WEBVTT - Polio: The Last Mile 0:00:02.080 --> 0:00:04.760 In the first decades of the twentieth century, parents in 0:00:04.800 --> 0:00:10.760 the United States lived in terror of polio. CDC is 0:00:10.840 --> 0:00:15.000 trying to solve the riddle of poliomyolsis, which kills or 0:00:15.040 --> 0:00:19.480 paralyzes thousands of people every year. Doctors didn't know how 0:00:19.480 --> 0:00:22.320 the disease spread or how to treat it. What they 0:00:22.320 --> 0:00:24.880 did know is that it mainly struck children, and that 0:00:24.920 --> 0:00:28.400 it left many of its victims paralyzed, often for life. 0:00:28.480 --> 0:00:31.720 As the century progressed, the disease kept becoming more common. 0:00:32.040 --> 0:00:35.960 In nineteen fifty two alone, polio paralyzed three thousand children 0:00:36.000 --> 0:00:39.800 in the US. One pole of American parents found that 0:00:39.800 --> 0:00:44.239 polio was their second greatest fear, right behind atomic apocalypse. 0:00:46.880 --> 0:00:50.200 The science of understanding viruses and developing vaccines had come 0:00:50.200 --> 0:00:52.440 a long way since the era of Edward Jenner that 0:00:52.479 --> 0:00:55.400 we talked about last week. Still, by the middle of 0:00:55.440 --> 0:00:58.760 the twentieth century, there was no vaccine to prevent polio, 0:00:59.120 --> 0:01:02.080 but scientists were about to develop not one polio vaccine, 0:01:02.240 --> 0:01:05.760 but two, and to this day we use these two 0:01:06.120 --> 0:01:09.600 very different kinds of vaccines to immunize people around the 0:01:09.600 --> 0:01:15.520 world against polio. On today's show, we'll tell the story 0:01:15.520 --> 0:01:18.800 of the cutthroat scientific rivalry that resulted in one of 0:01:18.840 --> 0:01:23.520 the greatest triumphs in American medicine, maybe two of the 0:01:23.520 --> 0:01:33.000 greatest triumphs. I'm Jacob Goldstein. This is incubation. So both 0:01:33.040 --> 0:01:36.039 of these vaccines protect people from polio, but they work 0:01:36.120 --> 0:01:39.480 in profoundly different ways. This is also true of the 0:01:39.560 --> 0:01:43.440 scientists who developed the vaccines, Jonah Salk and Albert Saban. 0:01:44.600 --> 0:01:50.280 Salk was everyone's idea of a hero. He was like Superman. 0:01:51.200 --> 0:01:55.280 He was good looking, he was soft spoken, polite, He's 0:01:55.360 --> 0:01:58.800 like the kind of guy you'd want your daughter to marry. 0:01:59.760 --> 0:02:07.800 And Saban was this abusive, loud mouth, obnoxious person who 0:02:07.840 --> 0:02:10.600 managed to offend even his best friends. 0:02:11.080 --> 0:02:14.440 This is Karen Torgaily. She's an epidemiologist and she's writing 0:02:14.440 --> 0:02:17.160 a biography of Albert Saban. I asked her to tell 0:02:17.160 --> 0:02:20.200 me more about Saban, this scientist who managed to offend 0:02:20.280 --> 0:02:21.480 even his best friends. 0:02:21.840 --> 0:02:27.520 By all accounts, he had an explosive temper, He was 0:02:27.600 --> 0:02:31.880 a perfectionist. He had little patience for people who weren't 0:02:31.880 --> 0:02:33.680 as smart as him, which. 0:02:33.440 --> 0:02:36.840 Was basically everybody, right. He was very, very very smart, so. 0:02:36.880 --> 0:02:38.040 Pretty much everybody. 0:02:38.120 --> 0:02:42.280 Yeah, so that's Saban tell me about Jonah Sulk. 0:02:43.280 --> 0:02:45.959 They had some things in common, both from Jewish families. 0:02:46.200 --> 0:02:49.800 He went to medical school at New York University, just 0:02:49.880 --> 0:02:52.639 like Saban did, because it was one of the few 0:02:52.680 --> 0:02:57.639 places that would take Jews in those days. Their paths crossed, 0:02:57.919 --> 0:03:03.440 probably for the first time woods Whole in Massachusetts. 0:03:02.760 --> 0:03:05.959 Woods Hall the Marine Biology Institute. 0:03:06.160 --> 0:03:09.040 Yes, so they got to know each other and they 0:03:09.080 --> 0:03:12.560 were friendly. Salk was kind of like the little brother 0:03:12.720 --> 0:03:17.280 scientists to Saban, who was by then getting well known. 0:03:17.400 --> 0:03:19.480 Okay, and Salk at the time was maybe still in 0:03:19.560 --> 0:03:22.959 medical school. Yes, yeah, how does he get from medical 0:03:22.960 --> 0:03:24.520 school to working on polio? 0:03:25.120 --> 0:03:28.920 So Salk moved to ann Arbor, Michigan and worked on 0:03:29.800 --> 0:03:33.680 a vaccine for flu. And the critical part of this 0:03:34.000 --> 0:03:38.800 is that the flu vaccine was made from a killed virus, 0:03:39.480 --> 0:03:40.560 not a live virus. 0:03:42.720 --> 0:03:45.280 Karen told me that working on this killed virus flu 0:03:45.360 --> 0:03:48.440 vaccine was a key moment for Salk and really a 0:03:48.520 --> 0:03:52.120 key moment in the history of vaccines because up until 0:03:52.120 --> 0:03:54.280 this point, there was basically one way to make a 0:03:54.360 --> 0:03:58.640 viral vaccine, use a virus that's still alive, but that's 0:03:58.800 --> 0:04:02.600 attenuated or weak. But the flu vaccine that Salt helped 0:04:02.600 --> 0:04:06.320 to create was different. It was made using a killed virus, 0:04:06.680 --> 0:04:11.600 a virus that had been completely inactivated. So now there 0:04:11.600 --> 0:04:16.320 were two potential strategies for developing a polio vaccine, attenuated 0:04:16.560 --> 0:04:19.800 or killed, and there were real trade offs between the two. 0:04:20.400 --> 0:04:24.480 An attenuated virus will multiply inside the body. This induces 0:04:24.640 --> 0:04:28.760 a stronger, more robust immune response, which is good, but 0:04:29.040 --> 0:04:32.080 if you're giving people this kind of vaccine, you better 0:04:32.120 --> 0:04:34.880 be really sure that their immune system is strong enough 0:04:34.920 --> 0:04:38.440 to handle it. Otherwise the vaccine might accidentally give people 0:04:38.520 --> 0:04:42.520 the very disease that you're trying to prevent. So that's attenuated, 0:04:42.760 --> 0:04:45.120 and then you have a vaccine made from killed virus, 0:04:45.240 --> 0:04:49.320 which often requires boosters for long term immunity. And if 0:04:49.360 --> 0:04:52.279 you're manufacturing a killed virus vaccine, you have to be 0:04:52.400 --> 0:04:56.159 really sure that all those virus particles are actually dead, 0:04:56.320 --> 0:05:00.760 that they're totally inactivated. So there are these two options 0:05:00.800 --> 0:05:04.440 for the polio vaccine, and it really wasn't clear which 0:05:04.480 --> 0:05:07.159 one would work better. For Salk and Saban. It was 0:05:07.200 --> 0:05:10.120 a key fork in the road and they chose different paths. 0:05:10.640 --> 0:05:13.760 Salk went to work on a killed virus vaccine. Saban 0:05:13.960 --> 0:05:19.720 chose attenuated. What is Saban's path to choosing an attenuated 0:05:19.760 --> 0:05:23.080 a weakened vaccine rather than a killed virus vaccine. 0:05:23.440 --> 0:05:29.360 His inspiration was Max Steiler, who was given the Nobel 0:05:29.440 --> 0:05:33.560 Prize for developing yellow fever vaccine, and that was an 0:05:33.560 --> 0:05:39.520 attenuated vaccine. He was convinced that the live attenuated virus 0:05:39.560 --> 0:05:41.559 made sense for polio as well. 0:05:42.200 --> 0:05:46.600 So Salk sets out to build this killed virus vaccine 0:05:46.640 --> 0:05:49.960 for polio. What are sort of the key moments in 0:05:50.000 --> 0:05:51.520 that quest. 0:05:52.279 --> 0:05:56.040 There was this sort of elite group of virologists who 0:05:56.960 --> 0:06:00.559 had their own sort of old boys club, and Sulk 0:06:00.720 --> 0:06:03.280 was not really in it because he was younger and 0:06:03.320 --> 0:06:08.919 they didn't see him as being up their caliber. They decided, though, 0:06:09.200 --> 0:06:11.400 since he was interested in it, that they would put 0:06:11.480 --> 0:06:14.520 him to work. One thing that he could do is 0:06:15.000 --> 0:06:19.440 a project for typing the different kinds of polio and 0:06:19.640 --> 0:06:22.680 figuring out which ones were the virulent ones to humans, 0:06:23.720 --> 0:06:27.360 because that had not been done. He had been sort 0:06:27.400 --> 0:06:31.720 of looking at the different strains and types and thinking, now, 0:06:31.720 --> 0:06:33.560 if I was going to make a vaccine out of this, 0:06:33.839 --> 0:06:37.800 which of these would I use? So he sort of 0:06:37.839 --> 0:06:39.640 had half the work done by the time he was 0:06:39.640 --> 0:06:41.679 finished typing these Oh. 0:06:41.520 --> 0:06:44.120 Interesting, So it seemed like the grunt work, but it 0:06:44.160 --> 0:06:49.159 was actually like meaningful progress toward the vaccine, right. 0:06:49.480 --> 0:06:49.800 Yeah. 0:06:50.520 --> 0:06:54.520 So he really surprised everyone when he told them in 0:06:54.600 --> 0:06:59.719 nineteen fifty three that he had a vaccine for polio 0:07:00.720 --> 0:07:07.320 and he was ready to test it, and they had 0:07:07.360 --> 0:07:13.400 to have this field trial. There were two million children involved, 0:07:13.960 --> 0:07:17.080 and of the two million, they had a sample of 0:07:17.160 --> 0:07:20.680 people who got the vaccine and people who thought they 0:07:20.680 --> 0:07:23.480 were getting the vaccine but really didn't, so they were 0:07:23.520 --> 0:07:27.240 a control group. There was an observed group too that 0:07:27.560 --> 0:07:32.920 got nothing. Only about half a million actually got the vaccine. 0:07:33.240 --> 0:07:36.720 So they do this giant study and what happens. 0:07:37.280 --> 0:07:40.560 They got the results and they kept a very secret. 0:07:41.400 --> 0:07:45.480 April twelfth, nineteen fifty five, came the day when they 0:07:45.520 --> 0:07:48.360 were going to make the announcement, so people were invited 0:07:48.400 --> 0:07:51.680 to come to ann Arbor on all people wanted to 0:07:51.720 --> 0:07:57.120 know does it work? Is it safe? Says basically, yes 0:07:57.240 --> 0:08:00.200 it's safe, and yes it's effective. And then and the 0:08:00.240 --> 0:08:03.560 reporters all ran to their phones and they reported, and 0:08:03.680 --> 0:08:08.880 the church bills rang. You know, there were big, huge 0:08:09.000 --> 0:08:12.560 headlines in the newspapers. It was just like the end 0:08:12.640 --> 0:08:17.800 of World War two. It was that happy of an occasion. Wow. 0:08:18.200 --> 0:08:22.800 And so Saban he doesn't have a vaccine yet, he's 0:08:22.800 --> 0:08:26.560 in fact in the room when when this Sauk announcement 0:08:26.640 --> 0:08:29.360 is made. How was he feeling at this point? 0:08:29.600 --> 0:08:33.640 He was pretty sad. His main worry was that his 0:08:33.760 --> 0:08:35.040 funding would be cut off. 0:08:35.720 --> 0:08:38.959 So let's talk about where Saban is in his research. 0:08:39.480 --> 0:08:41.079 At this point, he was. 0:08:41.040 --> 0:08:44.959 Within a year of having the vaccine that was made 0:08:44.960 --> 0:08:49.880 from a weekend attenuated stream, and he had tried it 0:08:49.920 --> 0:08:51.000 on his own daughters. 0:08:51.559 --> 0:08:53.479 He tried it on his own daughters. 0:08:53.120 --> 0:08:54.160 On his own daughters. 0:08:54.800 --> 0:08:57.480 Well, it's interesting to think about, right, because you can 0:08:57.520 --> 0:08:59.880 think of him giving it to his daughters as like, oh, 0:09:00.040 --> 0:09:03.240 prep scientist experimenting on his children. But you can also 0:09:03.240 --> 0:09:05.720 think of it as no, he believes this thing works, 0:09:05.760 --> 0:09:08.719 and there is this terrifying disease that could paralyze or 0:09:08.800 --> 0:09:12.200 kill his children, and he has what he has good 0:09:12.240 --> 0:09:15.640 reason to believe is like an elixir that will protect them. 0:09:15.720 --> 0:09:17.679 Yeah, of course he's going to give it to them. Yeah, 0:09:17.760 --> 0:09:20.280 remember they had to Also, you don't just get the 0:09:20.360 --> 0:09:23.679 vaccine and that's it. You have to be followed. Then 0:09:23.760 --> 0:09:26.160 you have to have blood tests, you have to have 0:09:26.360 --> 0:09:30.679 your stools analyzed to see if you're passing any virus 0:09:30.800 --> 0:09:32.640 or your stools. So they had to take these little 0:09:32.679 --> 0:09:36.640 cardboard boxes to school and if they had a bowel 0:09:36.679 --> 0:09:39.040 movement at school, then they had to give it to 0:09:39.080 --> 0:09:42.319 their teacher. So they said it was pretty embarrassing. 0:09:43.360 --> 0:09:45.800 Anytime my kids tell me that I'm going to embarrass them, 0:09:45.880 --> 0:09:46.760 I'm going to tell. 0:09:46.600 --> 0:09:47.400 Them that story. 0:09:48.760 --> 0:09:50.280 On the other hand, I'm not coming up with a 0:09:50.360 --> 0:09:53.960 vaccine for polio, So it's a trade off. So to 0:09:54.000 --> 0:09:55.920 go back to before in the sort of first part 0:09:55.960 --> 0:10:00.199 of the fifties, where Sulk and Saban aware that they 0:10:00.200 --> 0:10:02.160 were racing with each other, did they feel like they 0:10:02.160 --> 0:10:03.240 were racing with each other? 0:10:04.120 --> 0:10:08.400 Sulk was still the little brother scientist too. They thought, oh, 0:10:08.600 --> 0:10:11.160 you know, he's nice, he's making progress, but you know, 0:10:11.240 --> 0:10:14.640 he's not us. He also started to get sort of 0:10:14.679 --> 0:10:18.719 what they thought of as being uppity in a way 0:10:18.760 --> 0:10:20.719 that he wouldn't listen to anyone like. 0:10:20.679 --> 0:10:21.760 The know it all kid. 0:10:22.080 --> 0:10:27.320 Yeah, So for instance, Saban told him, you know, I 0:10:27.360 --> 0:10:31.280 see that you plan to use the mahoney strain in 0:10:31.320 --> 0:10:35.400 your vaccine. That is too dangerous to use in a vaccine. 0:10:35.520 --> 0:10:38.440 If any one of those got through and wasn't killed, 0:10:39.080 --> 0:10:42.640 it would kill whoever got it. And he said, oh, Albert, 0:10:42.679 --> 0:10:46.160 I have already made my decision. I've done it on 0:10:46.760 --> 0:10:49.120 my own experiments, and I'm going to stick with it. 0:10:50.080 --> 0:10:54.520 So actually what happened was there was an accident and 0:10:55.240 --> 0:10:58.840 children died from getting the Salk vaccine that was improperly 0:10:59.520 --> 0:11:04.400 killed at one of the labs. That started this contention 0:11:04.679 --> 0:11:07.640 between the two of them. They had been colleagues, they 0:11:07.840 --> 0:11:10.520 had been friendly with each other, but then it got 0:11:10.559 --> 0:11:12.719 into sort of open warfare. 0:11:14.320 --> 0:11:17.560 So they're having this basically a race, Salk and Saban. 0:11:17.800 --> 0:11:22.280 They're developing their vaccines in parallel. Salk wins piece, you know, 0:11:22.480 --> 0:11:25.760 like truly a national hero in the US. There's a 0:11:25.800 --> 0:11:30.240 massive vaccination campaign, and then not long after that, Saban 0:11:30.840 --> 0:11:34.920 essentially finishes developing his own vaccine, this very different vaccine, 0:11:35.080 --> 0:11:37.320 and he winds up taking it to the Soviet Union. 0:11:37.520 --> 0:11:41.760 Right, the Soviet Union started to have these terrible polio 0:11:41.880 --> 0:11:45.480 epidemics and they didn't have a vaccine, and they knew 0:11:45.480 --> 0:11:49.360 the United States did. Saban was going over and he 0:11:49.400 --> 0:11:53.800 would carry bials of this polio vaccine seed viruses in 0:11:53.880 --> 0:12:00.680 his pockets in these boxes just you know, it is jacket. 0:12:01.080 --> 0:12:03.640 He would show them how to make the vaccine, and 0:12:03.679 --> 0:12:06.760 so they got very good at producing the vaccine, and 0:12:06.800 --> 0:12:12.200 they actually immunized seventy seven million people. It stopped their 0:12:12.679 --> 0:12:15.120 polio epidemics. It just stopped them cold. 0:12:15.200 --> 0:12:17.559 Uh huh. I know, the Salck vaccine is a dead 0:12:17.720 --> 0:12:20.640 virus and the Saban vaccine is a live, attenuated virus. 0:12:20.640 --> 0:12:23.760 But beyond that, what are the basic differences between them? 0:12:24.000 --> 0:12:28.080 Well, so the Salt vaccine was more expensive and it 0:12:28.160 --> 0:12:30.880 was harder to make and store. The Saban vaccine was 0:12:31.480 --> 0:12:35.120 easier because you could take it orally and you didn't 0:12:35.160 --> 0:12:37.640 have to have a trained person to give it. And 0:12:37.760 --> 0:12:40.880 so they just were able to train people to put 0:12:41.000 --> 0:12:46.240 a couple of drops of the vaccine virus on cube 0:12:46.280 --> 0:12:49.760 of sugar. And there's a great little story that goes 0:12:49.760 --> 0:12:52.600 with that. This little boy he came home from school 0:12:52.640 --> 0:12:56.120 one day and his dad was a songwriter for Disney, 0:12:56.920 --> 0:13:00.520 and so he said, oh, son, what'd you do today? 0:13:00.559 --> 0:13:03.800 And he said, I got my polio vaccine. He said, oh, 0:13:03.880 --> 0:13:06.880 that must have hurt. I said, no, you just get 0:13:06.880 --> 0:13:10.360 these little drops and on a sugar cube and that 0:13:10.480 --> 0:13:15.640 was it, and so that's how his dad got the 0:13:15.679 --> 0:13:19.400 idea for Mary Poppins. Spoonful of sugar helps the medicine 0:13:19.400 --> 0:13:19.760 go down. 0:13:21.920 --> 0:13:26.000 So now we have these two effective vaccines in the world. Right, 0:13:26.080 --> 0:13:28.400 the Sabin vaccine does get approved in the US not 0:13:28.520 --> 0:13:31.559 long after the Soviet trial. We have the Salk vaccine 0:13:32.240 --> 0:13:34.959 and the Sabin vaccine. How does that play out in 0:13:35.000 --> 0:13:35.480 the world. 0:13:35.800 --> 0:13:40.040 So in the United States they stopped using the Salk vaccine. 0:13:41.000 --> 0:13:45.679 Uh why because the Sabin vaccine was cheaper and there 0:13:45.720 --> 0:13:48.720 was no need to give the Salk vaccine because you 0:13:48.760 --> 0:13:52.920 could take the Sabin vaccine once and for most people 0:13:52.960 --> 0:13:56.400 that last your lifetime. But with Salk you had to 0:13:56.440 --> 0:13:59.440 take the three initial doses and then a booster. It 0:13:59.520 --> 0:14:03.280 just made sense to switch to the to the Saban vaccine, 0:14:03.320 --> 0:14:04.520 and most countries did that. 0:14:05.440 --> 0:14:07.480 We know that with the Salt vaccine there was that 0:14:08.160 --> 0:14:12.480 manufacturing risk where in one instance it was manufactured wrong 0:14:12.520 --> 0:14:15.880 and they made a deadly dose of vaccine. What are 0:14:15.920 --> 0:14:18.800 the risks of the Saban vaccine. 0:14:19.120 --> 0:14:24.560 The Saban vaccine has something called vaccine associated paralytic polio, 0:14:25.640 --> 0:14:29.040 and it is when someone gets the vaccine who may 0:14:29.200 --> 0:14:34.520 have an immune disorder, and so even a very weakened 0:14:34.560 --> 0:14:40.560 poliovirus can cause polio like one in every three million 0:14:40.640 --> 0:14:41.800 doses or something. 0:14:42.160 --> 0:14:46.160 So in the eradication effort that has been going on 0:14:46.240 --> 0:14:50.120 for the past few decades, which vaccine were they using? 0:14:50.440 --> 0:14:53.120 Mostly these Saban vaccine. 0:14:53.320 --> 0:14:56.880 Wow, So in a way, Salt was like the hair 0:14:57.360 --> 0:14:59.520 and Saban was like the tortoise. Like in the end, 0:14:59.600 --> 0:15:02.400 even though it seemed like Salk one Saban one. 0:15:02.520 --> 0:15:06.440 Yeah. Well, and actually the truth is it really takes 0:15:06.480 --> 0:15:10.840 both vaccines because in our country now, what the recommendation 0:15:11.080 --> 0:15:14.200 is by the vaccine committees is that you get the 0:15:14.240 --> 0:15:16.040 Salk vaccine. 0:15:16.280 --> 0:15:20.600 Did they ever make up with each other? 0:15:21.600 --> 0:15:25.800 No, they didn't, and that It's interesting because one of 0:15:26.200 --> 0:15:30.560 Sabin's friends said to him one day, Albert, you have 0:15:30.720 --> 0:15:34.080 got to make up with Jonas. This is ridiculous. You 0:15:34.160 --> 0:15:36.720 are two grown men, and you just have got to 0:15:36.760 --> 0:15:40.320 make up. So he made him call Jonah Salk and 0:15:40.400 --> 0:15:46.160 they had this long, pleasant sounding conversation and at the 0:15:46.280 --> 0:15:49.000 end of it he said, Okay, well, it's been nice 0:15:49.040 --> 0:15:51.880 talking to you, and he hung up the phone and 0:15:51.960 --> 0:15:53.880 he said that Son of a Bitch. 0:15:59.240 --> 0:16:03.280 Karen's fourth book is Albert Sabin a fierce joy. It'll 0:16:03.280 --> 0:16:06.280 be out in twenty twenty four. We'll be right back 0:16:12.920 --> 0:16:16.520 because of Sock and Saban's polio vaccines. Transmission of polio 0:16:16.600 --> 0:16:19.400 in the US ended in nineteen seventy nine, but the 0:16:19.480 --> 0:16:21.720 disease kept spreading in many other parts of the world. 0:16:22.600 --> 0:16:26.160 Ananda Bandio Patia is a deputy director for Polio at 0:16:26.160 --> 0:16:29.160 the Bill and Milindigates Foundation. He told me he first 0:16:29.200 --> 0:16:31.320 saw the impacts of polio when he was growing up 0:16:31.320 --> 0:16:32.760 in India in the nineteen eighties. 0:16:33.440 --> 0:16:36.640 I grew up in Kolkata, a city in the eastern 0:16:36.760 --> 0:16:41.640 part of India, and I would see polio paralyzed kids 0:16:42.120 --> 0:16:44.880 in my own community used to play a lot of cricket, 0:16:45.040 --> 0:16:48.840 as you can imagine, and in our neighborhood there would 0:16:48.920 --> 0:16:54.320 be these sad instances of kids affected with polio and 0:16:54.400 --> 0:16:56.760 then all on a sudden, they would stop coming to 0:16:56.840 --> 0:16:59.320 the playing field. So it was very real. 0:17:00.400 --> 0:17:03.480 In nineteen eighty eight, organizations like the CDC and the 0:17:03.560 --> 0:17:06.760 WHO came together and decided to do with polio what 0:17:06.880 --> 0:17:10.440 the world had done with smallpox, to wipe it from 0:17:10.440 --> 0:17:13.679 the face of the earth. At the time, it was 0:17:13.800 --> 0:17:18.560 estimated that every single day polio paralyzed a thousand children. 0:17:19.760 --> 0:17:23.879 India led the way to really establish the proof of 0:17:24.040 --> 0:17:32.280 concept that polio can be stopped forever, including in complex geographies. 0:17:32.600 --> 0:17:35.840 And look at India. Now, it's not only the fact 0:17:35.840 --> 0:17:41.320 that India stopped polio in twenty eleven, it maintained polio 0:17:41.359 --> 0:17:46.399 free status for all these twelve years or so in between. 0:17:47.160 --> 0:17:51.639 So that's really a strong message for global health principles 0:17:51.680 --> 0:17:52.400 of eradication. 0:17:53.720 --> 0:17:56.200 Eradicating polio in India took a lot of work and 0:17:56.240 --> 0:17:58.480 Ananda was part of it. In two thousand and six, 0:17:58.520 --> 0:18:01.440 Ananda was sent by the WA to a remote part 0:18:01.480 --> 0:18:04.560 of India, the Kosi River basin in the state of Bihar. 0:18:05.640 --> 0:18:10.200 What was going on was this persistence of transmission, which 0:18:10.320 --> 0:18:16.200 essentially means we were seeing paralyzed children getting reported from 0:18:16.320 --> 0:18:22.600 these difficult areas of Bihar in the Kosi Basin. Despite that, 0:18:22.640 --> 0:18:25.399 attempts to vaccinate villages. 0:18:25.040 --> 0:18:27.440 In the Kosi River basin were really hard to reach. 0:18:27.920 --> 0:18:31.640 Roads were fewer, non existent, floods were frequent, and frontline 0:18:31.640 --> 0:18:34.520 workers like Ananda had to return again and again to 0:18:34.560 --> 0:18:37.120 make sure that every last child was vaccinated. 0:18:37.920 --> 0:18:41.560 To go there, Jacob, just to take you through that journey. 0:18:41.760 --> 0:18:45.159 I would initially take the project vehicle, it's kind of 0:18:45.240 --> 0:18:49.719 an suv, and then we would get onto boats. It 0:18:49.760 --> 0:18:54.399 would take us four hours sometimes five hours to reach 0:18:54.640 --> 0:18:59.560 those remotest villages. So we would start at four am 0:19:00.200 --> 0:19:05.040 on those boats. We would target to reach these villages 0:19:05.119 --> 0:19:09.600 by a m. Nine am or so. Then we would 0:19:10.040 --> 0:19:16.240 conduct the vaccination campaigns in coordination with the local government agencies, 0:19:16.320 --> 0:19:22.879 the medical doctors, female frontline health workers, local villagers would 0:19:22.960 --> 0:19:27.040 join in. It's almost like a festive you know day 0:19:27.240 --> 0:19:27.960 it used to be. 0:19:28.160 --> 0:19:29.560 And the thing you have to do this is an 0:19:29.640 --> 0:19:32.159 oral vaccine, right, so you have to put basically a 0:19:32.200 --> 0:19:35.879 couple drops of this vaccine into the mouth of what 0:19:36.160 --> 0:19:37.840 every person, every. 0:19:37.720 --> 0:19:42.680 Kid, Yes, two drops for all children aged under five. 0:19:43.520 --> 0:19:46.480 It's amazing that it's two drops. Like it really is 0:19:46.520 --> 0:19:48.919 like you have this magic potion, right, like we have it, 0:19:49.200 --> 0:19:51.879 we have enough of it. And the problem, the global problem, 0:19:51.880 --> 0:19:54.200 it's like we have to put two drops, just two 0:19:54.320 --> 0:19:57.280 drops of this potion into the mouth of every child 0:19:57.400 --> 0:19:57.920 under five. 0:19:58.000 --> 0:20:02.159 Absolutely, Jacob. The strategy she was to reach each and 0:20:02.480 --> 0:20:08.000 every children in those highest risk areas. When we talk 0:20:08.080 --> 0:20:12.320 about the Kosi River and we talk about the floods. 0:20:13.000 --> 0:20:15.720 Just to give you a sense of the scale. In 0:20:15.800 --> 0:20:18.640 two thousand and six, two thousand and seven, the time 0:20:18.680 --> 0:20:21.840 that I was in there, we are talking about about 0:20:21.960 --> 0:20:26.440 two and a half million to up to three million 0:20:27.320 --> 0:20:33.359 people displaced during these floods. I mean, this is almost 0:20:33.440 --> 0:20:38.040 like the entire population of Mississippi. You know, when we 0:20:38.119 --> 0:20:41.720 talk about these visits to these villages where you are 0:20:41.840 --> 0:20:49.520 essentially operating under a very strict time restriction because you 0:20:49.640 --> 0:20:53.560 got to get back to the mainland before the sunsets. 0:20:53.640 --> 0:20:56.960 You know, in dark it becomes very difficult. We're talking 0:20:57.000 --> 0:21:02.800 about remotest villages with a lot of difficulties. We were 0:21:02.880 --> 0:21:07.440 not waiting for people to come to us to get vaccinated. 0:21:08.160 --> 0:21:11.960 We were going to the folks, to the villagers, to 0:21:12.040 --> 0:21:15.160 that last child, that last household. 0:21:19.600 --> 0:21:22.120 So just to zoom out, like this is this sort 0:21:22.119 --> 0:21:25.280 of story of your experience broadly, like what is the 0:21:26.280 --> 0:21:28.119 end of the story of polio in India? 0:21:29.160 --> 0:21:35.120 January thirteenth, twenty eleven, was the last time we detected 0:21:35.560 --> 0:21:40.400 a polio paralyzed child, and interestingly, Jacob this time around, 0:21:41.000 --> 0:21:46.720 this last child was living essentially ten miles away from 0:21:46.840 --> 0:21:51.320 my home in Kolkata, So you know, it's very personal 0:21:51.320 --> 0:21:54.520 when I look back into you know, these children, and 0:21:54.560 --> 0:21:57.520 also the trajectory of India. 0:21:58.200 --> 0:22:02.280 Polio has not yet been eradicate. Where is there still 0:22:02.320 --> 0:22:04.359 polio in the world and why. 0:22:04.800 --> 0:22:07.360 Right now as you and I speak, there are only 0:22:07.720 --> 0:22:13.320 two countries, to be very precise, a few subnational areas 0:22:13.359 --> 0:22:19.520 of these two countries, Pakistan and Afghanistan, where polio is 0:22:19.600 --> 0:22:25.560 still endemic, which really means that in these subnational pockets 0:22:25.600 --> 0:22:29.720 of these two countries polio has never been stopped or 0:22:29.800 --> 0:22:33.520 interrupted for a long duration of time. I would say 0:22:33.560 --> 0:22:40.440 the primary issue in Pakistan Afghanistan is of access, and 0:22:40.480 --> 0:22:45.359 I think some of the reason is still the geographic complexity. 0:22:45.400 --> 0:22:48.480 You can draw parallels to what we saw in a 0:22:48.520 --> 0:22:51.960 Bihar in India where in some parts there were no 0:22:52.160 --> 0:22:56.960 road connectivity. In some parts there were nomadic populations always 0:22:57.000 --> 0:23:00.280 moving around. On top of that, there is the your 0:23:00.280 --> 0:23:05.840 political unrest, the civil unrest, and also the political turmoil 0:23:05.880 --> 0:23:08.280 that the two countries are going through. 0:23:08.640 --> 0:23:11.160 Let's talk about that in some detail, and we talked 0:23:11.160 --> 0:23:16.000 about this one region parts of Pakistan and afghan understand 0:23:16.119 --> 0:23:18.920 where polio is still endemic. And then there's a set 0:23:18.960 --> 0:23:21.240 of countries primarily in Africa, where there is a risk 0:23:21.280 --> 0:23:23.600 of reinfection. So, first of all, what does that mean. 0:23:24.760 --> 0:23:30.920 Reinfection means if we have a susceptible group of people 0:23:31.560 --> 0:23:37.840 who are either under vaccinated or unvaccinated, there is always 0:23:37.840 --> 0:23:41.640 a risk that polio will not only come back, but 0:23:41.960 --> 0:23:47.880 come back and re establish circulation because poliovirus can essentially 0:23:48.040 --> 0:23:54.159 travel through infected people into the polio free areas. And 0:23:54.440 --> 0:23:58.760 if that area is not only getting exposed to such 0:23:59.200 --> 0:24:05.000 population coming in, but if it is also under or unvaccinated, 0:24:05.640 --> 0:24:08.600 then not only the virus comes in, but it comes 0:24:08.640 --> 0:24:15.760 in and re establishes circulation in the susceptible, under vaccinated population. 0:24:16.280 --> 0:24:20.200 Right, Just so unclear these regions where there are problems 0:24:20.200 --> 0:24:23.000 with reinfection, where are those cases coming from? 0:24:23.480 --> 0:24:28.119 It does vary. Given the only two endemic FOSIGN now 0:24:28.520 --> 0:24:34.120 is in those subnational areas of Pakistan and Afghanistan, typically 0:24:34.240 --> 0:24:36.520 the source would be from somewhere there. 0:24:37.280 --> 0:24:40.200 So if we could knock it out in Pakistan and Afghanistan, 0:24:40.400 --> 0:24:41.840 we'd be done spot on. 0:24:42.119 --> 0:24:46.080 That's the primary and the central goal. We are not 0:24:46.160 --> 0:24:49.119 only in the last mile, we're probably in that last 0:24:49.480 --> 0:24:52.720 one hundred meter, you know, dash when it comes to 0:24:52.800 --> 0:24:54.119 reaching our goals. 0:24:55.720 --> 0:24:58.239 So we're coming to the end of this story, right, 0:24:58.280 --> 0:25:01.040 I mean I hope we're coming to the end of itself. Yes, 0:25:01.359 --> 0:25:05.360 existing in the world. How are we going to get there? 0:25:05.720 --> 0:25:07.639 And when? When is it going to happen? 0:25:08.560 --> 0:25:12.200 Jacob I wish I had a crystal ball and really 0:25:12.280 --> 0:25:16.920 answered the when part of the question. However, let's look 0:25:16.960 --> 0:25:23.400 into the data. Even within Pakistan, it's now cornered into 0:25:23.440 --> 0:25:29.840 a few districts, a few provinces. But beyond that geographic shrinkage, 0:25:30.320 --> 0:25:35.359 the genetic lineage shrinking is essentially telling us that the 0:25:35.440 --> 0:25:41.159 virus is gasping. We need to ensure that we have 0:25:41.400 --> 0:25:46.520 full momentum for this last push, the final push, to 0:25:46.760 --> 0:25:51.439 maintain our resolve to reach that last child in that 0:25:51.600 --> 0:25:56.240