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Polio vaccine at a pop-up vaccination clinic for polio at the Rockland County Department of Health in Pomona. (File photo: NYT)

Most American parents hardly think about polio right after their child is immunized against the disease. But there was a time in this country when polio paralyzed 20,000 people in a year and killed many of them.
Vaccines Turned the tide against the virus. Over the past decade, only one case related to international travel has occurred in the United States.
This could change very quickly if polio vaccination rates drop or the vaccine becomes less accessible.
Robert F. Kennedy Jr., a longtime vaccine skeptic who may become Health and Human Services secretary, has said the idea that vaccination has nearly eradicated polio is “a myth.”
And while Kennedy has said he does not plan to take vaccines away from Americans, he has long maintained that they are not as safe and effective as claimed.
As recently as 2023, he said, batches of early versions of the polio vaccine, contaminated with the virus, caused cancers “many, many, many, many, many more than polio.” People were killed.” The pollution was real, but research never found a link to cancer.
Aaron sirKennedy, a lawyer and consultant, has represented a client who wants to challenge the approval or distribution of certain polio vaccines on the grounds that they may be unsafe.
These efforts are unlikely to succeed. And there is broad support for vaccination among prominent Republicans, including President-elect Donald Trump. Trump And Sen Mitch McConnellWho had polio in childhood.
But the Secretary of Health and Human Services has the authority to discourage vaccination in less direct ways. He could withdraw federal funding for childhood immunization programs, accelerate the end of school mandates in states that are already vaccine-prone or increase skepticism about the shots. and may exacerbate declining immunization rates.
Scientists say that if polio vaccination rates drop, the virus could spread to parts of the country where large numbers of people have not been vaccinated, wreaking havoc once again. The virus may be almost extinct in its original form, but re-emergence is a constant threat.
Dr. David Hyman, an infectious disease physician at the London School of Hygiene and Tropical Medicine and former head of polio eradication at the World Health Organization, said that whatever decision the Trump administration makes regarding the polio vaccine is likely to spread around the world. .
He said that if the US takes away the license, many other countries will do the same. “It would be very, very, very, very sad” to see polio resurgence when it is so close to being eradicated.
Before 1955, when the vaccine was introduced, polio disabled more than 15,000 Americans each year and millions more worldwide. In 1952 alone, it killed 3,000 Americans from paralysis when they were unable to breathe.
Many of those who survived are still living with the consequences.
“People really underestimate how terrible polio was,” Dr. Kern said. KowalskiA physician and polio specialist at the University of Texas Southwestern Medical Center in Dallas.
Many people who recover now suffer from “post-polio syndrome”: some of the original symptoms, including muscle weakness and breathing problems, return.
Kowalske tends to about 100 post-polio patients who need braces, wheelchairs or other devices to cope with progressive weakness. Some are older adults who were infected before the vaccine was available. Other middle-aged immigrants are from countries where polio has been a problem longer than in the United States.
For some survivors, the thought of polio returning is unthinkable.
Carol Palak contracted the disease in 1943, when she was just 3 years old. Her right leg never healed, and for the rest of her life she walked with a pronounced limp and was in near pain.
Palak is among the lucky ones. Until recently, he did not experience the breathing, swallowing or digestive problems that often plague polio survivors.
She has lived “a wonderful, wonderful life” with a husband and three daughters, a law degree and extensive travel abroad.
But always, everywhere, she’s calculating how far the next set is, how long her energy will last and whether an activity is worth the debilitating discomfort the next day.
She did not participate in the 1963 March on Washington or play sports, as she preferred to go hiking, skiing, and bicycling with her husband.
If there were a public hearing on the polio vaccine now, “I’ll go, and I’ll take off my brace, and I’ll let them see my leg and ask them, is this what they want for their children?” he said.
Polio now cripples very few children. Vaccination has largely wiped the virus from the planet, reducing the number of cases by more than 99.9 percent and preventing an estimated 20 million cases of stroke.
Still, the virus has proven to be a stubborn foe, and has been eradicated time and time again.
In 2024, cases of polio were reported in 20 countries, and in five European countries, decades after its official eradication from the region, and the virus was detected in Australia.
“Any reduction in coverage rates increases the risk of polio anywhere,” said Oliver RosenbauerSpokesperson for the World Health Organization’s Polio Eradication Program.
There are three types of poliovirus, and all three must be eradicated for eradication. For years, the goal has been very close.
Type 2 was declared victorious in 2015 and Type 3 in 2019. Type 1 now circulates only in Afghanistan and Pakistan. In 2021, there were only five cases in the two countries. In 2024, they numbered 93.
But these figures tell only part of the story. In a surprising twist, the oral vaccine used in some parts of the world has kept the poliovirus in circulation long after it has been eradicated.
In most low- and middle-income countries, health officials still rely on oral vaccines given as two drops on the tongue. It is cheap and easy to administer, and it prevents the transmission of viruses.
But it contains a weakened virus, which vaccinated children can shed into the environment through their feces. When enough unvaccinated children are infected, the pathogen spreads slowly, becomes virulent and eventually leads to paralysis.
Here’s the problem: As of 2016, the oral vaccine used for routine immunization no longer protects against the type 2 virus. World health authorities made the deliberate decision to reformulate the vaccine on the basis that the naturally occurring type 2 virus had disappeared.
Which turned out to be premature. In some parts of the world, the type 2 virus has spread more than officials expected from orally vaccinated children. When some unimmunized children, or those who were given the new vaccine orally, were exposed to this “vaccine-acquired” type 2 virus, they became infected and paralyzed.
The vaccine-derived poliovirus now paralyzes more children than the naturally occurring virus. For example, Nigeria eliminated all so-called wild-type polio in 2020. But in 2024, the country saw 93 cases of type 2 vaccine-derived virus, more than a third of the global total.
None of this is a problem for Americans — as long as they’re getting vaccinated.
Inactivated polio vaccine (IPV) is the routine immunization of US children that protects against all three types of polio. These formulations contain dead viruses, and therefore cannot cause disease or revert to a virulent form.
But like some other vaccines for infectious diseases, these do not completely prevent infection or transmission of the virus. This aspect is one of Kennedy’s advisers’ criticisms.
Still, it’s less important than the vaccine’s closest potency to prevent strokes, experts said.
“Yes, yes, it’s true, IPV doesn’t stop transmission,” said the doctor. William Petrie.An infectious disease physician and former chair of WHO’s Polio Research Committee. “But, boy, it’s the best thing since sliced ​​bread to prevent a stroke.”
However, this means that people vaccinated with IPV can keep the virus circulating, even when they themselves are immune to illness and paralysis.
So here’s a realistic scenario that worries researchers: Someone who was vaccinated with oral polio vaccine in another country could bring the virus into the U.S. and then shed it in its weakened form. This has happened in other countries too.
As long as most of the population is vaccinated, it is unlikely to cause an epidemic. But if the virus makes its way into communities with low vaccination rates, it can spread, and then take a dangerous form that can cause paralysis.
That’s what happened in New York in 2022, when polio struck a 20-year-old unvaccinated member of an ultra-Orthodox Jewish community in Rockland County.
The county had a vaccination rate of just over 60% compared to the national average of 93%.
The virus that paralyzed the teenager had been circulating for months, and was later detected in the sewage of several New York counties with vaccination rates around 60 percent, prompting the state to declare a state of emergency. done
Genetically related polioviruses have been detected in wastewater samples in the UK, Israel and Canada, suggesting widespread transmission. Authorities later found two separate vaccine-derived type 2 polioviruses in New York sewage, suggesting two separate imports.
If polio reappears in the United States, it is unlikely to be as virulent as it was in the pre-vaccine decades. Many older adults still remember that as children they were not allowed to swim in rivers or pools, or anywhere else the virus might lurk.
“The reason we weren’t allowed to play in the rivers in the ’50s is because raw sewage was dumped into the rivers,” Hyman said.
That’s no longer the case, so “there won’t be immediate mass transmission in the U.S.,” he added.
But even if only a few children were paralyzed, “it would be terrible.”



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