Marjorie P. Pollack, MD

In 1983, the Pan American Health Organization (PAHO) held a major conference reviewing the situation with poliomyelitis in the Americas. The conference was noteworthy for the presence of both Albert Sabin and Jonas Salk because they had rarely attended a conference where both were present. There had been a longstanding unfriendly dispute and competition over which vaccine was the better vaccine — Sabin’s live oral poliovirus vaccine (OPV) or Salk’s injected inactivated poliovirus vaccine (IPV). As the two giants in the field each spoke, Sabin went first (alphabetical order was chosen), and when Salk got up to speak, his opening comment was, “Let it go on record that Dr. Sabin and I are in agreement — there is no need for two different vaccines.” While we are using quotation marks, it is possible this is more of a paraphrase from Dr. Pollack’s long-term memory cells of the event. This meeting served as the foundation for initiating a regional effort to interrupt poliovirus transmission in the Americas. The goal of polio eradication in the Americas was declared in May 1985.

It is almost certain that very few infectious diseases physicians who started practicing after 1993 have ever seen even one case of measles in the United States. Yet those of us who started seeing patients before the late 1950s (and those of us who worked and studied overseas) saw measles as one of the most common recognizable viral diseases occurring in children, usually by age 15 years. Before the introduction of live measles vaccine in 1963 — and subsequently a measles vaccine combined with rubella, and another measles vaccine combined with rubella and mumps, or MMR, in 1971 — virtually every single human in the U.S. over 15 years of age had experienced an infection with measles virus. During the decade before a measles vaccine was available, it is estimated that 3 to 4 million people were infected each year, causing up to 500 deaths and more than 45,000 hospitalizations, many with encephalitis.

Vaccines have been a wonderful addition to the medical armamentarium and have made major inroads in reducing morbidity and mortality due to infectious diseases. They have been the mainstay of effective public health prevention activities. That said, no vaccine is perfect, both in terms of vaccine efficacy and safety; no vaccine has demonstrated 100% efficacy, and there are certainly negative effects experienced by some vaccine recipients with all vaccines. The latter observation — negative effects — has led to a movement of parents refusing to vaccinate their children based on perceived risks of the vaccines along with a lack of sufficient perceived benefit. This movement is particularly strong in certain communities in the Western United States.

It is time for another update on the Middle East respiratory syndrome coronavirus situation globally. To refresh memories, MERS-CoV has been circulating in the Arabian Peninsula for some time now. The virus was first identified in September 2012, after a fatal severe acute respiratory illness, or SARI, with renal failure presentation in a Saudi Arabian male. Within a few days of publication of a report on this case in ProMED-mail, physicians in the United Kingdom identified another case of SARI and renal failure in a Qatari citizen who had been medevaced to the U.K. for treatment. Retrospective studies on specimens from fatalities due to SARI in an April 2012 outbreak at a Jordanian hospital ICU also identified MERS-CoV as the etiologic agent.

In May 1985, the director of the Pan American Health Organization proposed that polio be eradicated from the Americas region by 1990. Seeing the progress of the efforts in the Americas, the World Health Assembly passed a resolution launching the Global Polio Eradication Initiative in May 1988.

It has now been 3 years since the Middle East respiratory syndrome, or MERS, coronavirus was identified in a Saudi male with a clinical presentation consisting of severe respiratory illness and renal failure. During this 3-year period, we have watched the poorly orchestrated front-burner, back-burner shuffle, as transmission of the virus heats up and then cools down, only to heat up again ... and cool down again, not unrelated to the perceived threat of MERS to the industrialized world.

As physicians who have actually seen patients with tetanus, diphtheria, smallpox and poliomyelitis, we are appalled at the effectiveness of the anti-vaccination movement in the United States. The issue today is the resurgence of measles, but tomorrow it may be any one of the other vaccine-preventable diseases.

One year ago — 18 months into the outbreak of the Middle East respiratory syndrome, or MERS, coronavirus — we prepared an editorial on the status of the MERS epidemic. As of mid-February, we are now 31 months into the outbreak.

The severe acute respiratory syndrome outbreak in 2002 and 2003 led to more than 8,000 infections worldwide and killed close to 10% of those infected.