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Book review: The End of Polio? by Tim Brookes

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Few reporters can accurately claim to have written a one-of-a-kind book. But The End of Polio? by Burlington journalist Tim Brookes does qualify as a unique undertaking. It may be the only book ever published about a disease-eradication campaign that's still underway.

Accounts of the effort to rid the world of smallpox did not appear in print until in 1980, 20 years after humanity was officially declared to have been liberated from it. In light of Brookes' account, it's hard to understand such a long lag. As The End of Polio? shows, an as-it's-happening report can convey valuable information to specialists while providing general readers with an accessible, even exciting, narrative.

Brookes doesn't scrimp on the science of the polio virus and vaccine. But his 207-page paperback reads more like a travelogue than an academic disquisition. That's actually surprising, since The End of Polio? is published by the American Public Health Association, an outfit not known for printing page-turners.

Brookes, director of Champlain College's writing program and the author of six previous books, knows how to tell a good story without dumbing down his material. Readers will be moved by his chronicle of Pakistan's perhaps impossible attempt to replicate the success of the anti-smallpox campaign, which ranks as one of the most outstanding feats of benevolence and ingenuity in human history.

Brookes traveled to Pakistan with Dr. Omar Khan, a professor at the University of Vermont's College of Medicine. The two had met years earlier on the cricket fields of Fort Ethan Allen in Colchester. They forged a friendship on the basis of their shared interest in the sport - Brookes grew up playing it in England, where he was born 53 years ago.

Khan, a collaborator on The End of Polio?, also chairs the APHA's publications board. That connection has led Brookes to write a trilogy of health-related books. In 2003, APHA published his Behind the Mask: How the World Survived SARS, which traced the outbreak and containment of the deadly respiratory disease. The association also commissioned a monograph by Brookes on the 2004 flu-vaccine shortage.

In covering the disease beat, Brookes likes to get close to the action. For example, he booked himself into the same Hong Kong hotel where the SARS epidemic had erupted. It was a calculated risk, though tinged with practical considerations. "That hotel was bound to have some of the cheapest rates in Hong Kong, and it was certain to be one of the cleanest hotels, too," Brookes says with a smile.

In Pakistan, he got lost driving around the back streets of Karachi, the teeming and chaotic city where Wall Street Journal reporter Daniel Pearl was abducted and beheaded five years ago. While Brookes was there, a bomb planted by Balochi separatists exploded at a Kentucky Fried Chicken just doors away from his hotel.

Khan and Brookes also accompanied inoculation teams along the Pakistan-Afghanistan border high in the Hindu Kush mountains. This unpoliced terrain is fiercely contested by the Pakistan military and the CIA on one side and, on the other, indigenous tribal militants, Taliban fighters ousted from Afghanistan, and Al Qaeda terrorists from all corners of the Muslim world.

Even though he stood out as "the tall white guy" wherever he went in Pakistan, Brookes never had cause to fear for his safety, he claims. Reflecting from the comfort of his Champlain College office, he says, "I didn't feel I did anything heroic in the slightest" by touring this battlefront in the global showdown between Islamists and secularists.

The End of Polio? does amusingly describe the author's arm's-length encounter with a party of Taliban dining at an adjoining table in a roadside barbecue joint. Brookes says he knew the Taliban do not form a monolithic movement - some of the fundamentalists are more militant than others, he notes. And in addition to degrading women and blowing up ancient Buddhist statues, the Taliban did facilitate the anti-polio campaign during their years of misruling Afghanistan. "In some respects," Brookes suggests, "the Taliban have gotten a bad press."

Still, he acknowledges, "Having someone tell me the guys at the next table were Taliban was like being goosed." Everyone downed their lamb kebab without incident, however.

Pakistan was selected as the locus of The End of Polio? because it's easier to travel to and around South Asia than West Africa, which was also considered a potentially suitable site. Other professional obligations had left Brookes and Khan with less than two weeks for on-the-scene reporting. For these reasons the book falls somewhat short of its ambitions by affording only a quick glimpse of one anti-polio mobilization in one country.

Brookes tried to compensate for this limitation by conducting extensive research on the worldwide campaign; he presents his findings in succinct yet comprehensive form. But every impoverished country striving to eradicate polio has its own nuances, so this book can't provide an overview of what is and isn't working in the global struggle.

A lot of local color does accompany the interviews Brookes conducted with Pakistani officials, and with the workers on the frontlines of the anti-polio campaign. As he points out in the book, these crusaders are being paid $1 a day.

Brookes gives voice to those on the receiving end of the inoculation needle as well. He describes visits to households where residents initially seemed suspicious. After all, the book observes, "Vaccination is a psychologically volatile intervention. Allowing someone, often a stranger, to vaccinate one's children demands a considerable trust, and that trust may fracture at any number of points." In almost every home, however, Pakistani patriarchs proved willing to allow their children to be protected from polio. "They understood what's at stake," Brookes says.

But even unconditional cooperation is no guarantee that the anti-polio campaign is going to succeed. It did miss the goal of global eradication by the year 2000. Four years ago, the disease appeared close to being extinguished in sub-Saharan Africa, but there was a resurgence after Muslim leaders in northern Nigeria temporarily succeeded in halting local vaccination programs. They were reacting to a rumor that the polio vaccine is part of a Western plot to sterilize Muslim women and/or infect their children with AIDS. Vaccinations resumed in northern Nigeria after an 11-month hiatus. But this episode illustrates how easily hard-won gains can be reversed.

Polio may in fact survive the multibillion-dollar, 18-year onslaught being jointly conducted by the World Health Organi- zation, UNICEF, the U.S. Centers for Disease Control and Rotary International. Brookes persuasively presents the arguments of specialists who suggest that, with the virus now crippling a comparatively tiny number of children, it may be time to declare victory and move on. These skeptics maintain that the money being spent on an ultimately unwinnable war could be invested far more productively in other public-health endeavors. Decontaminating water supplies, for example, would help ensure that "not only polio but a number of other diseases would be dramatically reduced or eradicated," Brookes writes.

It's a view the author himself appears to endorse. Concluding the campaign with a 100 percent success rate "becomes increasingly more difficult and expensive as you approach case-zero," he comments. And because only one in 1000 cases of polio produces visible symptoms, it may be impossible even to know when a final case has been cornered.

On the other hand, Brookes adds, no charitable organization finds it easy to turn its back on fistsful of money. When it comes to setting priorities for improving global health, he observes, "It's often not a question of what you should do, but of what you can raise the money to do."

Polio has had surefire fundraising appeal ever since Franklin Roosevelt contracted the disease in the 1920s. A young polio victim also served as the first-ever "poster child" in a publicity drive launched in the 1930s by the newly founded March of Dimes.

Today's mass mobilizations that aim to inoculate millions of children on a single day have produced ancillary benefits that may justify the entire anti-polio extravaganza. Brookes notes in his book that in El Salvador, Lebanon, Congo, Sri Lanka, Somalia, Cote d'Ivoire and elsewhere, murderous civil conflicts have temporarily given way to a "pax polio" that allows vaccination drives to go forward.

In addition, the epidemiological surveillance that's part of every push against polio is enabling Pakistan and other poor countries to construct public-health infrastructures where none had previously existed. This framework for delivering the benefits of modern medicine will presumably remain in place long after the polio campaign has come to an end, win or lose. Regardless of whether a virus is eradicated for only the second time in human history, the polio mobilization will have indirectly saved millions of lives.

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