Monthly Archives: March 2013

ABC of Polio Vaccination in Nigeria – Part 2

Rules of Engagement

In the first part of this post, we saw that peer review is the mechanism that generally safeguards the integrity of scientific findings. To understand how the importance of peer reviewed papers are underplayed, it becomes important to separate two oft confused concepts: Justification and Persuasion. The role of report which claims certain findings is primarily to justify the conclusions reached. So Scientific papers deal with justification. Persuasion on the other hand is in the realm of politics. Ideally before any persuasion, there should be justification, especially in shaping public opinion on scientific findings. But often, persuasion leverages on the emotions of people, and that explains why public opinion is shaped more by sentiments than by what is justified.

The Part 1 of this post also touched on Certainty, and how we ought to distinguish between what is quite certain and what is not. But it did not expand on how an accepted scientific finding could be changed/challenged. Change is an important aspect of science/knowledge which allows scientific knowledge to improve. The rule of thumb is that all [scientifically] accepted knowledge is “true” knowledge until it becomes successfully challenged and proven to inferior to another. The burden of proving, that an accepted knowledge is faulty, rests entirely on the challenger, and it is not a simple task. It means the quality of study that is challenging should leave little doubt for the study’s integrity. This is the challenge all oppositions to Polio vaccination have to contend with, but as we shall see, they often fall short.

Polio Victim

“Leave that which makes you doubt for that which does not make you doubt” – The Prophet Muhammad, An Nawawi Forty Ahadith

It is interesting how sentiments provide abundance of alternative interpretations. The above saying has been used to justify decision of some opposition to Polio vaccination not to vaccinate their children. But actually, the saying offers more support for supporters of vaccination. What is certain is that Polio vaccine immunizes children from Polio virus, it is certain that Polio vaccination improves potential of a child in their life achievements, it is certain that Polio is an infectious disease that spreads fast, it is certain that… On the other hand, it is not certain that Polio vaccination contains AIDS virus, it is not certain that the west plans to reduce Muslim population in order to dominate the Muslims, it is not certain that… Therefore based on the quoted saying above, Muslims have a good reason to do Polio vaccination.

Unfortunately the alternative interpretation is that the overall benefit of Polio vaccine is not certain, so better stay away from it. It takes an appreciation of scientific methods in order to change this view, and perhaps less decisions based on sentiments.

Below are responses to some of the issues raised in the previous post. When using other people’s responses, names have been omitted to avoid bias, just as was done in the previous post when listing the issues. The aim is to explore arguments (ideas) and assess their strength/weakness.

Responses to Issues Raised in Part 1

Issue: The vaccine is contaminated with Estrogen; Estrogen (generally) is known to inhibit fertility.

Estrogen is a hormone found in the human body, both male and female produce Estrogen. However Estrogen is known as the “female hormone” because it is more abundant in females and serves several several functions in the female body. Estrogen can also be found in many everyday things, from tap water, to surface water, to processed foods, to drugs, to fruits and vegetables.

There are three known naturally occurring types of Estrogen, one is associated with reducing fertility. Excesses of it in adults is not uncommon.

It might be argued that babies do not consume all the mentioned food items above, so perhaps they will react differently to Estrogen when ingested through a Polio Vaccine. But breast milk contains about 10 times the amount of Estrogen than may be found in Polio Vaccine, and breast milk is consumed everyday for months whereas Polio Vaccine is about 6 times in three years. Moreover the Estrogen contained in the body of the mother may find its way to the baby while in the womb; research has shown that toxic synthetic chemicals do.

Given this information, the issue then becomes not of the presence of Estrogen, but of concentration of Estrogen in Polio Vaccines. After all, the researchers that raised this issue also mentioned that they used the most sensitive equipment to detect Estrogen. To propose that Polio Vaccine should be stopped because it contains Estrogen may be saying the truth, but a Half-Truth. Here is the same logic with different constituents: The chemical Ethanol is alcohol; Ethanol is found in most plants and also used in production of medical drugs; Drugs can be made from plant extracts; But neither pharmaceutical drugs nor herbal medicines are considered alcoholic; Testing drugs (or herbs) for alcohol with a sensitive-enough process, will reveal presence of alcohol. Now the person who says that there is alcohol in drugs and herbs is telling the truth, but a Half-Truth, because it does not mention the relative quantity of alcohol.

Issue: Polio Vaccine is a fake drug; Polio Vaccination should not only be opposed, it should be prosecuted;

According to the interview which raised the above issues in 2004, those present at the presentation of the paper (WHO, UNICEF, NAFDAC, USAID) agreed that there may have been “contaminants” in the Polio Vaccines that were tested, but not in others. The researchers that did the test appear to have taken a small sample of vaccines from the a singlr batch of vaccines. A proper study should take several samples from different batches and record findings of each sample with details such as batch number, date of manufacturing and expiry dates among other details.  Any scientific study resulting from such a basic fault such as sample size and documentation cannot be used to make generalizations. However, it could be used to make inference on that particular batch, only if adequate samples were taken

Given this, one cannot conclude that Polio Vaccine is a fake drug based on presence of “contaminants”. However, on the issue of prosecution, the contamination of that particular batch could be investigated, and if found to be deliberate action or negligence, then perhaps prosecution/disciplinary actions should be pursued.

Issue: There is a secret (evil) agenda by the US on third world countries, which is yet unproven; Powerful countries disdain the intellectual capacity of third world countries; Why put pressure on solving the polio problem instead of more pressing local problems.

Some in public health see campaigns on AIDS and Polio as futile exercises because those are not the most pressing health problems suffered in many third world countries. Diseases and deaths associated with sanitation (Cholera, Diahorea etc.) and maternal mortality do much more damage in these localities, yet there’s this fuss about the insignificant diseases like AIDS and Polio. Well these are usually campaigns sponsored by International Players (usually NGOs). The Players are more concerned about diseases they see as global, perhaps the diseases that could affect them in their distant countries, and then spread rapidly i.e. endemic diseases. Whereas cholera and maternal mortality can be tackled at local level, on the other hand, AIDS, Polio, Small Pox, Influenza and SARS must be tackled along all routes of travel where people move. NGOs may not be selfless angels, but they can certainly be good guys.

The US and other “Powerful” countries are known for their double standards and hypocrisy in designing policies and in implementation. It is well accepted that any Player (Nation States and NGO) in the international scene have their agendas which may be self interest. But to sell an idea it also has to be beneficial to the recipients, hence a mutually beneficial relationship. Many international players have their “agendas” publicly available. These “agendas” are to serve as points of accountability, which could be referred to when assessing if the international players are playing according to their claimed agendas or not.

When they are found wanting, it is to call them to order in reference to the agenda they “sold”. To make accusations of a Secret Agenda is firstly, unfounded unless supported by evidence, and secondly, reducible to many other conspiracy theories that do not deserve attention. Generally speaking, anyone can be accused of harbouring a Secret Agenda, after all it is secret, and so the slightest information to support that claim is elevated to status of “evidence” because it is assumed that it is the best available given the conspirators’ secrecy. Serious arguments should stay clear of such unsupported assertions.

That the perception of the West as disdainful to the Third World, is an issue may seem irrelevant to the discussion, but it may reveal a hidden force. It could be seen as this: the US thinks it can come and pass diseases to ignorant third-worlders, and get away with it. This poses a challenge to be solved, and at the same time to prove the intellectual capacity of the third world. So the refutation (that Vaccines are contaminated) exercise could be seen as a perceived challenge, then accepted challenge, then victory in the discovery of Estrogen. This perspective on the refutation is but one aspect of it because resentment of western disdain was registered in the interview, but the aim is not to reduce it simply to a perceived challenge.

Issue: Since the the introduction of Polio Vaccine a decade ago, paralysis that are not caused by polio have increased by 1200% in India; The more doses administered, the more cases of paralysis that are not caused by Polio virus;

The article that made these claims was not clear on how the figures came about, but this surge in figures is not uncommon. Here is a possible, and common, explanation to the increase or recorded paralysis.

First it is important to note that polio is not the only virus that causes paralysis. So how does one differentiate from Polio and non-polio? Cases of paralysis are identified, then taken to the lab to determine if it is polio or not. At the lab, all Polio cases are recorded, and all non polio cases are also recorded; these latter group form the issue of discussion.

Among the virus that cause paralysis, Polio Virus is the only one that is being pursued globally for eradication. This means surveillance is high, and as many corners of the villages and cities are being visited to vaccinate for Polio, while taking record of as many cases of paralysis in order to isolate those caused by Polio. This intensive exercise can explain the rise in figures.

It means these cases of paralysis exist already, but they are just being documented now, in addition to those that visit hospitals. It won’t be surprising that hospital records are not kept well in rural areas.

Issue: The Polio Vaccine contains actual living Polio Virus, which has been shown to cause paralysis rather than vaccinating;

In disease vaccination, there are two popular categories of vaccines: Live (attenuated) Vaccines and Inactivated Vaccines. The Live Vaccines contain a weakened form of the virus, which when in contact with the harmful virus, weakens the harmful virus. On rare cases, the reverse happens; the weakened virus becomes harmful. Inactivated Virus contains virus that cannot revert to being harmful. However the two are not equally effective and their efficacy varies depending on the the part of the body the harmful virus replicates and infects.

Small Pox, which is the first disease that was eradicate with planned effort, used Live Vaccines. Other viral diseases with Live Vaccines are Measles, Polio, Smallpox, Chickenpox, Influenza. Polio has both Live Vaccines and Inactivated Vaccines. The Live Vaccine is the one given through the mouth (OPV, Oral Polio Vaccine), and the Inactive Vaccine is injected.

Harmful Polio Virus is most dangerous in the gut (stomach) which is the virus’ primary site of infection and replication. Fortunately the Live Polio Vaccine, which is administered through the mouth, replicates very efficiently in the gut. Therefore, the Live Polio Virus is not only good for protecting a person from the harmful virus, it is also good at arresting spread of the disease between people because of its effectiveness in the gut.

Because of it’s effectiveness in arresting spread/infection, and because it is cheap and easy to administer, Live (attenuated) Polio Virus is the vaccine of choice during an eradication campaign. It is more popularly known as OPV (Oral Polio Vaccine).

Live Polio Vaccine has a side effect. On rare occasions, the Live (attenuated) Virus reverts into a harmful virus,  in about 1 person out of every 750,000 people (1 out of 3 million according to another study). If the goal is to make people immune to the virus while arresting the spread, then 1 out of 750,000 (which is 4 people in every 3 Million people) is a good risk figure for the worst case. The challenge has been then, how does one communicate this risk to the lay man without making it sound worse than it is, and without making it a logistics nightmare.

Issue: In twenty years, about 150 people were paralysed due use of live Polio virus in vaccines, in the US, which led the US to stop using it.

This means about 8 people in the US were becoming infected with the virus every year through Live Polio Vaccine. The average number of doses administered every year in the US around the same twenty year period is over 15 million; which averages to 5 million people. This does not differ too much from the expected risk mentioned earlier (4 infections out of 3 million vaccinations). However the fault in this argument is to assume that this is solely the reason why the US changed from the Oral Polio Vaccine to the Injected Polio Vaccine.

It has been seen earlier that OPV is especially effective for arresting spread of the virus, in addition to providing immunity. However the Injected Polio Vaccine is better in replicating in the nervous system. Standard practice in the science of epidemiology is that when percentage of immune people in a population reaches about 80%, arresting spread becomes less important and thorough immunity in individual patient becomes more important. This is a reason for the US to switch from OPV (which contains Live Virus) to Injection Polio Virus (which contains Inactivated Virus)

Therefore, the US’s change from Live Vaccine is the expected practice according to the science of epidemiology. So it will be standard practice to expect that after the percentage of community immunity rises to above 80%, Nigeria should switch to the Injected Polio Virus. Of course at that juncture, one must factor in the ineffective Nigerian Public Health.

Issue: Eradication of Polio is a Myth

The propounder of this argument cites a scientific paper where Polio virus was examined in a laboratory and it showed evidence of its (a synthesised “chemical called poliovirus”) determination for Survival in nature that it would be unthinkable to think Polio could ever be eradicated from the surface of the earth. Assuming this finding is understood well and true, first, we must start from the accepted knowledge that peer reviewed papers exist which showed that Polio has been eradicated in some areas. So if a person does not want to investigate in more details the meanings of these, just accept that Polio can in fact be eradicated.

For the non lazy minds, the point of contention is to ask what does Survival mean and what does Eradication mean in the above sentences? Survival may mean existence, but not necessarily harmful; as we have seen Live (attenuated) Polio virus are used in the vaccine to make the virus harmless. Eradication may mean not harmful to humans. Now it seems the two propositions are consistent with each other after all.

Another way to look at it is that Eradication is a technical term indicating a certain threshold, say less than 0.0001%, of a population having Polio virus. No scientist in their right minds should claim that they can absolutely eradicate something from the face of the earth. However, scientist can make statements like: Of all the humans [records] we have had access to, our tests show that none has a harmful Polio virus in their bodies. For many, this is eradication.

Nonetheless, whether Polio Virus can be eradicated or not, it is hardly relevant to an argument on whether vaccination should be allowed or not; even if it seems so at first. What is relevant is the more conclusive finding that Polio vaccine, immunizes humans from Polio infection and stops children from becoming cripple if they are lucky or death where they are unlucky- it stops unnecessary hardships. Vaccination then becomes a moral responsibility.

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