The Line is grateful for: Global vaccination initiatives
From polio to COVID-19 to malaria, vaccines are the triumph of the cooperation of science and politics. We should never forget it.
As we start a new year, The Line asked some of its friends to write us articles about things that they loved during 2023. Consider this a small act on our part to help get 2024 off to a good start. Today: Andrew Potter on something we are actually getting right, but too rarely celebrate: science defeating the world’s deadliest diseases.
By: Andrew Potter
One of the paradoxical features of our current era of secular economic stagnation and political decline is that it is, in many ways, perfectly consistent with steady, and sometimes spectacular, advances in science and technology. And so we get these strange juxtapositions, where, one the one hand, we live in a rich civilization that increasingly can’t manage to build proper infrastructure like pipelines or airports, provide essential public services such as health care, and is beset by internal political division and failing democratic legitimacy.
Yet on the other hand, even as the world seems to be falling apart, we carry chocolate-bar sized supercomputers in our pockets, with the wisdom and knowledge of the ages at our fingertips. With these same devices, we can watch real-time video of reusable rocket boosters landing on floating drone ships, or scan images of the distant universe beamed back to Earth from a telescope parked a million miles away at the L2 Lagrange point.
The COVID-19 global pandemic both underscored and exacerbated this paradox. With the pandemic, the slow but steady degeneration of the machinery of government into a gummed-up vetocracy revealed itself as a full-blown crisis of state capacity. Yet even as many countries struggled to set up proper contact-tracing systems, to source adequate PPE for the health systems, and fought pitched political battles over things like mitigation strategies (e.g. masks, curfews) and vaccine mandates, the vaccines themselves were incredible scientific achievements. It’s been four years now since COVID, and the emerging consensus appears to be, as the recent Bethany McLean/Joe Nocera book The Big Fail put it, that the vaccines worked and everything else was a sideshow.
As the pandemic fades from our collective working crisis memory, it is worth keeping in mind this singular triumph of vaccines, and to remind ourselves of how central they have been to human progress and flourishing. In 2023, there were two major advances in global vaccination efforts, and, if we are lucky, they will avoid the intense politicization and conspiracy-mongering of the COVID-19 vaccine rollout.
The first advance is the arrival of a genuinely effective vaccine against malaria. Developed at the University of Oxford and manufactured by the Serum Institute of India, the R21/Matrix-M was approved by the WHO in early October. While there is an existing malaria vaccine called RTS,S, which has been around since 2016, it is only about 30 per cent effective, requires four doses, and fades quite rapidly. The new R21/Matrix-M vaccine requires an initial three doses but is 75 per cent effective for a year, with protection that is maintained for at least another year with a booster. The vaccine will begin to be rolled out in parts of Africa in the next few months, where it has been approved for use by Burkina Faso, Ghana and Nigeria.
There are currently around 250 million cases of malaria in the world each year. It kills over 600,000 people annually, including almost half a million children under the age of five. That means over a thousand children a day are dying of malaria worldwide; this is a crisis and a tragedy by any measure. If this vaccine is able to put a serious dent in these numbers, it will be a cause for serious celebration.
If there is anything to criticize here, it is the relative lack of urgency around the rollout of the vaccine. In contrast with the COVID-19 vaccines, which were fast-tracked for approval through an emergency-use listing procedure, the malaria vaccine has gone through the normal WHO prequalification procedure. Tens of millions of doses have been sitting ready in India for months, and as Alex Tabarrok has argued, if 1,000 children dying per day isn’t an emergency, what is?
The second exciting development is the near-eradication of polio on Earth. Most of us know nothing about polio except through history books, or the occasional cinematic depiction of someone in an iron lung. But in the first half of the century it was a terrifying infection. At the peak of the outbreak in the early 1950s, there were 9,000 cases a year in Canada; it killed 500 people a year and left hundreds more paralyzed, almost all of them children.
Polio outbreaks were finally brought under control thanks to the vaccine developed by Jonas Salk, which was approved for use in 1955. It has been eradicated from the Americas since the 1990s, and globally, the number of cases has dropped from an estimated 400,000 worldwide in 1980 to under 2,000 cases by 2005. Since then, thanks to relentless efforts at vaccination and containment, the wild form of the virus has been steadily cornered and eliminated. A decade ago it was endemic in Nigeria, Pakistan, Afghanistan, Chad, and Niger, but in 2023 there were only 12 wild virus cases detected in the border regions between eastern Afghanistan and north western Pakistan.
It’s too soon to bust out the party hats and kazoos, though. The WHO-led Global Polio Eradication Initiative (GPEI) doesn’t expect to achieve its goal of eradicating the wild virus this year. This is in part because there remain large clusters of unvaccinated children in parts of Afghanistan, particularly around Kandahar, which can serve as unprotected population reservoirs in case of an outbreak. But more problematic is the persistence of circulating vaccine-derived cases of polio. These arise because the weakened forms of the polio virus that are used in the oral polio vaccines can on rare occasions become virulent. There were 430 such cases in the world last year, most of them in Africa. Eliminating these cases will be difficult, and a new report criticizes the GPEI for not focusing enough on this aspect of the disease.
But at its peak, polio was leaving more than 350,000 children paralyzed worldwide every year. It is for all intents a scourge of the past; perhaps malaria will join it in the not-too-distant future.
Vaccines are the great miracle of humanity, a triumph of science, ingenuity, and, it must be said, politics. We must not forget it.
Andrew Potter lives in Montreal. Follow him at his newsletter Nevermind: The Forgotten History of Generation X.
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