the fact that they can prove whether the origin is wild or vaccine-derived.
I don't think that is what's interesting or new in those articles and papers.
The new information is this: they have a better estimate of the vaccine-caused cases of paralysis because they have data from when they started and when the stopped the pulse vaccination with OPV, supporting data going back 30 or more years, but showing that the rate of vaccine-caused cases in India is higher than previously thought, which has implications for which treatment is best.
Indeed, the controversy goes back to Salk and Sabin. Salk and the March of Dimes always preferred the safer "killed" virus Salk vaccine over Sabin's OPV, but trials by Sabin in the USSR and later Cincinnati demonstrated the incredible effectiveness of the OPV, precisely because polio enters the body through the intestines. But it was known to be more dangerous even back in the 1950s. Again, it was a risk/reward question. Ultimately, for those areas facing epidemic and hyperepidemic conditions, the Sabin OPV won out over the Salk vaccine because the risk was deemed worth it.
I think you're being perhaps confused by the talk about Type 2 polio. There are three types of polio, and the OPV in use at the time is a trivalent OPV (designated as tOPV in the literature and developed by Sabin circa 1964). If you look at that link to the WHO plan, you can see that part of the plan is to switch to IPV and bivalent OPV (bOPV).
The idea there is that if Type 2 is eradicated in the wild, and you find cases of Type 2, that means it is probably vaccine-induced (or your belief that it was eradicated is wrong). But that does NOT mean that the vaccine is not ALSO causing Type 1 and Type 3 infections. It gives you another tool at the epidemiological level to determine the number of cases of polio you're *causing* by vaccination and, by extension, you can directly attribute *some* of the vaccine-induced cases, but you're still missing those vaccine-induced cases where the wild type still exists. But you still account for those using epidemiological methods as in the IJERP you link to.
That's the point of the Economist article.
The scientific paper you're looking at is not focused on that at all. Rather, they are simply saying that as there are now places that have stopped doing the pulse vaccination in India, they can get a better estimate of the number of cases caused by vaccine and they can more strongly prove a causal relationship, because they can see when pulse vaccination declined and then look at the evolution of cases.
By itself that does not say which vaccine is better, but helps determine the inflection point where you switch from OPV to IPV (and tOPV to bOPV if appropriate).
Look at it this way. Say you have treatment A and treatment B for preventing people from becoming Twitter users.
Effectiveness (percentage of infections prevented)
A: 99.99%
B: 99.9%
Very bad side effects rate (risk of becoming a Twitter user).
A: 0.0015%
B: 0.00015%
Which is better? A is 10X more effective, but 10X more dangerous. Does that make it better, or worse? Well, it depends.
The rate of bad side effects is determined by the number of treatments. But the benefits are proportional to the number of wild infections.
So let's say you give treatments to one million people. Then you expect that B will result 15 people using Twitter who would not otherwise have done so without the treatment. But A will result in 150 Twitter users, which is obviously worse.
Now the question is, how many cases are prevented? If the natural incidence is 10%, that would be 100,000 natural cases of Twitteritis per million. If you administer treatment A to those million people, you still end up with 100 cases compared to the 1000 wild Twitter cases you get with treatment B.
Case A: 100 natural cases of Twitteritis
Case B: 1000 natural cases of Twitteritis
So then you look at the totals
A: 100 + 150 = 250 total Twitter users.
B: 1000 + 15 - 1015 total Twitter users.
And both are astronomically better than the 100,000 cases in the "no treatment" scenario, but the "dangerous" treatment results in fewer overall Twitter users. As a public health official, you have to opt for treatment A, even in full knowledge that some people will be harmed by that treatment.
But what if the natural infection rate is only 1%? Well, your bad outcomes per million treated do not change, but the number prevented does. Now you end up with 10 and 100 so your totals are
A: 10 + 150 = 160
B: 100 + 15 = 115
Again, both are astronomically better than the 100,000 cases in the "no treatment" scenario, but now the "less effective" treatment results in fewer total Twitter users.
You've hit the inflection point. Now it's better to switch to the less effective, but safer treatment as that results in the lowest possible number of Twitter users, which, obviously, is a fundamental social good.
If you go back to the data from South America from the 1980s and 1990s (see my previous post), then you in fact are looking at rates of 1-1.5 per 100,000. If you look at the numbers from India, though, it is much higher. Some is reporting inconsistency (at 60 days, 56.5% in UP were found to have recovered; in some other places those people would not be counted). But a lot of it is probably due to the incredibly high vaccine loads that the Indians were using in the effort to fight this scourge.
So basically, what the paper does is show that the inflection point occurs earlier than you might think based on earlier studies, and therefore India should transition earlier to IPV or at least bOPV with IPV backup for Type 2. And that's the point of the WHO roadmap and the Gates Foundation article as well. New data. New strategies.
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That said, what I was really objecting to was this statement:Gates-supported polio vaccine causes more polio than wild polio
This is incredibly misleading. Sure, because of the incredible effectiveness of the polio eradication programs, the incidence of polio is now so low, that we have passed the inflection point and need to transition to Phase II vaccination strategies. That is a testament to the GOOD that Bill Gates (and Rotary and WHO and others) have done here, not proof of a nefarious plot.
As you state it, the implication is, rather, that Bill Gates is evil because he is pushing an unsafe vaccine on the poor populations of the world. That is simply turning the world upside down. What Gates has done is one of the most significant humanitarian efforts in history. The question is not whether or not there is an undeniable good to what he did there, but whether or not they should have transitioned earlier to a different vaccine.
The problem with the assertion that Gates is evil for pushing a dangerous vaccine is that you can't know that until years later after you have the good epidemiological evidence that the authors give in the study you cite, and the Gates Foundation is adjusting accordingly.
Was Gates a cut-throat monopolist who created a graveyard of viable businesses that died young because of him? Of course. I'm not interested in litigating Bill Gate's past and arguing over whether on balance he has been a force for good or bad when looking at his whole life in perspective.
He is no Jonas Salk or Albert Sabin (two of the GREAT heroes of the 20th century; hopefully we are not going to debate that).
But setting aside anything else Gates may or may not have done, funding polio eradication in India, did
immeasurable good.
It's just that, as the Gates Foundation document and the scholarly articles state, it is time to move to Phase II of the battle (see the paper I linked in the previous post), because India is finally passing the inflection point where the cheapest and most effective treatment is doing less good than the more expensive and less-effective treatment would do due to the fact that OPV has a higher rate of highly negative side effects (death and paralysis).
Gates could have used his billions to build fantasy man-toy rockets like cut-throat billionaire monopolist Jeff Bezos.
Gates could have used his billions to fund climate disinformation efforts like cut-throat billionaire monopolists Charles and David Koch.
But instead, Gates used his billions to rid India of one of the most devastating communicable diseases known to humanity. By 2009, the number of annual cases in India was roughly the same as the number of *daily* cases a decade earlier. Thanks Bill!
