Polio: The Odyssey of Eradication by Thomas Abraham (review)

Polio: The Odyssey of Eradication is a comprehensive history of the effort to eradicate polio, spanning from Roosevelt's founding of the National Foundation for Infantile Paralysis to the modern program's struggles to eliminate polio from Pakistan. The book is quite simply the best comprehensive history of polio eradication I've ever read. It is an accurate, illuminating narrative suitable not just for those interested in polio but for those considering the ethics and methods of eradication programs more generally. It would work well in the classroom and is highly recommended reading for anyone interested in the history of global health programs.

The book opens in Karachi, Pakistan, where vaccinators struggle to deliver the oral polio vaccine in a community that doesn't trust them. The area is one of the world's last reservoirs of wild poliovirus, which has proven stubbornly resistant to eradication despite the Global Polio Eradication Initiative spending a billion dollars a year on the effort. This vignette introduces many of the themes that resonate throughout the book, including the tension between global goals (polio eradication) and community needs (basic sanitation and health services), and the ethical complexities that arise while attempting to eradicate a vaccine-preventable disease in places with poor routine immunization.

Much of the story in Abraham's book has been told before, in excellent histories including David Oshinsky's Pulitzer Prize–winning Polio: An American Story and William Muraskin's Polio Eradication and Its Discontents.¹ These earlier books cover specific time periods in depth. Abraham's achievement is in tying all of this material together into a comprehensive narrative, showing how midcentury fears of polio in the United States led to a global eradication program with deep tensions at its heart. Abraham's thoughtful, balanced discussion avoids the hubris of polio eradication's champions as well as the cynicism of the project's detractors. He gives polio eradicators credit for a heroic effort that has reached long-neglected populations, even while he explores complex ethical questions about the project's history and trajectory.

Abraham conducted many interviews with key players in the eradication program and followed the program in settings from the Rotary Convention in Atlanta to door-to-door vaccination in Karachi. This original research, along with a vibrant writing style (Abraham has spent much of his career working in health communications), gives the book an engaging immediacy.

Abraham makes beautiful use of South Asian examples to illuminate the ethical debates at the center of polio eradication efforts. In a few scattered places discussions of some areas in India and Pakistan can lean on stereotype. For example, health systems in Bihar are far from perfect, but it's not true, as Abraham states, that they have "changed little" since the smallpox eradication era (p. 157). Overall, however, the discussion is nuanced and sensitive.

This is the rare book that would work well in the classroom at a variety of levels. Abraham does not assume preexisting knowledge on the part of his readers, and he gives comprehensive explanations of key issues including the biology and epidemiology of the poliovirus, the structure of global health institutions, the debate between those favoring vertical programs and those championing primary health care, and political aspects of global health programs. All of this, coupled with the easy, accessible writing style, would make the book work beautifully in an undergraduate classroom, giving a vivid view of the complexity of programs that look good on the surface.

At the same time this book would also have a great deal to offer a doctoral seminar. In particular, its detailed description of the complex politics of global health decision making is illuminating, providing surprising insights into a range of issues including the exact mechanisms by which dissenting voices are sometimes sidelined and how blame for problems is shifted from global decisions to local implementation. Pairing this volume with a book on smallpox eradication like William Foege's House on Fire...