A post came across my feed on linkedin current chair of the CDC’s Advisory Committee on Immunization Practices (ACIP) Kirk Milhoan, MD, PhD (a pediatric cardiologist) said polio and measles vaccines should be optional. Within a few hours of reading this article I found myself barely able to talk, crying for our country.  More on this later in this post.

I thought that can’t be right so I sought out media which is know for being fact based.  I found this story widely covered.  One of the more medically oriented articles was in contagionlive.com. 

In that article is a quote by Milhoan which provides his framing of this issue:

But it’s been very important to us, members of committee, is that what we are doing is returning individual autonomy to the first order, not public health, but individual autonomy to the first order.

I thought the CDC’s first order was public health, with an understanding that individual autonomy should not be unnecessarily restricted.

Polio Eradication – Almost

Before the widespread vaccination program in the 1950s, there were tens of thousands of people (the vast majority being children) in the USA who were paralyzed by polio each year, with hundreds needing to be placed an iron lung because they were unable to breathe on their own.

Within a few years of Salk’s inactive polio vaccine being available, more than 85% of the children in the USA were vaccinated. The last case of polio which was indigenously contracted in the USA was 1979. There have been cases since then where the source of the infection came from outside the country.

In 1988, the WHO started the polio eradication program. If successful, polio would be the second disease that would be 100% eradicated, smallpox was the first.

In 2021 it seemed like this effort was close to being successful.  There had been a 99.9% reduction of cases, and there were only 6 cases world wide.  The only countries that had cases were Pakistan, Afghanistan, and Nigeria.

Since 2021, the number of infections has started to increase. We were so close to ending this terrible disease.  Why did we fail to eradicate polio?  Because vaccinations weren’t delivered because of armed conflict, but mostly because of mistrust. A common conspiracy theory was that the vaccine’s real purpose was to sterilize the population.

Guidance around the World

With polio almost eliminated, what is the guidance for polio vaccines?

The WHO still advises all children to be vaccinated against polio. I believe (after a bit of research and asking several LLMs) that every nation in the world strongly recommends polio vaccines, and many countries require a polio vaccine.

Why is this?  Because polio is highly contagious, and when it re-enters a location it spreads quickly when vaccination rates have fallen.

Between 2000-2020 there have been several polio breakouts in locations that had been declared polio free. How did this happen.? People became complacent.  The vaccination rate dropped, in some places as low as 50% and when the virus was reintroduced, likely by a traveler, it spread. In each case the governments launched initiatives to “catch up”, that is worked to get everyone vaccinated because polio was still a threat.

My Reaction

A couple hours after reading I was talking with a friend, who hadn’t see the story.  As I started to tell him about it, I found myself reduced to tears. I could barely talk.  I am writing this post partly to process my reaction, particularly to encourage others to think about balancing autonomy with public health.

This story hit me hard for several reasons:

• I know people who have been affected by polio.  Just a couple days before reading the polio story I was talking with a friend who’s survived polio, but now lives with debilitated pain from the long term effects of polio.
• I still remember feeling hopeful that polio would be eliminated, only to see the number of cases start to increase. It was frustrating to see how a major impediment was conspiracy theories (believing the vaccine was actually a plot to reduce fertility), and now, in my own country, we could see polio return because of our own conspiracy theories.
• The growth of populism and the dismissal of science. I am amazed by the growing number of people in this country who are buying into the narrative that vaccines are dangerous. Most of these concerns come from discredited studies. There is overwhelming evidence that the number of people protected is orders of magnitude more than the number of people who would have had one of the extremely rare negative outcomes.

There is an even deeper pain in my heart. I am seeing “personal autonomy” becoming a sacred cow, an ultimate criteria in the USA. We are seeing a breakdown of civil society because people increasingly only care about themselves, their rights, their freedoms, with little regard for the general good because that could be restrictive. I will have more to say about this later.

It’s ironic that I broke down in tears with a group of men just before we continued a studying the book of Judges. It seems that we don’t learn from history. Israel was a “hot mess” during the period of the Judges. It seems like we are going in that direction again, where people (at least those with power) do whatever they want, and to hell with everyone else.

Everyone did what was right in his own eyes.  – Judges 21:25 (ESV)