How the fight over polio is being won

‘In the Eighties there were more than 400,000 new cases a year … last year a mere 37’

The devastation wreaked by Hurricane Irma and other natural disasters in recent weeks may suggest our world is merrily going to hell in a handcart – making it easy to overlook how, for hundreds of millions, life is now immeasurably better than just 30 years ago.

The economic transformation of China and India is mainly responsible, but there has also been a cultural shift, epitomised by last week’s interview in this paper with Bill Gates: the recognition that some of the most seemingly intractable problems of human suffering and illness are realistically soluble with a little goodwill and a lot of money.

The eradication of polio is a case in point: the infectious disease is an almost-distant memory for us in the West, but as recently as the Eighties there were more than 400,000 new cases a year.

The precedent of smallpox eradication (the last recorded case was in 1979) seemed encouraging, but the practicalities were much more daunting. Smallpox is readily recognisable and preventable by a single vaccination that provides lifelong immunity. But with polio, there are 200 carriers of the virus for each clinical case, the vaccine has to be kept cold prior to administration, and it may need to be given several times. So far, the fight against polio has cost $9billion dollars (18 times more than the smallpox programme). There are thousands of cases of paralysis to detect and investigate every year, and treatment to date required the delivery of 2.2billion doses of oral vaccine to 430million children in 60 countries. But by 2006, there were just 2,000 new cases, and last year a mere 37. This immensely impressive achievement – to which Bill Gates has made such a significant contribution – is yet more propitious for the future than it might appear.

The polio eradication programme, with its network of 146 laboratories, more than 30,000 personnel and millions of volunteers, has created a global infrastructure that can now, it might be hoped, be turned to further advantage allowing for the control of several more of the common infectious illnesses that continue to blight the lives of so many children – notably measles, rubella and tetanus.

Night-time trips

This week’s medical query comes courtesy of Mr PG from Swansea who, along with several friends, is comfortably losing weight by following the Slimming World diet, and abstaining from snacks and alcohol.

Though not drinking any more than usual, they are all passing urine much more frequently, including having to rise several times at night. Can anyone, he wonders, explain this interesting physiological phenomenon?

Cure for hip pain

Finally, my thanks to a reader in her mid-60s for passing on this serendipitous cure of her arthritic hip pain. As so often, this had prevented her sleeping – “lying down was very painful, no matter which side” – but it was somewhat alleviated by taking an antiinflammatory Mission: Bill Gates speaks with villagers in Aulali, Khagaria district of India pill on retiring and placing a pillow between her knees and ankles.

She had also been troubled by bouts of cystitis, warranting several courses of antibiotics, before her family doctor suggested she use a vaginal oestrogen cream to counter the post-menopausal changes that can predispose to infections of the urinary tract. Since then, no more cystitis – “and, now comes the amazing bit, no more hip pain, either”.

This is no mere coincidence, as alongside the usual tribulations of the menopause (hot flushes, mood changes etc), the fall in oestrogen levels may also – for reasons that are not entirely clear – cause joint and muscle pains or exacerbate those due to arthritis of the hip and knees.

The dangers of HRT, as reported last week, have been much exaggerated, so women of a certain age should certainly consider a trial of patches (or, as here, oestrogen cream) in anticipation of a similarly felicitous outcome.