxx people, but flaws of the original vaccine itself: "The U.S. case and most of the current outbreaks in Africa (which was declared a polio-free continent in 2020) are linked to vaccine-derived strains of the virus. These strains were originally part of oral polio vaccine" "Last year there were only 30 cases of wild polio detected while there were nearly 800 cases of vaccine-derived polio. Of the 15 cases reported in the first quarter of 2023, 14 are from strains of the virus that mutated from the oral polio vaccine used in lower-income nations."
- epgui 4y ago
  > Except that the reason for the comeback of Polio are not anti-vaxx people, but flaws of the original vaccine itself No, it's both factors together. Without skyrocketing anti-vaxx prevalence, even the vaccine defects would have been self-limiting collateral. Anti-vaxx is what turned a linear problem into an exponentially growing problem.
  - hutzlibu 4y ago
    Ok, so can you cite a reasearcher who shares your opinion? We are talking about large scale campaigns that were thought to be succesful as they were widely deployed. But the virus simply mutated back to dangerous. solution: expensive and working vaccine problem: cost
    - xupybd 4y ago
      You've over simplified the problem. Yes infinite resources would solve this. However, the cost is astronomical. You require not just the vaccine but the infrastructure to support it in regions that are very far off this level of infrastructure. It will take generations of political stability in these nations to get there. That doesn't look likely anytime soon.
    - epgui 4y ago
      I’m sure you could go and cherry-pick someone who had the opposite opinion somewhere, but in reality this is not a very controversial position. It’s introductory textbook / basic reasoning material (if you consider “basic population dynamics” to be “basic”, that is). The only thing I can think of that would make what I said wrong would be if the mutation rate of the iatrogenic strain was many orders of magnitude higher than the wild strain, which does not appear to be the case. And even then, I’d say it would be a “maybe” at most.
hvs 4y ago
I'm not sure you read the article. Vaccine-derived cases of polio far outnumber cases of wild polio in the world now. Polio can be created in a lab with publicly available information. This virus WILL be with us forever. The discussion is how to handle that fact.
rajin444 4y ago
No liability for the Covid vaccines (yes, I’m aware there are options that in reality almost never pay out) was a huge mistake. How do you repair a breach of trust that severe, outside of massive propaganda campaigns? And that’s just one small part of how the Covid vaccinations were abysmal in terms of trust building. Blaming the “vaccine hesitant” instead of the politicians and media who lied (directly and indirectly)…further strengthens vaccine hesitancy.
- saiya-jin 4y ago
  I dont know enough about liability part to comment on it, but most probably neither do you. Vaccine hesitant in general is already a term for those who reject science, so any rational discussion is unfortunately pointless. How you get there are just pure manipulated emotions of the worst kind, ie fear, and thats not a point any rational scientific argument can fight against and win. If you yourself cant conquer your basic fears, you will always be a puppet to anybody who can play with that, which in real world is tons of pretty bad actors. So there lies your way out, if you actually care about it.
  - hanselot 4y ago
    If science can be equated to: "Trust me bro, it works, the man on the TV said so.", perhaps I could buy that this is a good faith take, but those that still refuse to accept that they are suffering from the same blind ignorance is bliss bull** that drives all religions, I can tell you that with something where the opportunity cost is sterilization of the majority of the planet's population, perhaps you should be skeptical. You know, as the scientific method dictates? Perhaps you were too distracted by the fearmongering to notice the promises slip by your very eyes, as day by day the companies that forced this onto the planet changed the script. From 100% effective, and safe, to, what are we at now? I don't think you even know. Sunken Cost Fallacy is real, and one way or another at least 50% of the planet have it right now regarding the orwell juice. I wish you the best of luck with your 50th breakout case of, what are you calling it now, flu? (The same flu that was mysteriously extinct for 2 years)............................................................................................... Despite all the people pointing at AI and shouting, look over there be scurred, you will find that every person you demonized and belittled will be laughing when you come begging for unvaccinated blood. And to clue you in, no, I don't care if you brigade me to hell.

garbagecoder 4y ago

Wow that’s quite a fine at Rotary

poulsbohemian 4y ago
Well played. In all seriousness though, given the money and effort Rotary has put into this cause, this article has certainly given food for thought.
- garbagecoder 4y ago
  It is, but even if your goal is technically unattainable, I think it's sorta the journey that matters to mix metaphors. Getting the number as low as possible matters and remembering the how scary something we take for granted as an out-of-date problem is good on all kinds of levels. It totally always warmed me up a bit to know that my local Rotarians who where I live anyway are not usually the sweetest types would make this their thing.

code51 4y ago

> In a perfect world, health experts say they'd like everyone would get the more expensive polio shot which is incapable of mutating into a dangerous, circulating virus. but then... > Mass immunization campaigns with the more expensive yet safer injectable vaccine, he says, are nearly impossible in some of these places. There simply isn't the infrastructure or trained medical staff to carry out such campaigns. So, let's try to understand this: if we throw a boatload of money onto this problem, is it possible to eradicate polio using that decent, more expensive vaccine? or... do we have a theoretical misunderstanding of viruses? If I'm not mistaken both IPV and OPV is applied to children in national immunization problems of developed countries. So there must be something still missing in IPV.

makomk 4y ago
As far as I know, OPV isn't used in childhood immunization programs in developed countries any more, but it used to be and I think every successful polio eradication program in countries where it's no longer endemic relied on it. There's also some evidence that the inactivated vaccine isn't so good at preventing polio from multiplying in people's guts and spreading to others. Is this a problem in practice? There's probably not any way to know for sure. Also, since polio spreads via the oral-fecal route it's obviously going to spread more effectively in developing countries with poor sewage treatment, so what works in the developed world may not work so well elsewhere anyway.
- throwway120385 4y ago
  This would seem to suggest that it's not a problem with the vaccine but with the level of sanitation. The one big relevant difference here is that in developed countries we had flush toilets and sewer systems carrying effluent away from the populace, which may not be true in places that still have polio. So OPV could work but doesn't not because it's ineffective but because the polio-rich effluent produced by vaccinated people isn't being carried away from them effectively. So maybe the best way to eradicate polio is to build sewers and septic systems.
di4na 4y ago
The problem is that money would not be enough. Training people to the level they can inject it would still take incompressible time.

miguelazo 4y ago

Never forget: https://www.newscientist.com/article/2277145-cias-hunt-for-osama-bin-laden-fuelled-vaccine-hesitancy-in-pakistan/ https://www.newscientist.com/article/2277145-cias-hunt-for-o...

xupybd 4y ago
Yeah that "clever trick" has no doubt cost tens of thousands of lives. If not more.
- saiya-jin 4y ago
  Thats secret services or state interests in general, they have a goal and rest is collateral damage. In some cases its neglible, in some other its massive and borderline genocide. Not that people in general care about it that much, those people dont have US or EU passports to cause much outrage. I am little bit afraid the best possible outcome would be some lesson for the future, but I dont think its even that. More like a lot of bragging about success part, and thats it. I guess human life in general has completely different value for average HN user like you and me, compared to some military or intelligence high rank.

phkahler 4y ago

Can we modify the oral vaccine (virus) to be more resistant to mutation? Specifically, I'm thinking there is a lot of redundancy in the codon table - mapping triplets to amino acids. If we increase the levenshtein distance between the vaccine-virus and the bad one without changing its protein structure it should reduce the likelihood of reverting back in the wild.

btilly 4y ago
We tried that. It reduced the frequency with which it happens, but not as much as we would like. https://www.science.org/content/article/first-polio-cases-linked-new-oral-vaccine-detected-africa https://www.science.org/content/article/first-polio-cases-li...

amluto 4y ago

I don’t understand how the current strategy can be expected to work. There are two vaccines: IPV and OPV. IPV does not cause outbreaks, but it does not induce sterilizing immunity [0]. So polio (harmless vaccine polio or dangerous polio, vaccine-derived or otherwise) can circulate in IPV-vaccinated populations. But the US hasn’t administered OPV since 2000 [1]. So polio can circulate in the US without causing symptoms! Anywhere with a sufficient population of people under 23 can be a reservoir of polio. I don’t understand how the overall strategy can be expected to eradicate polio. Even if the nOPV vaccine were perfect, any reintroduction of polio from any source (wild, old type 2 vaccine-derived, nOPV-derived) could circulate in the US and then be reintroduced elsewhere from here. I don’t get it. Presumably the US should start administering nOPV just to control its own outbreak. [0] https://pubmed.ncbi.nlm.nih.gov/22532797/ https://pubmed.ncbi.nlm.nih.gov/22532797/ [1] https://www.cdc.gov/vaccines/vpd/polio/index.html https://www.cdc.gov/vaccines/vpd/polio/index.html