Franklin Delano Roosevelt began his presidency during the Great Depression in 1933 and remained president throughout World War II until his death in 1945, serving over three terms. He is known for many things, including his “fireside chats,” establishment of Social Security, and vast expansion of the federal government. He is also known as the president who suffered from polio, much like JFK is known for Addison’s disease. FDR was first diagnosed with poliomyelitis in the 1920s, and was given limited treatments, but he never completely recovered and dealt with paralysis and health issues for the rest of his life.
Poliomyelitis is a life-threatening disease caused by the poliovirus. Poliovirus is transmitted person to person, and enters the body through the mouth. It then lives in the throat and intestines, and can be transmitted through feces. About three quarters of people who are infected do not show any symptoms, and those that do, have very flu-like symptoms such as fever, sore throat, nausea, and headaches. In most people with symptoms, the symptoms go away on their own without any additional side effects. In some people, the disease goes on to affect the nervous system, causing paralysis, meningitis (inflammation of the coverings of the spinal cord and brain), and paresthesia (“pins and needles”). If the paralysis is extensive enough, it could lead to death because it affects the muscles required for vital functions (read: breathing). As a side note, poliomyelitis, or “polio” for short, only refers to the paralytic disease, so not everyone infected with the poliovirus has “polio.”
There are two available vaccines effective against the poliovirus. One is the inactivated polio vaccine (IPV), developed in 1955. The IPV contains inactivated strains of poliovirus and is administered via an injection. Because it doesn’t contain any “live” virus, there is no risk for vaccine-associated paralytic polio (VAPP). It also contains strains from all three types of poliovirus, so it protects against all three. The disadvantage of the IPV is that it is more expensive than the other vaccine option, and requires health professionals to give the shots. The IPV also requires a series of vaccinations to be most effective, with shots given at 2 months, 4 months, 6-18 months, and 4-6 years old. This requires a somewhat stable health care system to ensure proper timing of vaccinations. The U.S. has only used the IPV since 2000.
Another polio vaccine was developed in 1961, called the oral polio vaccine (OPV). The OPV is given orally as drops, and was recommended in the U.S. from inception until 2000. The vaccine contains an attenuated virus, which means that it contains weakened, but “live,” viruses that have lowered virulence. These attenuated polioviruses are able to replicate in the digestive system but are much less likely to spread to the nervous system. It is significantly cheaper than the IPV, and can be administered by non-health care professionals because it doesn’t require shots. This is helpful for widespread vaccination campaigns in developing areas. The OPV induces antibodies in the gut, so it can also interrupt the transmission of the virus through the fecal-oral route. The IPV induces antibodies in the blood stream, and not the intestines, so it does not have that same ability. One significant downside to the OPV is that because it is a live virus, in very rare cases (about 1 in every 2.4 million recipients) it causes paralysis (VAPP).
Essentially, OPV is much more common in developing areas because it is (1) cheaper, (2) easier to administer, and (3) reduces person-to-person transmission in areas where the disease is not eliminated. It is no longer used in places like the U.S. because (1) polio has been eradicated in the country and person-to-person transmission is less of a concern, and (2) it removes the risk of VAPP to use only the IPV.
Due to the vaccine campaign against polio, it has been eradicated from over 120 countries, including the U.S, and remains endemic to only three (Afghanistan, Pakistan, and Nigeria). In 2018, there were only 33 cases of wild poliovirus (WPV), and 104 cases of circulating vaccine-derived poliovirus (cVDPV). This is considerably better than 30 years ago, when there were over 350,000 cases of polio worldwide in 1988, the year that the Global Polio Eradication Initiative was founded. However, there was an increase in WPV cases in 2019 to about 113 cases, and there were more outbreaks of cVDPV from the OPV. There is not necessarily enough data to call this a trend, but it is concerning. It is difficult to eliminate the disease from these last few areas, which may be politically unstable, isolated, nomadic, or resistant to vaccination. Anti-vaxxers in Western countries don’t help matters because the unvaccinated can still contract polio from tourists and immigrants who travel from countries where the disease has not been eliminated.
There are three types of WPV, cleverly named WPV 1, WPV 2, and WPV 3. WPV 2 and WPV 3 were eradicated in 2015 and 2019, respectively, so the only one left to eradicate is WPV 1. The current goal is to completely eradicate polio by 2023 (although this is one of many deadlines to eradicate polio). If and when polio is eliminated, it will likely be the second human disease to be removed from the global population, the first being smallpox.
Poliovirus is a fantastic example of the far-reaching benefits of a solid vaccination campaign. Millions of lives have been saved by the development and implementation of poliovirus vaccines. Again, poliovirus has a human-only reservoir, so vaccination of all people would eradicate the disease from the face of the earth. There would be no more polio-related paralysis or death. I’m sure that all who have fallen victim to poliovirus before the possibility of vaccination would appreciate that, FDR included. It would be amazing to be able to completely eliminate a harmful pathogen from the world, like we did with smallpox (although many governments still hold on to samples of the virus). It’s amazing in the same way that the human life expectancy has doubled in the past 200 years due to huge strides in medicine and public health. Through a deeper understanding of human immunity and viral processes, we have allowed people to “cheat death” in a way.
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