ASP Source — Jon Gonzoph

The source I found on Academic Search Premier was “SOME ETHICAL ISSUES ARISING FROM POLIO ERADICATION PROGRAMMES IN INDIA,” written by Yash Paul and Angus Dawson and published in the August 2005 issue of Bioethics.

The claim behind my original white paper polio article was that while the risk of paralysis from the OPV (oral polio vaccine) exists, and the alternative vaccine IPV (innactivated polio vaccine)  that does not carry this risk exists, the WHO and similar organization should switch to using that to vaccinate the countries where polio is still a threat. Paul and Dawson’s paper both supports and refutes this claim.

The paper clarifies that the does of polio contained in the oral polio vaccine (OPV) can mutate and cause polio in recipients. It is also possible to spread this mutated polio to others through the same process that creates herd immunization (fecal-oral transmission transmits the same benefits as taking the OPV directly), which has the risk of causing paralysis in both those with and without prior polio vaccinations. It also gives evidence that implies that the OPV is not effective, noting thatfrom 1998 to 2003, at least  33% of those who developed polio had recieved 4 or more doese of OPV, although they also note there is a variety of reasons why this could occur. The report also provides detail on how this information regarding the risks of OPV is given out — it is not, with WHO specifically requesting that it only be discussed in academic circles. This results in a lack of informed consent from the parents, which Paul and Dawson theorize could backfire and cause people to actively campaign against vaccinating their children, should this withholding of information become known. Despite this, Paul and Dawson also stress that the herd immunity effect passed through from those vaccinated to those who have not been is an important part of eradicating polio, and also that the costs of using the less risky inactivated polio vaccine (IPV) may not be reasonable.They also tentatively conclude that, if it is indeed possible to eradicate polio through OPV vaccination and appropriate compensation is provided to those paralyzed as a result of OPV, then the benefits necessarily outweigh the costs.

This new information poses a number of difficult questions. Is it better to sacrifice some people to eradicate polio than to allow the virus to continue infecting people? Is the herd immunity benefit of OPV worth the increased risk of paralysis? Is it even possible for the virus to be eradicated at all? Information in the paper notes that it is entirely possible that the current OPV dosing scheme has done little to actually decrease polio cases, noting that the change in defining a polio case and not counting polio paralysis from VAPP (vaccine associated paralytic poliomyelitis) arising from a result of the vaccine may skew the numbers.

This new information makes my original claim look stronger. With the doubt cast on the effectiveness of OPV and the lack of informed consent about the risks, my belief that OPV should stop being used is reinforced. However, at the same time, their conclusion that OPV and its herd immunity effect might be necessary to eliminate polio entirely goes contrary to my claims. More research will be needed to fully justify my position.


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1 Response to ASP Source — Jon Gonzoph

  1. davidbdale says:

    Overall, you’ve done a very fine job of summarizing a variety of topics and claims here, Jon.

    Let me caution you against over-concluding, as you do in this case:

    It also gives evidence that implies that the OPV is not effective, noting that from 1998 to 2003, at least 33% of those who developed polio had received 4 or more doses of OPV, although they also note there is a variety of reasons why this could occur.

    Regardless what that “variety of reasons” may be, you cannot conclude from the fact that some dosed children develop polio that “OPV is not effective.” You may certainly complain that it’s not 100% effective, nor as effective as we might wish, but a success rate very close to perfect, and certainly effective, is still consistent the finding you quote about the unlucky dosed children who do develop the disease.

    When you say the cost of IPV is “not reasonable,” do you mean “not affordable”?

    I think I understand your summary (which may include analysis) of the “redefining” issue, Jon, but such an important claim as “little to actually decrease cases” will have to be very carefully supported. Eradication efforts may be victims of their own success. Millions become thousands become hundreds, and eventually, nothing more than zero sounds like a decrease.

    At the end, you may both be arguing “practical matters” rather than scientific matters, don’t you think? I could say “we must use OPV” to describe what I can accomplish given my budget; someone hearing that claim might think I mean “polio cannot be eliminated without OPV.” In one case biology might compel its use, in the other, economics.

    Just one grammar caution here, Jon. Passive voice is the wrong choice in this construction: “my belief that OPV should stop being used.” You can insist that someone stop using OPV, but it’s pointless to tell OPV to stop being used.

    Excellent work. Grade recorded.

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