Why diversity matters

Polio and the Need for Global Infectious Disease Research

Standing on the stage of the University of Michigan's Rackham Auditorium on April 12, 1955, Dr. Thomas Francis, Jr. announced: “The vaccine works. It is safe, effective, and potent.” The vaccine of which he spoke, Salk’s revolutionary polio vaccine, was immediately put into widespread use. Within a few decades, the vaccine had completely eliminated the once common disease in the United States and many other countries.

Yet although polio cases have now been reduced by 99% worldwide and in many countries the disease has been eradicated for decades, in others it is still endemic. Between January and August 2008, more than 550 cases of polio were reported in Nigeria and more than 350 in India. Fortunately, in several subsequent years, rates have been lower in these two countries. Why is it that in spite of the existence of a safe and effective vaccine, polio persists in these and other countries? Why are children still being paralyzed and killed by a disease that has been preventable for more than 50 years?

There are of course many reasons that disease eradication is difficult, ranging from lack of funding to difficulty distributing vaccines and medication in areas with minimal infrastructure and in times of war. But one often overlooked problem has been key to the continued survival of the poliovirus: distrust.

In Nigeria in 2002-3, many parents refused to have their children immunized because they feared the vaccine contained HIV and sterilization factors. Worse yet, they didn’t believe that these supposed contaminants were accidental: they believed they were part of a systematic effort on the part of the industrialized world to sterilize or kill Muslim children. In India, the number of polio cases skyrocketed from 66 in 2005 to more than 300 in 2006 due to the refusal of many Muslim parents to participate in what they believed was a western conspiracy to sterilize their children.

While scientists, politicians, and public health workers alike have made every effort to dispel these and similar rumors, we suggest that there is another way to reduce fears of western medical conspiracies. Perhaps Muslim parents in India and Nigeria would be less worried about the polio vaccine if an Indian or Nigerian Muslim had helped develop it. Perhaps they would be more willing to have their children vaccinated if vaccination efforts were spearheaded by members of their local communities.

The Michigan Infectious Disease International Scholars Program strives to increase global participation in infectious disease research in order to reduce the distrust that many people have for western medicine. By training scholars from around the world to study infectious diseases and develop vaccines and cures, we can create a global health initiative that truly is global. Fortunately, polio eradication efforts are now showing great progress and there is no need for a Nigerian or an Indian to develop a vaccine for polio. But for many other pressing global health problems, international participation in the development of a cure may circumvent the distrust that plagued polio vaccination efforts, unnecessarily prolonging human suffering when an effective vaccine existed, and leading to expenses that might otherwise have gone to attacking other global health problems. If an African cures AIDS, perhaps Africans with HIV will be more willing to accept that cure.