November 2013

We no longer need to think about smallpox, and by the time those who are children now grow up they will no longer need to think about polio. For the moment, however, it is tenacious. Pakistan, Afghanistan and Nigeria are three countries where the war is being waged. Recently Syria had to be added. Health workers administering the vaccine have been attacked, some killed. There is resistance from several sources. In some regions, the Taliban is fighting and threatening against the necessary vaccinations to eradicate the disease and protect vulnerable children. Beyond social, religious and political issues, there are funding ones. Vaccinating millions of children has become quite costly. Health workers have to be trained and at least nominally protected. The war against polio began in 1988 when there were 350,000 cases reported. Last year there was 223. We may have come a long way in a relatively short time, but the last battles are challenging besides being expensive. It is estimated that $5bn is needed to finish the job, and some ask, why take resources away from TB, from cholera, from HIV, from illnesses very much in need of attention? Because, says the WHO once polio is eradicated, then resources that are currently spent on treating and fighting it, can be allocated to other diseases. While in the short run it seems unfair, in the context of time, it’s an investment that will permit greater attention to those other illnesses. When it’s all done, the result will not only be a polio free world, it will also have made inroads into health care delivery systems and enlisted workers able to apply their training to fight other diseases. Smallpox too had difficult battles to wage before it could be declared gone. And one day we won’t remember the war against polio, only that it was won.

In a hidden corner of the construction for a metro rail station not far from where I live, 5 or 6 men have organized their equivalent of a living space. They have pillows and blankets and sit there, laugh, talk and drink I’m not sure what. I try to peek through a hole in the tarp covering the chain link fence around the site and try not to be noticed. In a few weeks they’ll have to move, maybe they realize it, maybe they’ll only deal with it when they have to. At least one is disabled, I see them help each other move around their few feet of space. They have no clean sheets, no clean anything in fact, no hot water, no running toilet. I walk on and I think of the 2.5 billion in the world who have no sanitation, the one billion who is forced to defecate in the open, of the lives blighted and harmed by the illnesses and consequences from the lack of hygiene. Too I think of the 29 million who are trafficked or in servitude of some kind—and once again I remember how fortunate I am.

Several states have been searching, secretively says the BBC, for lethal injection drugs. The 3 drugs combination used in the past has not been available for some time since the manufacturer of a key ingredient, sodium triopental, stopped supplying it. Some states then tried to used Propofol but the German supplier stopped filling orders, warning of EU sanctions since the death penalty is outlawed in the EU and at one point even asked for the Propofol it had shipped back. Now states are turning to compounding pharmacies, pharmacies which make drugs in small quantities usually for specific clients, and critics are concerned because the drugs they manufacture do not come under FDA regulations. It is feared that the combinations now used can create pain and not be as effective as the former 3 drugs. Meanwhile, the present is a patchwork with each state doing what it thinks best to carry out its mandate of execution. In Missouri an execution was postponed due to the lack of drug availability, while in several states various and untested drug combinations are being used. It’s a ghoulish and perverse search pointing to the need to totally rethink our use of the death penalty.