Perspectives in Biology and Medicine

ROLE OF MY COOPERATION WITH SOVIET SCIENTISTS IN THE ELIMINATION OF POLIO: POSSIBLE LESSONS FOR RELATIONS BETWEEN THE U.S.A. AND THE USSR ALBERT B. SABIN* The purpose of this communication is threefold: (1) to bring into perspective the important role ofmy cooperation with Soviet scientists in the development of the oral poliovirus vaccine used for more than 25 years for the elimination of paralytic poliomyelitis; (2) to describe the obstacles to worldwide eradication of the disease; and (3) to describe a hope I have derived from this experience that cooperative endeavors between the U.S.A. and the Soviet Union against the larger common enemy of poverty in more than half the world's population may become a means of breaking the dangerous impasse ofjustifiable, mutual distrust that causes the U.S.A. and the USSR to continue preparing for a barbaric war against each other, a war that neither nation wants and the whole world dreads, a war that cannot be won but can lead to the greatest tragedy ever inflicted on the human species. Some people think that poliomyelitis, the crippling disease that has been part of the human heritage since earliest evolutionary times, has already been conquered, that is, eliminated, brought under control, or even eradicated. This conception is partly true and partly false. It is true for about 2,000 million of the world's population living in temperateclimate countries where it is reasonably estimated that during the past 20 years the oral polio vaccine has prevented about 5 million cases ofpersistent paralysis and perhaps 500,000 deaths [I]. But it is not true for most tropical and subtropical, economically undeveloped countries inhabited by about 3,000 million people, where much polio has undoubtedly been This paper is a slightly modified version of the Twenty-third Cosmos Award Lecture presented April 15, 1986, at the Cosmos Club, Washington, D.C. ?Fogarty International Center for Advanced Studies in the Health Sciences, National Institutes of Health, Bethesda, Maryland 20892.© 1987 by The University of Chicago. AU rights reserved. 0031-5982/88/3101-0552$01.00 Perspectives in Biohgy and Medicine, 31, 1 · Autumn 1987 \ 57 prevented by the limited and improper use of oral polio vaccine, but where crippling polio remains a serious public health problem with an estimated average of 250,000-400,000 new paralytic cases per year. How do we know this? The introduction of surveys for residual polio paralysis during the past 10 years, first in Ghana in tropical Africa and subsequently in other countries in Africa, Asia, and Latin America [2] provided evidence that, contrary to previous dogma, persisting paralytic polio has been and currently continues to be a bigger public health problem in these poverty -stricken countries than it was in the United States and other affluent countries in the prevaccine era. A new strategy of annual, national days of vaccination of all children in the susceptible age groups in which the vaccine is brought to the people by well-organized auxiliary armies of nonprofessional community volunteers has already demonstrated its capacity to rapidly eliminate and maintain control of poliomyelitis [2-4]. This strategy is now in use in some Latin American countries—Cuba, Brazil, Nicaragua, Dominican Republic, Bolivia, Paraguay, and most recently Mexico. This strategy is needed in the poor countries of Asia and Africa, where the problem is greatest and where it has not yet been used. Now let me ask another question. Can we expect to achieve complete eradication of paralytic polio first from individual countries and ultimately from the world the way smallpox was eradicated so that further vaccination could be discontinued? The answer is NO, not only because the inapparent spread of the polioviruses is different from that of the single smallpox virus, which always causes clinically recognized disease, but especially because clinically and pathologically typical paralytic polio can be caused not only by the three different types of poliovirus but occasionally also by many other viruses against which it is impractical to prepare vaccines. Even people who should know better seem to forget that in the prevaccine era—a little over 30 years ago—it was estimated that perhaps as much as 1 percent...