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 viruses. 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 secretary of Health and Human Services, has called the idea that vaccination has nearly eradicated polio “a myth.” “is
And while Mr. Kennedy has said he does not plan to take vaccines 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 cancer “that killed many, many, many, many, many, many more people than polio.” Killed people.” The contamination was real, but the research No link has ever been made to cancer..
Aaron Surrey, a lawyer and adviser to Mr. Kennedy, has represented a client who has sought to challenge the approval or distribution of some 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 J. Trump and Senator Mitch McConnell, who contracted polio as a child.
But the Secretary of Health and Human Services has the authority to discourage vaccination in less direct ways. He can draw federal funds for it. Childhood vaccination programstates already rush the end of school mandates. Not inclined to the vaccine or raising doubts about the shots, a Decline in 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. A resurgence of polio while it is so close to eradication “would be very, very, very, very sad.”
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,” said Dr. Karen Kowalski, a 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.
Dr. Kowalske cares for about 100 post-polio patients who require 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.
Ms. 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 the virus was found in wastewater in five European countries, decades after its official eradication from the region, and In Australia.
“Any reduction in coverage increases the risk of polio anywhere,” said Oliver Rosenbauer, spokesman 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 there are enough unvaccinated children to become infected, the pathogen spreads slowly, recapturing its virulence and eventually causing 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.
He Came out prematurely. 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.
The inactivated polio vaccine (IPV), used for routine immunization of American children, 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 is the aspect. Amid criticisms of Mr. Sriadviser to Mr. Kennedy.
Still, that’s less important than the vaccine’s near-perfect power to prevent strokes, experts said.
“Yes, yes, it’s true, IPV does not prevent transmission,” said Dr. William Petrie, an infectious disease physician and former president of the 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 on 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 percent, compared to the national average of 93 percent.
The virus that paralyzed the young man had been circulating for months, and was later detected in the sewage of several New York counties with a vaccination rate of about 60 percent, leading the state to Declare an emergency.
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 was because raw sewage was dumped into the rivers,” Dr Hyman said.
That’s no longer the case, so there “will not be immediate mass transmission in the United States,” he added.
But even if only a few children were paralyzed, “that would be terrible.”