The return of polio
by Jon Joaquin
In high school I had a good friend who had been stricken by polio when he was a small child. The disease left his legs atrophied and he walked with the characteristic gait of a polio victim. He was very intelligent and had good grades, but he was also a little withdrawn and kept only a small circle of friends. And while we were buddies, he wasn’t beyond accusing me – falsely, of course – of mocking the way he walked behind his back. We remained good friends, but we lost touch after high school graduation since he went to a different school.
Last year I saw him again at a mall near our house in Malabon. He looked well and we had a great chat. In a way I was happy to see that he still walked the same, but this is because I know that many polio victims become less and less mobile as they age. In fact he and I had a classmate who was similarly stricken and, based on his Facebook account, he is now already wheelchair-bound much of the time. One reason, I think, is that this second classmate was a big man and exercised his upper body so that he was muscled in that area. This may have been his way of compensating for his lower body problem, but the inadvertent result was that he grew too heavy for his legs. Don’t get me wrong: he may be in a wheelchair now, but he still looks buff.
Polio has always been a reality for me and my generation. I had two classmates who had had it, and it seemed that each grade and year level had at least one. I don’t know how it happened for them because I still remember being given the oral polio vaccine on a sugar cube when we were in kindergarten – perhaps they contracted it when they were much younger. Whatever it was, polio was still a threat and remained so until 2000 when the Philippines was declared polio-free (the last case was reported in 1993).
For the past two decades the country has been safe from polio, until a few weeks ago when the Department of Health (DOH) suddenly announced an outbreak. To be clear, it takes only one case for a country to declare an outbreak, and initially there was just the case of a child in Lanao del Sur. A few days later, however, the DOH confirmed that another child had contracted it in Laguna.
How did we get to this situation? Some blame it on the Dengvaxia mess that had supposedly scared parents away from all forms of vaccines. I’m sure there is some truth to that, but it doesn’t really tell the whole story. According to health authorities, the polio virus that has surfaced is not from the wild but actually came from vaccines that have mutated. Davao City-based pediatrician Dr. Richard Mata, who is the Philippines’ consultant on dengue to the World Health Organization (WHO), wrote an explanation in Filipino, which I am translating in part here:
Before 2016, there were three kinds of polio, which were labeled Polio 1, Polio 2, and Polio 3. Polio 2 is able to mutate, so aside from being used as a vaccine, it can also become a live polio virus and infect a child without polio vaccine. A child who has taken the oral polio vaccine is safe, but he defecates in an open canal or river, the virus can be transferred there.
Another child who swims in that canal or river and swallows water can ingest the vaccine form of the virus. It’s OK at the start because that child would actually be getting vaccinated from polio. If that child also defecates in the canal or river, the virus again gets transferred there.
This can happen several times, but eventually the type 2 polio vaccine mutates and becomes a live virus. Another child who ingests it from the canal or river can contract polio, especially if he hasn’t been vaccinated yet. This is called Vaccine Associated Paralytic Polio or VAPP. It’s very rare but it can happen.
In other words, the current outbreak is a combination of a number of factors, including the lower number of children being vaccinated and the lack of proper sanitary facilities. The virus has been detected in Manila and Davao, and now the DOH is setting a weeklong Nationwide Outbreak Response Immunization starting on October 14. It’s banking on creating herd immunity in which 80 to 85 percent immunization of the population is needed for everyone to be protected – although health officials in Davao Region are actually targeting 100 percent immunization.
Now Dr. Mata notes that the oral vaccine that will be given in October contains the type 2 polio, which raises the question: won’t it mutate again? He says it can happen, which is why it is important for everyone to practice good sanitation (especially not defecating in canals or rivers). Ultimately, polio is everyone’s concern, and it takes all Filipinos doing their part to stop it from spreading.
The views and opinions expressed in this column are those of the original author, and do not necessarily represent those of the Pilipino Express publishers.
Jon Joaquin is the Editor-In- Chief of the Davao City-based Mindanao Daily Mirror. E-mail Jon at firstname.lastname@example.org.