I am starting a series of posts that will address the COVID vaccines. I thought before we get to the particulars, it might be helpful to gain some historical perspective on vaccines. Let’s start not with science or data, but with a human story. I always tell my patients that medicine is not ultimately about data, but about human beings. With that in mind, why do we have vaccines at all?
A Young Lady Far From Home
Caitlin is exhausted and exhilarated at the same time. It is her third week in India. The jet lag, sickness, and long hours of work have taken a toll, but the experience could not be more thrilling.
This larger than life world jolts her regularly with strange wonders. Saris and glittering gold flash in the bright sun. Exotic music and clamoring merchants generate a surreal buzz. The frenzied traffic is indescribable. A press of humanity surges all around.
In the mission hospital where Caitlin is spending a month doing volunteer work before her senior year of college, another universe has come into her awareness, as well: the world of suffering people.
The plight of her fellow creatures eats at Caitlin as she lies in bed in the guest house at night. She has shed many tears on this bed, never imaging how disease could undo so many. But none have pierced her heart like one little girl.
Anika
Anika, an eight year old girl from an outlying village was admitted to the hospital three days ago. Initially Anika had been brought by her parents to the local clinic with a day of fever and diarrhea.
Assuming she had some sort of bacterial infection, the medic there administered an intramuscular shot of antibiotics into her left arm. Within a day Anika’s mother noted that the girl had stopped using that arm.
By the time she brought Anika to the mission hospital two days later, the child was too weak to stand. It turns out that this episode of fever was not one of the routine intestinal infections that commonly afflict children in the developing world. It was Polio.
Old Names and Fresh Horrors
On rounds with the doctors, Caitlin heard that word Polio, and it struck her as quaint, the same way that other vaguely familiar names like Diphtheria and Typhoid had sounded weeks before. Until recently Caitlin had viewed these maladies as the laughable ailments of yesteryear. Surely these were silly illnesses that infected very old people. She has since learned better.
Today, watching the virus cripple this adorable girl in front of her, the name of Polio is a fresh and horrifying reality, like an ancient monster that has been unleased upon Caitlin’s sanitized world.
Caitlin finds herself lingering at Anika’s bedside, stroking her ebony hair and thin face in an attempt to soothe her. The two make quite a contrast. Caitlin is blond, blue-eyed, and tall with an athletic build that makes her a star on the lacrosse team. Anika is thin and short, even for her age. Her skin is a radiant brown. Her eyes are as dark and large as chestnuts, haunting and beautiful, but filled with fear.
Whenever Caitlin tries to leave and attend to other patients, little Anika clutches at her frantically, grasping with her good arm, while her left arm, thin as a stick and increasingly limp, lies pitifully useless at her side.
But Polio may not just cripple; it can also kill by weakening muscles of breathing – thus the haunting 1950s images of children in iron lungs. Alerted to monitor Anika for evidence of respiratory distress or signs of swallowing difficulty that could precede deadly aspiration, Caitlin cringes whenever Anika coughs and watches her apprehensively during each meal.
Lurking in the Water
Anika contracted Polio through oral ingestion, likely from contaminated water. This route of transmission is why swimming pools evoked fear in American parents in the mid 20th Century.
From her intestines the virus spread rapidly – too rapidly for the immune response to catch up. By the time the central command realized that an invasion was taking place, it was too late.
Multiplying, moving, and hiding within infected cells, the pathogen damaged the motor neurons in Anika’s spinal cord. Despite the marvels of immunity, if Anika survives, she will walk with a crutch and have a weak left arm throughout her life.
Ironically, that well-intentioned dose of antibiotics proved to be a huge disservice. The majority of polio cases resolve within a week or two without causing paralysis. Neurologic damage can actually be triggered by injections.
Internal Commotion
Meanwhile, a commotion more teeming than the streets of India is raging inside of Caitlin’s own body. Her immune system has been on high alert for the last few weeks. Culture shock is not just for the emotions, but the whole being, physiology included.
Just ten days ago she experienced a bout of unpleasant, but uncomplicated, diarrhea – likely caused by the local E coli bacterium. Known as “traveler’s diarrhea,” this infection also bears more colorful labels like “Montezuma’s Revenge” in Mexico and “Delhi Belly” in India. After 36 hours of antibiotics, the miserable diarrhea and cramps remitted, and Caitlin was back at work, feeling weaker and wiser.
Today, however, Caitlin was unwise. Inexperienced and overwhelmed, she got so caught up in Anika’s care that she did not wash her hands thoroughly enough. As a result, at lunch, as Caitlin hurriedly bolted down some food between patients, it happened. She ingested enough Polio virus to infect herself. Now something graver than Delhi Belly is threatening Caitlin.
It is evening by this time. Caitlin sleeps, exhausted and oblivious to the bustle of the street outside, as well as the peril within. Once again the invasion is beginning. The virus is ready to rampage unabated as it has done throughout human history. Is there any reason to think her body will fare better than Anika’s?
Caitlin is in the crosshairs. In the prime of her life with such a bright future ahead, is it her turn to face a withered arm, crippling paralysis, or death?
Dr. Bill Maynard