Polio: The Odyssey of Eradication, by Thomas Abraham

When Halfdan Mahler stood up to give his final address as director-general of the World Health Organization in Geneva in 1988, he stunned gathered health ministers with his challenge: “What about having the guts to eliminate poliomyelitis from spaceship earth by the year 2000?”

It was a statement less remarkable for its boldness than for the fact that it came from a man who had spent the previous 15 years resisting just such a request. Despite the recent success of the eradication of smallpox (in 1980), Mahler had long argued that seeking to get rid of a second disease would be a distraction from more valuable efforts to fight disease by strengthening global health systems.

Three decades on, there is a continued undercurrent of opinion that his doubts were justified. The global polio eradication campaign has saved many lives and reduced residual infections to small numbers in a handful of countries. But it has failed to meet numerous deadlines, taken more than twice as long as promised, with no end in sight, and cost more than $15bn so far — money that could have helped many more people if deployed in other ways.

It has also brought unexpected consequences, as Thomas Abraham relates in this book, from infections caused by the vaccine itself, to the killing of more than 100 vaccinators and their guards in Pakistan by religious extremists. “The practice of public health, with its eyes fixed firmly on the protection of entire populations, can be curiously blind to the cost that individuals often bear,” Mr Abraham writes.

The story of polio vaccines that he describes is one of remarkable scientific innovation spurred by rivalries and marred by expediency, with “witches’ brew” techniques to produce prototypes tested in large numbers of monkeys and then in humans able to provide only ethically questionable consent: institutionalised children, soldiers and prisoners.

While the benefits have far exceeded the risks, officials pushing for eradication long played down cases of paralysis caused by the vaccine itself and the occurrence (most recently in Papua New Guinea) of infections when the live virus in the vaccine adapts, is excreted and causes illness in others.

Polio caused widespread death and paralysis during the 20th century, notably in richer countries. The rise in hygiene and living standards reduced the risk of infections triggering natural immunity in young children, but also made it more likely and dangerous as they got older. The central question is whether the early successes in eliminating the disease in the US and other industrialised countries should have been replicated in poorer countries.

As Mr Abraham describes, in Pakistan vaccination programmes — often imposed by coercion — are making slow progress not only because of corruption but also because the country’s poorest and most neglected residents see polio as less of a priority than other more pressing causes, such as improved sanitation.

The US’s role has been pivotal. In the 1950s, it hosted the development of both the injected “killed virus” vaccine of Jonas Salk (safe but expensive) and Albert Sabin’s “live” oral one (cheap but with a risk of onward infection). President Franklin D Roosevelt, who himself contracted the disease, provided political support, while agencies and businesses, including Rotary International and, latterly, the Bill & Melinda Gates Foundation, spearheaded funding for expansion abroad.

Much of the history of polio has been covered in previous excellent books. Mr Abraham’s work is a useful additional primer, describing campaigns in different countries and bringing the story up to date with examples such as how Pakistan has made progress by seeking Muslim funding. Yet, despite his background as a journalist and a one-time insider at the WHO, he relies too heavily on official documents rather than bringing the personalities involved alive (or to account).

Mr Abraham relies on speculation rather than insight to explain Mahler’s volte-face and spends too little time on the motivations of Rotary and others. His is not the definitive account, but there will be plenty of additional twists for another author before, if ever, polio is eradicated.

The reviewer is FT global education editor

Polio: The Odyssey of Eradication, by Thomas Abraham, Hurst, RRP£25, 320 pages