1. mongering, much of it outlandish,, can
THE CHILDREN IN GADAP scare the public into refusing immuni-
zations. The polio vaccine contains IIIV,
TOWN LIKE TO PLAY thcy arc told. It's made from pig or mon-
key urine. It's meant to stcrilize children.
TEA PARTY. THERE ARE Whetherit'sbecauseoffearofoutsidersor
-
~ e n e r asuspicion of anythinl: touched by
i
;he West, the lies work:
NO LITTLE TEA SETS "We arc an illiterate pcople:'says Saiful
Islam, a shopkeeper in Mohih Banda, near
HERE, NOT IN THIS DENSELY Peshawar, in northein Pakistan. "When
one person says something, we don't ask
PACKED, GRINDINGLY where he learned it. We just believe it." Is-
poor Pakistani slum, the biggest in the open sewer or an unclean dish, anyplace
megacity of Karachi. So children scavenge children come into contact with children, 6mo;th-old daughter. Now she wears pink
bottle caps from piles of bash near the foul- the viruscould be growing. braces with blackVelcro straps on her little
smelling stream that flows through the Pakistan once had plenty of company legsandsquirmsas heexercises herleft foot
town.Usingthemascups,they sipthe filthy inbattlingthc po1ioscourgc.A~ recenlly as to prcvcnt it lrom curling in on itsell. All
water, imagining perhaps what it wouldbe 7988, thedisease wasendemic to i25 coun- virusesfightbackagainst their eradication.
like to sit downat a real tea party oneday. tries, paralyzing or killing j5o,ooo people Polio is the only one with a propaganda
Whal the children don'l lhink about is each year-mostly children. Thanks to wingandanarmedmilitiaonits side.
the poliovirus that swirls in Lhc water, de- cxhaustivc medical, philanthropic and
positedthereby humanwaste-thebiggest political teamwork, the virus has been At the Brink
reason the stream is so foul to begin with. routed, corralledinto only three countries: BY AI.MOST 4 N Y MEASURE, T l I h R E A R G U A R D
They know nothing of the way a capful of Pakistan, Afghanistan and Nigeria. In protecting the poliovirus is outgunned by
water canintroduce the virus to the mucus 20:2, there were only 215 casesworldwide. . ,the forces trying to eliminateit. Alot ofthe
,
mcmbrancs of thc mouth, whcrc it hinds Only onc other timc in human history ;grgrcrcsthatts bcen n i a d ~ . ~ ~ & = G 6
with cells in thc ~ h a r y n xreplicatcs there
, has a diseasc-smallpox-bcen wiped ~hc,cffo_ltsof,R~t~r_y International, w h ~ c h
and thenmi~rates t h e ~ uand the lymph
to t out in the wild. Polio, that fearsome crip- in 1979-the year polio'Iw~EL;ii.ederadi-
system-multiplying explosively all the pler of children, scourge of peasants and cated in the U.S.-decided to make it the
while--until it iinds its wav to the central Presidcnts.could soonbecome thesecond. missionofits then 18,00oclubsand8~0,000
nervous system, slaughtering the motor unless the entire crusade, so close to com- mcmbers worldwide to wipc out thc dis-
case everywhcre. UNICEF, WHO and the
u A , u ~ u . U.S. Centers for Disease Control have put
sometimes the arms and occasionally the drive in Pakistan, nine field wor1;crs-six their muscle behind the push, andin 2007,
muscles that controlbrcalhing. of them womcn or lccnage girls-wcre thc Bill &Mclinda GatesFoundalion joincd
But Salma Khan thiliks about that killed in lnotorcycle drive-by shootings in as well, spending $1 billion so far to
kind ufthing alot. rust afew months ago, linked to the Pakistani Taliban. On Jan. r, battle the disease. "I'm very focused on im-
her son Bilal would race Lirclcssly around sixmorewo~ncnar~do~icman--allolthcrn pacl pcr dollar," Gates said at a September
their family compound in Sango; far to medical aid worl;ers-were similarly shot meeting of thc U.N.'s Economic and Social
the north of Karachi, chasinl: his twin to death. All of that bloodshed followed a Council-a meeting also attcndcd by the
Presidents of all three endemic countries
, " and ILN. Secretary-General Ban Ki-moon.
days, he coild no longer walk. Today, North Waziristan province until Ameri- "This is onc of the smarlcst allocations of
Khan holds her sonin herlap,lifts hisleft can dronestrikcsstop. resources the world can mal;e."
leg and watches as it drops limply back "In the garb of these vaccination cam- In terms of raw caseload, it's not easy
down. p s t 18 monlhs old, hc is a toddler paigns,"said one picce of propaganda,"lhe to see how. When you're down to count-
who can toddle no morc. "Now all my U.S. a~idilsallicsarcrun~iing theirspying ing cascs in the hundreds, yon should bc
dreams are shattered," she says. "He will networks." Thcre is no truth in that, but able to dcclare victorv and zo homc--
~ ~
L ~ .
#
.- Bilal's lczs nrobablv camc from Gadan b i n ~ a d e n , a ~ a k i & a ~ ~ i d o c t o r m ~ s s u e r a d e d have malaria. But those numbers
lion
; &d Town. G~iilhtic profiling has trac1;cd t<c asahepatitis-vaccincworkcrina~attcmpt can mislcad. For one thing, lor every 2 0 0
& slum strain to all four Pakistani~rovinces to collcct chcck swabs from familv mem-
i aswellastoAfghanistanandChi~~a."Gadap bersin bin 1.aden'scompound to try to c o n Pn?vantion cause A child is unccir?nfedat
aurl
1 I?, . .
Organizatio~i(WHO).It'snottheonlysuch kernels of t r u t h to sabotagc vaccinc snnitationnwdirasi~ dirn~pslikc
< ,
tltisoncin
factory in the c ~ u n t r y .
Anyplace thercCs
an cfiorls, howcver--no1 whcn rumor *aiadii, buttonl ?igllt.;.end ~i1CPolioVir115
b,
* ~ ~ ~~ ~ ---~ ~~~ .- -- ..~~
-

2. polio infections, only one results i n pa- that led to ferocious arguments when to take care of any vaccine-related cases
ralysis. The rest look lilce nothing more the men were alive, arguments that have that remain. In the U.S., where cost and
than a cold or a passing fever, though the continued long after their deaths. The Sallc the greater difficulty of administering an
child is still spreading the virus. What's a
vaccine uses lcilled virus to trigger the injection are not issues, Sallc is used almost
more, polio moves fast. In 2003 the dis- critical immune reaction and reauires exclusively."The Salltvaccine never causes
ease seemed near its end until clerics in a n injection. The Sabin vaccine uses a symptoms and never causes transmissible
northern Nigeria halted inoculations on live, weakened virus that is talcen orally, polio," says Gates. "It is a perfect vaccine."
the basis of rumors about sterility and multiplies i n the gut and spreads to the Another complicating factor: polio is
HIV contamination. Two years later, po- bloodstream, where, lilce the Sallc vaccine, not just one disease; it's actually three. The
lio cases-nearly all of them the Nigerian it teaches the immune system to recognize virus comes i n a trio of genetically dis-
strain-were raging across 16 countries polio and go on the attaclc if it ever sees it tinct types, ltnown prosaically enough as
throughout Asia and down to Oceania. again. The Sallc vaccine costs up to $3 per Type I, Type 2 a n d v p e 3, and each reacts
Fighting these periodic outbrealcs gets dose today. The Sabin formulation costs differently to vaccines. The way to attaclt
expensive, which is why eradication is the less than 2 0 and can be administered
~ them all at once is to administer what's
most cost-effective goal. Rotary and other with just two drops. "You could train lcnown as a trivalent vaccine, with three
groups calculate that $I billion spent per people to do this," says Dr. John Sever, vice formulations i n each drou or shot. That
year over the next few years to extinguish chair of Rotary's international antipolio usually worlts, but not always. In Egypt,
the last fugitive strains of polio could save drive. "If they could count to two, they Types 2 and 3 were eradicated as early as
up to $50 billion over the next 20 years, could be an immunizer." 2004, but Type I refused to die.
both i n treatment costs for infected chil- But the Sabin vaccine isn't as obvious a "We worlted with the Egyptian govern-
dren and i n the perpetual, hold-the-line choice as it seems. Polio spreads via feces, ment to tighten up the whole operation,"
vaccination programs that must be main- and on a single passage through a single says Aylward. "We had them malce sure
tained as long as the virus is at large. Vac- body, a live Sabin-vaccinevirus can mutate their vaccination teams actually went to
cinations against smallpox have not been from safe to deadly, infecting both the re- the top floors of all of the apartment build-
a burden on medical balance sheets since cipient of the vaccine and people close by. ings." Even that wasn't sufficient, however,
the late 1970s. "These cases are rare as hen's teeth," says and WHO decided that what was needed
"Once polio is gone, you eliminate those Dr. Bruce Aylward, WHO'S chief of polio was a highly potent, monovalent vaccine
costs forever," Gates told TIME.What's eradication, "but after you spend $10 bil- to hit Type I alone. Pharma giant Sanofi
more, the medical infrastructure put i n lion and 25 years to eradicate the disease, Pasteur said it could develov it within 12
place to get the po!io vaccine out there- you don't want a vaccine-related epidem- months. Aylward gave them four, and they
the supply chains, volunteer networlts and ic." (Hen's teeth, in this case, are 610 cases settled on five. The Gates Foundation do-
innovations lilte GPS trackers on vaccine out of 2.5 billion vaccinated children since nated omil ill ion to the effort-enough to
shipments to prevent them from going 2000, according to WHO-rare indeed.) buy 50 million doses-and by 2006, polio
astray-can then be repurposed to fight I n the three endemic countries, a was expelled from Egypt for good. In the
other diseases. But the polio battle must two-pronged strategy is thus being used: three endemic countries, Type I is again
first be won. And even if that battle has stay with the Sabin vaccine to wipe out causing headaches, withType 2 eradicated
already led to bloodshed in the field, it's at naturally occurring polio, then use Sallc and Type 3 getting close. But if you don't
the submicroscopic level, down where the stay on top of the virus until the very last
viruses live, that the truly consequential case of the very last strain is wiped out,
war is being waged. polio will brealc free again.
The Half-Century Fight
IT WAS I N 1955 T H A T E P I D E M I O L O G I S T
THE MOST All Medicine I s Local
THERE'S NO O N E WAY TO FLUSH THOSE LAST
Thomas Francis Jr., who led the massive
field trial of Jonas Salk's polio vaccine the
WORRISOME cases out, and the right strategy depends on
the country in question. Despite the shoot-
year before, stood onstage at the Univer-
sity of Michigan's Racltham Auditorium
PLACE IN i n g in Paltistan, the most worrisome place
~
in terms of caseload is Nikeria. It's the only
and announced the results. "The vaccine
worlts," he said. "It is safe, effective and
TERMS OF country whose polio rates actually went
up in 2012, to 118 cases compared with 62
potent." That was the epidemiological tri-
fecta scientists had been hoping for, and
CASELOAD IS in 2011. (In Palcistan, there were 57 cases
in 2012 and 198 in 2011.) Nigeria's problem
the six-inch headlines and global hoopla
that followed were measures of the pro- NIGERIA, area continues to be the north, with anti-
vaccine propaganda againleading to refus-
found relief the world felt. In 1952, nearly
58,000 Americans were striclten by polio; WHERE als. In 2012, WHO dramatically increased
its presence in the country, from 744worlt-
by 1961, the figure was down to 1,312.That
was the year before Albert Sabin's oral vac- POLIO RATES ers to 2,948. It is also using satellite map-
ping to reach children in villages that, says
cine went into wide use. When it did, the John Hewlto, general secretary of Rotary In-
U.S. numbers fell effectively to zero. W E N T UP ternational, "we didn't even ltnow existed."
There are critical differences between Afghanistan, so often a source of trou-
the Sallc and Sabin vaccines-differences ble in the region, is moving comparatively
TIME January 14, 2013

3. smoothly toward eradication, with just 35 Mobiile care Workers at a Karachi tollplaza to answer those rumors of vaccine-related
cases in 2012, down from 80 in 2011. The canfind and immunize as many as 800 sterility?Tahira Yasmin, a polio worlter for
Islamic Development Bank has made a unvaccinated children in a single eight-hour shift UNICEF, has a way: "I tell them I am mar-
$ 3 million grant to Afghanistan to help ried and young. 1f-Iwere worried, I would
antipolio efforts. That's just a small frac- Paltistan is putting institutional power not talte it," she says. Then she downs a
tion of the $227 million the banlt made behind the sentimental appeals. After the few drops. "They laugh and they let their
available to Paltistan, also for polio vacci- December shootings, the government children talte it."
nations, but the disparity in funding part- temporarily suspended the inoculation Rotary, W E 0 and the other groups
ly reflects the disparity in need. What's program, but Prime Minister Raja Pervez had hoped to have halted transmission
more, the fact that the banlt is involved ksh;af quicltly issued a statement con- in all three endemic countries by the end
at all suggests a regional buy-in that was firming.the countrv's commitment to the
a
of 2012. NOW they acltnowledge they will
lacking before. campaign. He called for an inquiry into have to continue intensively vaccinating
It's also a hopeful sign that the leaders the attacks, promised the safety of polio in 2013, especially during the compara-
of all three endemic countries have put worlters and pledged to proceed with plans tively cool months when the virus is at its
their prestige on the line. Nigerian Presi- to deploy 250,000 health worlters to vac- wealtest. "You pound the disease through
dent Goodluclt Jonathan pledges that polio cinate 34 million children in 2013. Polio the low season," says Aylward. "Then you
will be wiped out in his country by 2015. teams will continue to work at toll pla- need 12 months of no cases before you
Afghanistan's Hamid Karzai signed a zas, boarding buses and loolting for chil- could say that we did it. You're not going
polio-eradication plan in September and dren who don't have blue ink staining a to open the champagne at least until 2014.''
made a show of personally administering finger-a mark applied by field worlters When that does happen-when po-
drops to children. But it's Paltistani Presi- after a vaccine has been administered. lio joins smallpox in the supermax loclt-
dent Asif Ali Zardari who has the most to When they find an unmarked child, they down of the lab-it will be an existential
gain-and lose-in the polio campaign. vaccinate on the spot. as much as a medical victory. Viruses and
His daughter Asifa Bhutto Zardari is a Appeals to religion and reason are be- bacteria have had their way with humans
leading spolteswoman for the eradica- ing deployed as well. Health worlters in since the dawn of history--a species-vs.-
tion effort, recalling in speeches that her tribal areas cite Koran verses that encour- species war we have too often lost. We are
mother-the late Prime Minister Benazir age the care of children and reach out to on the brink of wiping out a virus that
Bhutto, who was assassinated in 2007- local religious leaders for support. If the richly deserves extinction.The war may be
administered the vaccine to her when she mullah in Mohib Banda had endorsed the slow,but there is no tonic lilte a big victory
was a child. President Zardari spealts of vaccine, says Saiful Islam, father of the over a disease to ensure there will be more
"my martyred wife," who dreamed of a paralyzed 6-month-old girl, "1oo~10 theof victories to Come. -WITH R E P O R T I N G B Y
world free of disease. village would have accepted it." And how ARYN BAKER~PAI~ISTAN