March 05, 2008

By Jean-Paul Chaine
The Kaselehlie Press

I recently had occasion to administer a quick questionnaire to a small group of honor students on Saipan. One question simply asked "What is polio?" Not one student could answer the question; one even responded "Not a clue". They also did not know anyone who had polio. I was unprepared for this response. I have been working in Public Health for the last 40 years in Africa, Asia and for the last ten in the Pacific Islands. A recent assignment was with the World Health Organization Polio Eradication Program in South Equatorial Sudan. Polio is very real for me, both professionally and personally, two cousins my age were victimized by this virus. How could a disease that caused so much concern just one generation ago simply disappear from the public conscience? The answer is, of course, vaccines. In 1956, when I was a sophomore in high school, the nation conducted a mass polio vaccination campaign. Before the vaccine was available, healthy vibrant children were tucked into bed only to wake up with incurable poliomyelitis (also called infantile paralysis).

This happened without warning and was a parent's worst nightmare. The disease took several forms. Polio could kill you outright. The death-to-case ratio for paralytic polio was 2% to 5% in young children but from 15% - 30% in adults. Polio could paralyze your diaphragm so you spent the rest of your life in an iron lung, a casket like tube which did your breathing for you. Spinal polio often involved a single leg which could become permanently paralyzed and required wheel chairs, massive iron leg braces and crutches. We now know that nearly everyone was exposed to polio virus but only a few unlucky individuals got sick. The disease reached its peak in the USA in 1952 with 21,000 paralytic cases. Thanks to vaccines, the last case of wild polio acquired in the USA was in 1979 and will be eradicated from our planet in the next few years. Another vaccine has recently been approved by the FDA called Human Papillomavirus (HPV) Vaccine. Like polio, infections with HPV are common and generally go unnoticed. Yet this virus is responsible for 100% of all cervical cancers, which in the RMI, is the second leading cause of all cancer deaths in women. The RMI rate for cervical cancer is many times more than the US Mainland. This means that every few weeks a woman in the RMI learns that she has invasive cervical cancer. In the FSM, the Department of Health and Social Affairs, the Cancer Coalition, and the Department of Education are planning a mass immunization campaign targeting girls from 12 to 18 years of age. The vaccine is very expensive: $130 a shot and three shots are required over a six month period. The Department of Health has obtained enough vaccine for the campaign from the federal Centers for Disease Control and Prevention (CDC). The vaccine will be provided free to the young women. The catch-up campaign is planned to be completed by December 2009, thereafter the vaccine will be provided every year to sixth graders. We will thus vaccinate our daughters as young girls to protect them as women. The campaign will require considerable effort on the part of the DHSA and the coalition but they will depend entirely on women stepping up to be vaccinated. We can make our high school graduating class of 2009 the first class to be free of cervical cancer. Indeed all women under 18 can and should be protected. Hopefully our grandchildren when asked about cervical cancer will respond: "Not a clue".