Polio Coming Back On Politics, Mistrust, and War

Kiyotaka ISHIKAWA

It is very rare that people appreciate being kept from contracting polio for life until they find the disease is still scourge in a few developing countries like Pakistan. Polio is one of the pathological history for rich countries in which humans ended up with a victory in fighting for the eradication and the virus locked down into medical laboratories, but some local health workers, international funds, and Bill Gates are still in battles against polio in the least developing countries; nevertheless far from the eradication. What makes polio’s endless nightmare in those specific regions. 

Polio’s natures that make it difficult to exterminate

First of all, contracting polio does not necessarily result in paralysis, but only one per 200 polio infections does, which means the rest look like having a cold or a passing fever while spreading the virus all the time. Second, the virus moves fast. it took only two years for Nigeria’s infections almost eliminated in 2003 to spread over all the country’s regions and then throughout Asia and down to Oceania. These natures are why the virus must be prevented from the epidemic by patient and exhaustive immunizations. 

Socioeconomic reasons that allow polio alive 

Pakistan, one of last three countries with Afghanistan and Nigeria still fighting against polio, is suffering from slow progress over the public immunization program provided by the government with financial and material supports from WHO and some international development banks. The project has been sabotaged by Pakistani Taliban; directly, they attacked and killed some of polio-vaccine deliverers and medical aid workers who consist of local women and teenage girls; indirectly, they rumored that the polio vaccine contains HIV or sterilize children, most of which are groundless and unscientific but powerful in combination with people’s fear of outsiders and general suspicion of anything touched by the West. What’s more, local religious leaders tend to refuse the vaccination offer for children in their village because of religious dogma or belief in the rumors. 

Intensive funding plus something for immediate eradication

Fighting these periodic outbreaks might be more expensive than finishing up polio immediately with intensive funding on effective programs. Rotary International and other groups calculated spending $1 billion annually over the next few years to extinguish polio would save $50 billion over the next 2 decades both in treatments for infected children and in the perpetual hold-the-line vaccination programs (TIME issued Jan 14, 2013). However, this fund is to effectively distribute only through local efforts, such as appealing to rural religious leaders to encourage the care of children as well as individuals to give a reason why the vaccination is worth trusting and why those rumors of vaccine-related side effects are worthless. Not only these human resources but also technical innovations like GPS trackers on vaccine shipment are necessary to prevent them from missing out due to Taliban attacks. Most of these costs arise from information asymmetries between those who try to help, for example, Bill Gates, and those who want help but hardly appreciate it, for example, extremists, religious leaders, and poorly-educated folks. And this is the very target we have to deal with in order to release people from ever lasting fight against polio. 

Should We Know It Or Should Not?

-Individual genome testing reveals every disease risk, even if no treatment available-

Kiyotaka ISHIKAWA

What would you do if your baby was revealed the risk of mental disabilities in the distant future; for example, a high probability of Alzheimer’s at his 50s? Parents tends to answer that they want to know every disease risk with their children even if no treatment available while a majority of doctors, researchers, and bioethicists who engage in genetic testing say they should be informed only results which could be immediately treatable. 

Genetic test available for everyone

The mapping of the human genome completed a decade ago costs $2.7 billion, but now an individual’s whole-genome sequencing (WGS) is available from $7,500 and will be provided at a much less cost in the future. A teaspoon of blood is all you need for the test that read every bit of information in your genome and find any mistakes in the basic arrangement of genes that might cause diseases. Moreover, some researchers reported that the pre-born DNA test was successfully operated by analyzing a fetus’ DNA from cells gathered from the mother’s blood.  

The DNA dilemma

Most parents who experienced Parkinson’s disease, a progressive neurologic disease caused by genetical defects, amongst their relatives by blood tend to want the WGS for their children even if no effective treatment has developed (TIME, issued December 24 2012). In addition, the genetic testing might bring about incidental findings which the clients were not looking for. There is a serious argument for doctors to decide how much to tell patients or their parents especially in the case of an incurable adult-onset disease such as Alzheimer’s, concerning about a lifelong burden on the clients and their family; if a mother learnt her girl carries a mutation that increase ovarian cancer, she would feel much responsibility of her own blood. 

Getting along with the results

A common response from doctors is that one possible solution to the problem is to do no harm, which means patients would be better to have only a part of results that could be acted on immediately. A new Web-based venture called My46 offers a online service that store genome sequencing results and chose what people want to know and when. For example, parents can learn any risks of childhood diseases with their baby distinguished from unclear results and increased risks of adult-onset diseases amongst a whole data on his genome. If any adult diseases are expected at a specific stage of his life, he and his family will be warned about them in advance so that they can reduce the risk and prepare for presenting symptoms.