World Health Day: Past Pandemics & Modern Inequality

Yesterday, people across the planet celebrated the 72nd World Health Day. First recognized in 1950, World Health Day is sponsored by the World Health Organization (WHO) to celebrate international efforts to improve people’s health and to raise awareness of a particular health-related issue. In response to the extreme social and economic inequities exposed by the covid-19 pandemic, the theme for World Health Day 2021 is “Building a fairer, healthier world.” Many are already aware of the risks and sacrifices essential workers have been forced to make in most of the United States, but less have considered the global inequity that this pandemic has exposed, or what that inequity will mean in the long term. But this is far from the first time the WHO and the global community have worked together to address a deadly common threat. Now, as the vaccines are rolling out and the end of the pandemic may be in sight for some, let us examine a few of those past instances in order to duplicate our greatest successes -- and avoid our worst failures.

By 1950, due to widespread systemic changes to modern life in many parts of the world, an invisible menace would descend upon communities in the summer months, maiming and even killing 20,000 to 60,000 people, especially children, each year. The mysterious threat was the poliovirus, and in the first half of the 20th century, the disease was mutating to become even deadlier. Incurable, highly contagious, and easily spread by asymptomatic carriers (up to 70% of those infected), polio first attacks the intestinal tract, but then moves to attack the central nervous system in about 1% of victims. Once in the central nervous system, polio can cause muscle weakness, partial paralysis, and sometimes death. Around the middle of the 20th century, three brilliant U.S. scientists led teams to track, study, and eliminate this devastating illness. The vaccines that they developed saved countless lives around the world, and one is still used today in the WHO’s ongoing international quest to eliminate polio forever. 

The three men most responsible for the development of these vaccines were Hilary Koprowski, Jonas Salk, and Albert Sabin. Many are familiar with the heroic story of Jonas Salk, who famously devoted two and a half years to the effort, tested the injected “killed” vaccine on himself and his family, and then famously refused to patent the vaccine so that its distribution would not be hindered. After years of trials, the Salk vaccine was approved in the United States in 1955 and saved thousands of lives. Few, however, know that Polish-born virologist Hilary Koprowski’s team developed an oral-delivery “live” vaccine first in 1950, which was never approved in the United States but saved countless lives overseas. Then, through the 1950s, Albert Sabin’s team developed a safer and more potent version of Koprowski’s vaccine, which was first approved in the United States in 1961. Before it was approved in the U.S., though, Sabin freely shared the vaccine with the Soviet Union, the rising rival to the United States, acknowledging that the polio pandemic was not just an American problem but a global one. Like Salk, Sabin never patented his team’s vaccine either. It is the Sabin-Koprowski vaccine that has gone on to be the primary vaccine used globally by the WHO today. 

Through international cooperation, humans have completely defeated one other viral threat to our species: smallpox, declared eradicated in 1980. Polio is likely next -- after the immense amount of attention and activity to develop and distribute a vaccine in the mid-20th century, the WHO with its regional partners have eliminated the poliovirus from the Americas, Europe, Africa, Oceania, East Asia, and most of South Asia. In recent years, the number of worldwide annual cases have reduced to a range between the hundreds and the low thousands. The main hurdle to complete eradication is regional political instability, in large part caused by violent nationalism and exacerbated by foreign interests looking to exploit the instability for their own ends.

In our current covid-19 pandemic, we have seen both ugly racial prejudices cropping up as well as an immense international effort to address the global threat. The scientific cooperation has been rather inspirational, if underreported. But former President Trump pulled the United States out of the WHO just when American expertise could have assisted the global community, as covid-19 became a global pandemic. Biden has rejoined the United States to the WHO, but international inequality in the distribution of vaccines continues. Rich countries are ordering and stockpiling many more vaccine doses than their total populations -- the United States has ordered a little less than double the number of its total population -- despite the immense difficulty that many poorer countries are having in acquiring any vaccine doses at all and despite the United States’ own massive culpability in incubating and spreading the covid-19 pandemic. At the same time, “vaccine nationalism” has convinced regional political entities like the European Union to halt the export of vaccine doses to their partners abroad, while their own citizens are not fully inoculated -- despite the failure of the EU vaccine rollout stemming from poor management and a lack of infrastructure as opposed to a lack of doses. Meanwhile, as rich countries subsidize the vaccine for their own citizens, some pharmaceutical companies are making tens of billions of dollars from these vaccines. A fourth issue is that after rich countries have reached the threshold to achieve herd immunity, international efforts to distribute the vaccine will significantly slow down. This was the pattern with HIV/AIDS; while a massive grassroots campaign of HIV-positive people and their allies was largely responsible for educating the public about HIV/AIDS and getting the medical community to address the epidemic, as the therapies became more effective at managing the symptoms, more privileged individuals and communities could live healthy and happy lives with the disease, while more impoverished communities were left behind. Today, the majority of HIV/AIDS cases occur in middle and low resource countries, and in rich nations, in poorer communities and communities of color. Some have described it as “a disease of inequality,” citing the strong correlation between HIV prevalence and income inequality, but it is just one on a long list. It is not unthinkable that a similar situation could develop with covid-19.

Of course, covid-19 is much more easily transmissible than HIV, and the thought of permanently eradicating covid-19 in one or a few countries while the rest of the world continues to suffer is completely nonsensical. In our global economy, as we have seen, regional diseases can become worldwide pandemics within a matter of weeks, and just as soon as one region seems to have it under control, visiting neighbors from another region can set entire communities back. With new technologies being pioneered with the covid-19 vaccines, the rate of new vaccine development is expected to accelerate in the next few years -- perhaps fast enough to keep pace with even more dangerous covid-19 variants. But even that is a pipedream, considering how much the United States relies on overseas labor and goods. This present pandemic has revealed how extraordinarily unequal this country is; as essential workers making starvation-level wages have been forced to risk their lives, oftentimes without health insurance, the call for Medicare for All is more relevant, pressing, and louder than ever. As of this date, over 515,000 American lives have been lost to the pandemic -- many of them with comorbidities or other risk factors that are preventable given adequate healthcare. Even if we quickly get the pandemic under control, we as a society will be dealing with the long-term health consequences (and associated costs) for years. The establishment of universal single-payer healthcare in the United States is an actionable, equitable, and immediately beneficial goal for us as Americans. In the 1970s, a movement to create equitable accommodations and to remove social stigma for people with disabilities was often led by polio survivors; they are the reason we have ramps next to stairs, special parking for the handicapped, and other accessibility options that have improved our society. But this is a global pandemic, and we live in a global community. As we as a nation begin to recover from this catastrophe, let us not forget that full recovery can only occur after the pandemic has been defeated everywhere.

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