ATLANTA -- Following a walk through nearly empty hallways, there is no receptionist at Dr. Thomas Frieden's outer office. Just a ring-for-service sign. The director of the Centers for Disease Control and Prevention is trying to manage a partial shutdown at an institution where nearly everything is ultimately a matter of life or death. "The longer it goes," he says, "the more complex it is. What isn't an imminent threat to health on day four is on day 10."
As of now, eight of 10 global disease detection centers -- the field offices where outbreaks are identified and countered -- are closed. No processing of blood samples for parasitic diseases is taking place. No testing of counterfeit malaria medicines.
Fortunately, the CDC's polio eradication effort has been largely exempted from the shutdown. It is part of one of the most ambitious medical enterprises in history -- attempting to eliminate a highly contagious virus from the wild. This has been achieved only twice before, with smallpox and rinderpest. The end of polio transmission is a few hundred yearly cases away. Even a brief pause would risk losing ground.
Poliovirus -- which destroys neuron cells controlling swallowing, breathing and use of limbs -- was once a source of seasonal panic in the United States. Epidemics (usually arriving in summer) sometimes caused states to close their borders, with inspectors demanding certificates of health from children under 16. American infections peaked at nearly 58,000 in 1952. (Sen. Mitch McConnell and Rep. Steve Cohen were both infected as children.) As late as 2004, dozens of Americans still lived in iron lungs.
But the use of the Salk and Sabin vaccines has chased the virus across the planet. The last American infections were in 1979 (among Amish who resisted vaccination). This was also the year that Rotary International started a campaign to eliminate polio transmission in the Philippines, beginning a global eradication movement that now includes the World Health Organization, UNICEF, the Gates Foundation and the CDC. In 1999, Type 2 poliovirus (of three types) was eliminated in the wild. India has been polio-free since 2011 -- an important proof of concept. (If polio can be eliminated in northern India -- with its dense population and poor sanitary conditions -- it can be defeated anywhere.)
More than 99 percent of poliovirus transmission has been stopped over the last few decades. But the final bit is the hardest.