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An early-childhood photograph of Ravi Prakash, Pria AnandÔÇÖs grandfather. (Courtesy of Pria Anand)

## The Historical Impact of Polio: A Pandemic Reemergence in the Modern Era

Perspective by Pria Anand

September 10, 2023 at 7:00 a.m. EDT

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The first known victim of polio lived and died in the 14th century B.C., during EgyptÔÇÖs 18th dynasty. He is immortalized on a carved limestone slab, the Stele of Roma the Doorkeeper.

In the carving, Roma leans against a tall staff, holding a goblet in his left hand. His left leg is muscular, the foot planted flat against the earth. By contrast, his right leg seems shrunken. His right knee is bent, and the muscles of his calf have wasted away. The toes of his right foot rest lightly on the ground, as if he is a ballerina posing en pointe.

Thousands of years after Roma died, decades after the Americas were declared ÔÇ£polio-free,ÔÇØ a 20-year-old man in Rockland County, N.Y., arrived at a hospital in summer 2022 unable to walk. His legs were limp and weak, his abdomen was painfully distended, and his neck was rigid. In his stool, and in the sewage systems of Rockland County and New York City, scientists found fragments of the poliovirus that had ravaged the manÔÇÖs spinal cord and left him paralyzed. This year, four children in Israel tested positive for poliovirus, and the virus has been detected in wastewater throughout Europe and Africa.

This global reemergence seemed to be the result of a more contemporary pandemic: covid-19.

Pandemic lockdowns, overburdened public health infrastructures, and burgeoning public mistrust of vaccinations have led to tens of millions of children missing essential vaccines, a devastating blow to herd immunity that the World Health Organization described as the worst setback to vaccination campaigns in the three decades since its Global Polio Eradication Initiative was launched in 1988 with an elusive official mission of eradicating polio by the year 2000.

In response, scientists have redoubled their efforts: In June, two newly developed oral polio vaccines were featured in the journal Nature. The same month, Gavi, the organization that supplies vaccinations throughout much of the world, approved a new combination vaccine for distribution beginning in 2024. And an August article in Nature reported that Afghanistan and PakistanÔÇöthe only countries where wild poliovirus remains endemicÔÇöare closer than ever to eradication.

But polio has an insidious reach.

In the vast majority of people, polio causes no symptoms. About 1 in 4 of those infected will have mild symptoms, akin to a cold or stomach flu. Some 1 to 5 in 100 will have the symptoms of meningitis, neck pain, and a fever. Just 1 in 200 people infected with polio will develop paralytic polio, in which the virus afflicts the brain and spinal cord.

Paralytic polio is as unrelenting and unforgiving as it is rare: The symptoms of paralytic polio are lasting, and even those who recover often relapse decades later, victims of a poorly understood ÔÇ£post-polio syndromeÔÇØ that eventually afflicts the majority of the worldÔÇÖs tens of millions of polio survivors. Like long covid, post-polio syndrome inevitably follows any polio epidemic, leaving a second, equally devastating epidemic in its wake.

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