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What happens when diseases do not have a cure?

Whether it is the United States of yesteryears or the India of 2019-20, when the fear of death grips people, neither place nor time matters. Campaigns may succeed, some people may change for the better, a drug or vaccine may offer promise, but fear always gets better of us, says Pradeep Krishnatray

There had not been a polio case in the United Sates for nearly a decade. Then, in July 2022, a case suddenly and inexplicably propped up. An adult living outside New York was diagnosed with polio. Tests conducted showed that poliovirus was present in wastewater of three districts around New York. The governor of New York soon declared disaster emergency in early September 2022.

If you go by media reports, there isn’t any panic in New York or in the US. One of the important reasons why this is so is the availability of a vaccine. So, when the poliovirus case propped up in New York this year, the authorities called upon unvaccinated persons to get vaccinated.

To be sure, it wasn’t like this before the children and adults began vaccination from 1955. The early 1900s was bad for the US and particularly New York.

It was all hope and prayers, but no relief. Children, adults, particularly those suffering from ‘infantile paralysis’ (polio), and animals were subjected to weird experiments, untold agonies. Myths, misconception, misinformation reigned supreme. New York suffered the brunt, as it had in the latter half of the 19th Century. It was the hotbed of diseases. You name it, and it was there: Smallpox, cholera, typhus, yellow fever, diphtheria, tuberculosis.

A remarkable book by Oshinsky David, Polio: An American Story, tells a harrowing story of what New York was like, “Until the late nineteenth century, New York City had a higher mortality rate than London or Paris, Boston or Philadelphia, making it one of the most dangerous places in the Western world. In the 1870s, 20 per cent of the babies born there did not live to see their first birthday. And among those lucky enough to reach adulthood, one-quarter died before the age of thirty.” It is unthinkable that barely a hundred years or so ago close to 45 per cent of city’s population was extinguished midway through its life.

Into this miasma, crept in polio. No one knew what caused it, how to prevent it, who was affected and why some others were not, and what cured it. People had nowhere to run and hide. No one had answers, but all had vague ideas. Each one was tried.  Children avoided crowds, washed their hands regularly, took enough rest, and avoided swimming pools.

Patient, young and old, had their limbs packed with hot compresses, some of them were fitted with iron lungs — a ponderous iron contraption, a sort of cage that patients wore that enabled them to breathe. Others floated in hydrotherapy tanks hoping the use of water would treat their disability and disease. Others sought electrical stimulation and ensconced in oxygen tank hoping that the increased atmospheric pressure would spur muscle growth. Just about any idea worth trying was tried. Nothing worked.

The Health Department mandated that all children leaving New York City get a travel certificate proving they were polio-free. Churches were closed, theatre doors shut, windows screened, festivals cancelled, trash picked up, and thousands of stray animals killed. The authorities sprayed DDT magnanimously. Parts of the cities were drenched with it. Cleanliness, sanitation became the mantra.

None of this really worked. With the virus continuing to baffle, those who were privileged turned against those who could not defend themselves. The newly arrived Italians were the scapegoat. That they were poor, impoverished, and helpless made them more vulnerable. A well-known sociologist Ross commented, “Such people lack the power to take rational care of themselves; hence their death rate in New York is twice the general death rate and thrice that of the Germans.”

The data did not support the claim but the sociologist had tapped into a popular, pent-up fright. This wasn’t particularly surprising. In the 1840s, the Irish were accused of bringing cholera to New York City; fifty years later, the Jews were suspected of spreading tuberculosis. Now it was the Italians blamed for carrying the ‘deadly germs’.

No amount of finger-pointing and blaming the other helped. The virus spread to newer areas. In New York City, clean and sanitized areas, areas sparsely population and inhabited by rich had more patients than those areas where the poor inhabited. The confusion mounted further when an official (wrongly) claimed, “Negro children are more or less immune and the virus attaches itself more often to blondes than brunettes.”

The doubters were never too far behind. Their rank boasted of some remarkable and erudite people. In 1903, Bernard Shaw called vaccination “a peculiarly filthy piece of witchcraft”. Luckily, the scientists disregarded his opinion. Earlier, a pamphlet circulated in Montreal by Dr Alexander Ross pronounced, “Smallpox can no more be stamped out by vaccination than sin can be by priesthood. Vaccination is poisonous.”

Still others made hay by exploiting a gullible population. Oshinsky reports, “The Hi-Tone Cleaners vowed to disinfect its equipment before each pressing and wash. Local Sani-Flush ads urged a closer scrubbing of the family toilet “when polio’s on the rampage”. Clorox warned, “It’s the dirt you don’t see that does the damage.” Companies hawked ‘polio insurance’, while chiropractors promised immunity from the disease. “Keep your child’s body correctly adjusted,” said a Dr Roy Crowder, “and there is no likelihood of polio.”

All this while, through much of the 20th Century, in the rough and tumble of claims and counter-claims, furious debates and bitter rivalries, the scientists struggled to keep ahead of the virus. They finally succeeded but during those turbulent 50-odd years, several lives were lost and many more were maimed and disabled. Amidst all the well-deserved chest thumping, the one whose contribution was hardly ever recognized were the animals: Monkeys, to be precise.

It is one of the ironies that a wrong monkey was used to test the efficacy of vaccines. This was on an India-based rhesus monkey. The animal had to be exported from India, properly fed in the US and then transported to labs. All this cost a lot of money. A rhesus monkey, in those days, cost seven dollars, more than what a research associate was paid. The cost climbed to 26 dollars per monkey if all costs were added.

The cost of purchasing, feeding and transporting monkeys ate up a sizable part of the grant some agencies received. During the long 50-year quest, American scientists killed more than a lakh of them. It is said that had the scientists then used the Philippine-based cynomolgus monkey or the chimpanzee, a vaccine to treat polio would have come much before 1955.

What does all this tell us? Whether the United States of yester years or India of 2019-20, when fear of death grips people, neither place nor time matters. Campaigns may succeed, some people may change for the better, a drug or vaccine may offer promise, but fear always gets better of us.

October – December 2022