I am Dr. John Sever, vice chair of Rotary’s International PolioPlus Program and I’ve dedicated my life to eradicating polio. This year there have been just 6 cases of polio due to the wild polio virus - we are on the verge of making polio history....

Doctor, thank you very much for your tireless work.

As a fellow Rotarian, supporter of the Polio Plus program for over 10 years and someone who has contact with polio survivors through work and personal life, I have one question.

What would be the best way to communicate the importance of continued support for this program to younger generations that we interact with and recruit as Rotarians everyday?

While I am very excited by the support, I am concerned that with this influx of support from the Gates Foundation that some may think, "oh that should do it." When the truth is this is a long road we are going down.

I apologize for the run-on sentences.

I remember vividly the fear of polio when I was young and when my own cousin developed paralytic polio and the great sadness in my family because of this.  I remember her need to have multiple surgeries and braces in order to walk.  But, in general, each summer the swimming pools would be closed and contact between children kept to a minimum because of the fear of polio.  And my father was a practicing physician and I remember going with him and seeing homes where there was a sign on the door: Quarantine and Keep Out Because of Polio.  Younger generations won’t remember this. This experience is a distant memory in the U.S. but is still very real for those living in polio-impacted countries.  I think that we need to communicate that struggle to younger generations.I think it is important to emphasize in meetings and literature the value of eradicating polio. We have almost reached the point of accomplishing the goal of eradication, but we need to push over the finish line to accomplish the goal.  In some regions, like Afghanistan and Nigeria, they’re still having experiences with paralytic polio, which the United States hasn’t since the 1980s.  That’s why it’s important to stay engaged with this effort across the world.

Hello Dr. John Sever,

Thank you for your service. My questions are :

1. There have been outbreaks of vaccine-associated polio in the past. How difficult was it to restore people's faith in the vaccines?

2. Are there any goals for eliminating oral polio vaccine, and using only injectable polio vaccine?

There have been outbreaks of vaccine associated polio, but they are extraordinarily rare - 1 in about 2.7 million doses of the vaccine administered. And these have been met with intensive immunization in the areas.  With that approach the outbreaks have been put under control.  There is an acceptance of the immunization program to proceed. In most areas of the world, parents are eager to protect their children from paralysis and there is strong acceptance of the vaccine.

Once the wild poliovirus has been shown to no longer be present, we anticipate we will transition to using only the injectable polio vaccine. But until that time, it is necessary to continue with intensive immunization with the oral polio vaccine. A combination of both vaccines (oral and injectable) is necessary to eradicate polio.  

Do asymptomatic carriers exist for polio and would we need to continue to inoculate even after zero cases? And for how long?

Most people infected with polio don’t exhibit symptoms. Only about 1 in 200 people infected with polio are paralyzed by the disease. We will need to continue inoculation for at least three years after we reach zero cases and the virus is eradicated – very likely for several years beyond that time. 

What got you interested in the eradication of polio?

In 1979, polio was no longer active in the United States and a few other countries.  So, we knew that it could be controlled and eradicated.  But most countries in the world were not immunizing for polio.  So, it was important that immunization be taken to all of the children of the world.  And Rotary was interested in accepting this opportunity and helping to immunize the children of the world.  

Thank you so much for your service, and doing this AMA. Apologies in advance if any one of them is inappropriate, but I've got three questions for you:

1. Many people from a select few third world countries are violently opposed to getting their children vaccinated against polio. This opposition is primarily based on different conspiracy theories. A simple discussion with them isn't enough. They refuse to even consider. How can we overcome this, given that they are a hurdle in eradicating polio globally?

2. The rivalry between Dr. Salk and Dr. Sabin is quite famous. Was Dr. Salk ever bitter that Dr. Sabin had violently opposed him?

3. Whom did you spend more time with? Dr. Salk or Dr. Sabin?

Rotary has thousands of members in places like Pakistan. Since they are friends, neighbors and leaders in local communities, they are trusted community voices. Parents trust these members when they talk about the safety and importance of the vaccine. Rotary and its partners also work closely with other trusted community voices. For example, Rotary hosts regular workshops for Ulemas (religious leaders) to educate them on the importance of the vaccine. They then become advocates who go back to their communities and talk about why the polio vaccine is important. Overall, trust and demand for the vaccine in other parts of the world is high. 

Both Dr. Salk and Dr. Sabin were brilliant and highly committed to vaccines for polio.  The inactivated vaccine was used in the U.S. from 1955.  We switched to the live vaccine in 1962.  Today we are using both vaccines together toward the eradication of polio.  Both Drs. Salk and Sabin met with me in my office at NIH and Dr. Sabin moved to NIH in his retirement.  So I saw him very frequently and we worked together on the polio eradication program as well as on developing a new aerosolized measles vaccine.  

which vaccines for other diseases are easiest to deploy alongside polio vaccines, and which are the most difficult (for cost, logistical, political, etc... reasons)?

Some of the vaccines that are being used along with polio include vaccines to prevent cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.  Other vaccines are being considered and require further development and reduction in cost. We aren’t just limited to giving other vaccines alongside the polio vaccine. We can deliver other health interventions as well – Vitamin A, mosquito nets, etc. The polio infrastructure is reaching some of the hardest-to-reach children and we take advantage of that access to provide as much healthcare as possible to them. 

Dr. Sever, early in your career you worked with Jonas Salk. How did that shape your thinking about polio, your career and your life?

I was at the National Institutes of Health doing research in infections in children and pregnant women and prevention of these infections.  I knew Doctors Salk and Sabin because of their work on polio vaccine.  Both doctors visited my office at NIH and discussed immunization.  Dr. Sabin was particularly interested in mass immunization to eradicate polio.  And we discussed this frequently.  With Rotary, I saw the opportunity to take this approach to the international level and to eradicate polio throughout the world.  I invited Dr. Sabin to join me in meetings with Rotary on this topic.  Rotary accepted the eradication of polio as their main program of international service.  

Hello, how do you think we should go about making organizations like Rotary become more a part of a community''s life today such that issues like the one you have working towards can be more easily championed with more people involved?

Rotary works actively to make people aware of its purpose and activities. We have 1.2 million members committed to raising awareness of the importance of polio eradication. Examples of our polio education include major lighting of buildings with information about ending polio now, celebrity endorsements, showing how close we are to polio eradication and creating publications and videos on Rotary’s efforts on polio eradication. And, of course, participating in AMAs. 

Hey Doc, what can people without that kind of money do to help and what's in your cross-hair after Polio ?

Rotary is working actively to raise $50 million dollars per year for the next three years.  Even small donations will help to reach that goal.  People can also help raise awareness of the problem within their personal networks.  Consider contacting your local Rotary club to get involved as a volunteer. We are dedicated to completing the eradication of polio before moving on to other projects.  

All organisms exist for some purpose in our ecosystem. What do you think the purpose was/is of polio? Should we save a bit just in case? I know some is in storage now.

The polio virus has been present for centuries and was shown in Egyptian drawings as paralysis of an individual with a deformed leg.  It appears that polio’s main purpose has been for the virus to survive and multiply and continue its life as a virus.  As other viruses do.  Hopefully we will eliminate its ability to cause paralysis and death to human beings.  Samples of smallpox virus (the only human disease ever eradicated) are kept in highly secure facilities for possible need in relation to research.  Upon eradication, polio virus will be contained in the appropriate facilities where studies will continue.

I drink a can of Coca-Cola^TM everyday, and I’ve never gotten polio. I think this may be the cure. What do you think the chances of Coca-Cola^TM being the cure are?

While I think it’s very unlikely, tests are still ongoing. But I prefer to use the vaccine.  

Why is it up to humans to decide what viruses get to live? This post is unfortunately another example of people playing god and personally I find it wrong.

I’ve always called it playing Doctor.