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Weakest Links In Polio VaccinationElimination of the ten weakest links impeding the global eradication of polio, as Scott Barrett describes in his paper (Jul/Aug 09), would be productive only through attention to people with poor capacity to fight disease and the basics of poliovirus vaccine storage and field practices during its distribution among recipients. During the twenty-first century, innumerable individuals would be rendered poliovirus-susceptible following cancer chemotherapy or organ transplants. In Piscataway, New Jersey, serologic profiles for poliovirus antibody in post-chemotherapy pediatric patients with several sarcomas pointed toward polio-virus 2 and 3 susceptibility that required revaccination.1 Furthermore, organ transplants are frequent even in countries still endemic for polioviruses. In Pakistan, thirteen centers in Lahore reported more than 2,000 transplants from purchased kidneys. In 2006, foreigners received two-thirds of those transplants.2 Obscure issues linked with poor-quality live vaccine–linked faulty distribution practices were apparent during the 1970s in the United States.3 Recent experiences in rural distribution centers’ health facilities in endemic countries have not been encouraging. A mere switchover to inactivated poliovirus vaccine would not by itself eliminate the inadvertent administration of poor-quality vaccines. Even the current inactivated poliovirus vaccine lots, including any with enhanced potency, require constant storage between 2 and 4 degrees Centigrade and are not to be frozen.4 Any fiscal input toward the development of environment-stable inactivated poliovirus vaccine would augment efforts to strengthen ten weakest links. Only such vaccines would counteract any calamity linked with a bioter-rorism misadventure.
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