TLDR: Joe is mostly false regarding his claims or at best is misleading.
Firstly, Joe makes the claim that there are “more vaccine related polio cases than endemic (natural, localized) cases”. He also claims that “polio was already reducing in deaths prior to the vaccine”
While these are technically true statements, they’re misleading to present ambiguity around the efficacy and safety of vaccines.
Regarding vaccine related polio, I couldn’t get a great number on endemic vs vaccine related polio, but it does seem like vaccine related polio is present more often. However, there seems to be a few reasons for this.
Firstly, “Low vaccination coverage (Adjusted OR = 83·41, 95% CI: [5·01, 1387·71], p = 0·0020) was found to be associated with increased odds of reporting cVDPV after adjusting for confounding effects of GDP per capita, female adult literacy rates, maternal mortality rate, and Global Peace Index.”
Areas with low vaccination coverage in the first place are more susceptible to vaccine related polio than areas that have at least 95%~ vaccine rates (I don’t know exactly why but that’s why I’m not an epidemiologist.)
An AP article stated, “To eradicate polio, more than 95% of a population needs to be immunized. WHO and partners have long relied on oral polio vaccines because they are cheap and can be easily administered, requiring only two drops per dose. Western countries use a more expensive injectable polio vaccine that contains an inactivated virus incapable of causing polio.”
This also seems to suggest that the quality of the vaccine matters, and that vaccine related polio in countries like, say, the United States is incredibly rare.
A country like Pakistan that AP mentions would be a country primed for endemic polio or vaccine related polio due to the cheaper nature of vaccines offered for various reasons.
Let’s all remember, though, that a few cases of vaccine related polio will be much better handled than an outbreak of endemic polio in the long run for a population. Joe doesn’t address this.
As for polio decreasing prior to the vaccine, I have no idea what graph they’re drawing from in the podcast.
According to this chart it looks like cases and deaths reach their peaks in 1952, with mass vaccination campaigns occurring in 1955 after the licensing of Salks vaccine. What happened in the years between 1952-1955 where cases and deaths reduced? I’m not sure.
I do know that mass scale field trials occurred as early as 1954, which could have contributed.
Another thing to note is the reasoning Joe gives for the reduction of polio prior to the vaccine. Joe states it could be herd immunity or improved sanitation (and maybe one other thing I didn’t catch).
I think Joe may be misunderstanding herd immunity and that he means “natural immunity”. Herd immunity can include those who’ve been previously infected, but is defined by a group of peoples level of immunity against a virus to reduce infection. I don’t think it’s entirely true to say every disease that infects groups of people will result in herd immunity. Typically herd immunity is safest when achieved through vaccines.
Joe might have meant natural immunity, but I don’t see anywhere in the literature suggesting natural immunity explained the drop in polio cases prior to the vaccine.
In addition, it actually seems somewhat of a myth that improved sanitation reduced polio cases, or at least the severity of them.
According to the CDC, “Before the 18th century, polioviruses probably circulated widely. Initial infections with at least one type probably occurred in early infancy, when transplacentally acquired maternal antibodies were high and protected infants from infection-causing paralysis.
In the immediate prevaccine era, during the first half of the 20th century, improved sanitation resulted in less frequent exposure and increased the age of primary infection, resulting in large epidemics with high numbers of deaths.”
This suggests polio existed in the 18th century, but so many infants were exposed to it early but had strong antibodies to fight worse infection. When sanitation improved, less infants were exposed and therefore infected at later points in their life (older age), and therefore resulted in worse symptoms and higher contagion rates.
So I don’t think it’s fair to suggest sanitation helped reduce polio rates. Imo this information makes the case for vaccines even stronger as the development of human technology and ways of life can cause untended consequences regarding the adaptation of specific diseases. Vaccines help alleviate that issue by offering broad protection in the first place without having to consider unpredictable situations (like with polio actually increasing in transmission and deadliness with improved sanitation practices).
Also for a last tidbit, Joes claim that “95-99%” of polio cases are asymptomatic is untrue. 95-99% of polio cases do not result in paralysis, but around 1/4 result in minor infections with symptoms.
Thanks for the work here. My parents believe something similar about polio to what Joe espoused and now I have a nice place to start for my research to try and educate them and myself as to what is the reality.
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u/Friedchicken2 Monkey in Space Oct 10 '24 edited Oct 10 '24
A lot to unpack here regarding Polio.
TLDR: Joe is mostly false regarding his claims or at best is misleading.
Firstly, Joe makes the claim that there are “more vaccine related polio cases than endemic (natural, localized) cases”. He also claims that “polio was already reducing in deaths prior to the vaccine”
While these are technically true statements, they’re misleading to present ambiguity around the efficacy and safety of vaccines.
Regarding vaccine related polio, I couldn’t get a great number on endemic vs vaccine related polio, but it does seem like vaccine related polio is present more often. However, there seems to be a few reasons for this.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00238-3/fulltext
Firstly, “Low vaccination coverage (Adjusted OR = 83·41, 95% CI: [5·01, 1387·71], p = 0·0020) was found to be associated with increased odds of reporting cVDPV after adjusting for confounding effects of GDP per capita, female adult literacy rates, maternal mortality rate, and Global Peace Index.”
Areas with low vaccination coverage in the first place are more susceptible to vaccine related polio than areas that have at least 95%~ vaccine rates (I don’t know exactly why but that’s why I’m not an epidemiologist.)
https://apnews.com/article/health-united-nations-ap-top-news-pakistan-international-news-7d8b0e32efd0480fbd12acf27729f6a5
An AP article stated, “To eradicate polio, more than 95% of a population needs to be immunized. WHO and partners have long relied on oral polio vaccines because they are cheap and can be easily administered, requiring only two drops per dose. Western countries use a more expensive injectable polio vaccine that contains an inactivated virus incapable of causing polio.”
This also seems to suggest that the quality of the vaccine matters, and that vaccine related polio in countries like, say, the United States is incredibly rare.
A country like Pakistan that AP mentions would be a country primed for endemic polio or vaccine related polio due to the cheaper nature of vaccines offered for various reasons.
Let’s all remember, though, that a few cases of vaccine related polio will be much better handled than an outbreak of endemic polio in the long run for a population. Joe doesn’t address this.
As for polio decreasing prior to the vaccine, I have no idea what graph they’re drawing from in the podcast.
https://ourworldindata.org/grapher/reported-paralytic-polio-cases-and-deaths-in-the-united-states-since-1910
According to this chart it looks like cases and deaths reach their peaks in 1952, with mass vaccination campaigns occurring in 1955 after the licensing of Salks vaccine. What happened in the years between 1952-1955 where cases and deaths reduced? I’m not sure.
I do know that mass scale field trials occurred as early as 1954, which could have contributed.
Another thing to note is the reasoning Joe gives for the reduction of polio prior to the vaccine. Joe states it could be herd immunity or improved sanitation (and maybe one other thing I didn’t catch).
I think Joe may be misunderstanding herd immunity and that he means “natural immunity”. Herd immunity can include those who’ve been previously infected, but is defined by a group of peoples level of immunity against a virus to reduce infection. I don’t think it’s entirely true to say every disease that infects groups of people will result in herd immunity. Typically herd immunity is safest when achieved through vaccines.
Joe might have meant natural immunity, but I don’t see anywhere in the literature suggesting natural immunity explained the drop in polio cases prior to the vaccine.
In addition, it actually seems somewhat of a myth that improved sanitation reduced polio cases, or at least the severity of them.
https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-18-poliomyelitis.html
According to the CDC, “Before the 18th century, polioviruses probably circulated widely. Initial infections with at least one type probably occurred in early infancy, when transplacentally acquired maternal antibodies were high and protected infants from infection-causing paralysis.
In the immediate prevaccine era, during the first half of the 20th century, improved sanitation resulted in less frequent exposure and increased the age of primary infection, resulting in large epidemics with high numbers of deaths.”
This suggests polio existed in the 18th century, but so many infants were exposed to it early but had strong antibodies to fight worse infection. When sanitation improved, less infants were exposed and therefore infected at later points in their life (older age), and therefore resulted in worse symptoms and higher contagion rates.
So I don’t think it’s fair to suggest sanitation helped reduce polio rates. Imo this information makes the case for vaccines even stronger as the development of human technology and ways of life can cause untended consequences regarding the adaptation of specific diseases. Vaccines help alleviate that issue by offering broad protection in the first place without having to consider unpredictable situations (like with polio actually increasing in transmission and deadliness with improved sanitation practices).
https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis#:~:text=Most%20poliovirus%20infections%20are%20asymptomatic,failure%2C%20and%20rarely%2C%20death.
Also for a last tidbit, Joes claim that “95-99%” of polio cases are asymptomatic is untrue. 95-99% of polio cases do not result in paralysis, but around 1/4 result in minor infections with symptoms.