The battles won against viruses – Eula Biss

My father has a scar on his left arm from the smallpox vaccination over half a century ago. That vaccine is responsible for the worldwide eradication of smallpox, whose last case of natural infection occurred in the year I was born. Three years later, in 1980, the disease that had killed more people in the twentieth century than all the wars of that century had officially disappeared from the face of the earth.

The smallpox virus now exists in only two laboratories, one in the United States and the other in Russia. The World Health Organization, shortly after the eradication of smallpox, has set a series of deadlines for the destruction of these reserves, but neither country has respected them. In 2011, in the course of a debate on the issue, the United States argued that more time was needed for the virus, so that a better vaccine could be developed, for safety reasons. Smallpox has now ceased to be a disease to remain only a potential weapon. And even if the last reserves are destroyed, it could continue to be a weapon. There is still a lot we don’t know about smallpox, including why it is such a virulent disease, but we know enough, at least in theory, to be able to recreate it in the laboratory.

Carl Zimmer observes: “Our knowledge gives the virus its own form of immortality.” Thirty years after routine vaccination against smallpox was stopped in the United States, the government asked researchers from the University of Iowa to verify the effectiveness of the vaccine‘s remaining reserves.

This happened in the long run following September 11, 2001, during which any potential terrorist attack was envisioned, including the use of smallpox as a biological weapon. The smallpox vaccine proved effective even after being stored for decades, while also being diluted to increase supplies. But the results of the vaccine trial, according to the director of the university’s Vaccine Research and Education Unit, Patricia Winokur, were “unacceptable by current standards.” One third of the people who were vaccinated suffered from severe fevers or rashes and felt ill, in some cases, for several days.

That vaccine eliminated smallpox, but it remains far more dangerous than any other vaccine currently included in the childhood prevention plan. The risk of death after vaccination against smallpox, according to an estimate made, is about one in a million, while the risk of subsequent hospitalization is one in a hundred thousand.

Many children of my father’s generation took that risk. They were the generation of the so-called Polio Pioneers, the six hundred and fifty thousand children from all over the country that their parents had volunteered to test the first polio vaccine. This happened after Jonas Salk tested the vaccine on himself and his three boys. I saw some photographs of the Polio Pioneers, schoolchildren a little older than my son standing in line with their shirt sleeves rolled up, smiling in front of the camera. “They were afraid of polio and the bomb,” writes Jane Smith of her parents, “and tended to think of both in the same terms, as forces that could attack without warning and destroy their lives and those of their children.” .

The Polio Pioneers were born soon after Hiroshima, to parents who in many cases had been recruited for military service. In signing the forms before administering the experimental vaccine to their children, the parents did not give their consent, but “asked” to be part of the trial. It is difficult today to imagine parents making such a request. While we regularly ask for more vaccine tests and more human trials, the implicit assumption is that we don’t want our children to be the subject of those tests. Polio is likely the next disease to be eradicated through vaccination, although this has proved to be a more difficult project to accomplish than eradicating smallpox.

Unlike those with smallpox, most polio sufferers are asymptomatic carriers and never develop paralysis, but they can still transmit the disease. Since there is no visible rash to help identify and quarantine the individual case, as with smallpox, polio elimination is more dependent on universal vaccination. Polio today is endemic only in Pakistan, Afghanistan and Nigeria. The campaign for his eradication in Nigeria came to a temporary standstill in 2003, when local religious and political leaders rode fears that it was a plan by European powers to sterilize Muslim children.

Campaigns and plots
“We are convinced that modern Hitlers have deliberately adulterated oral polio vaccines with fertility drugs and that they have contaminated them with viruses known to cause HIV and AIDS,” argued the president of the Supreme Council of Sharia in Nigeria, urging parents to refuse vaccination. In a time of growing hostility towards Islamic countries by the West, as anthropologist Maryam Yahya notes, Muslims in Nigeria were establishing a link between the invasion of Iraq and Afghanistan on the one hand and the invasion of their homes by vaccinators door to door from the other. And since polio was endemic in a largely Muslim region, the polio campaign seemed to be overly targeting Muslims.

The rift within the Nigerian state was also a cause of uncertainty. When competing political groups examined the oral polio vaccine for an estrogen that could affect fertility, they produced different results: one found nothing, another found traces. Then there was the problem of the lack of basic health care in the country. Yahya writes: “The Nigerian population is stunned that the federal government, with the support of the international community, is spending enormous resources on ‘free’ polio vaccines, when essential medicines to treat minor ailments are out of reach of the people. common”.

In the effort to eradicate polio, not the same attention has been given to other preventable diseases, such as measles, even if they kill more children. “What emerges more and more clearly from the speeches that are being made”, writes Yahya in reference to his field work in Nigeria, “is a lack of trust in the government and in the West, portrayed by many as ‘accomplices of crime'” . This distrust, he warns us, should not be ignored and rumors about vaccination should be understood as “a language that crystallizes an unfounded judgment on a broader political experience in the colonial and postcolonial sphere”.

By 2004, less than a year after the boycott began, Nigeria had become the world‘s polio transmission center. The disease has spread to seventeen other countries, including Benin, Botswana, Burkina Faso, Cameroon, Central African Republic, Chad, Ivory Coast, Ethiopia, Ghana, Guinea, Mali, Sudan and Togo. The boycott ended when Nigerian officials approved the use of a polio vaccine produced by a company based in an Islamic country.

In 2012, a Taliban leader in northern Pakistan banned polio vaccination in his region until the United States stopped its drone strikes. He argued that the vaccination campaigns were a form of American espionage. While this might have sounded like rumors about secret plans in Nigeria, it was, unfortunately, much easier to experience. In the hunt for Osama bin Laden, the CIA had simulated a vaccination campaign – by administering a genuine hepatitis B vaccine, but not in the three doses necessary for immunity – in order to collect traces of DNA that could help find bin Laden’s hideout. This subterfuge, like other acts of war, cost the lives of women and children.

Pakistan’s Lady Health Workers organization, a team of over 110,000 women trained to deliver door-to-door health care, had already suffered years of brutal intimidation by the Taliban and felt no need to be associated with the CIA. Not long after the Taliban ban on vaccinations, nine polio vaccinators, five of them women, were murdered in a coordinated series of assaults. After these killings, the polio campaign was suspended in Pakistan, but as soon as it started again there were new killings, both in Pakistan and Nigeria.

Nine polio vaccinators were executed in Nigeria in 2013 and 22 health workers have been killed in Pakistan to date. During the suspension of the vaccination campaign, the polio virus from Pakistan was discovered in sewage samples in Egypt, where the disease had not been present for nearly a decade. Polio was subsequently found in Israel, Gaza and the West Bank; in Syria the disease has paralyzed thirteen children. Its ability to spread beyond national borders is one of the factors that makes vaccine refusal a usable weapon in international conflict.

In a scene from Apocalypse Now, which is much scarier than anything Francis Ford Coppola could have come up with for his adaptation of Dracula, Colonel Kurtz tells of returning to a camp where he had helped vaccinating children against polio and discovering that the arms of the little ones they had been amputated. “The little arms were there, in a heap,” he says. That bunch of little arms symbolized the Vietnam War, and in turn it called through Heart of Darkness, the piles of human hands that represented the Belgian Congo.

(Translation by Albertine Cerruti)