By Matt Gibbs
My mother, Margaret Gibbs, is seventy years old and doesn’t look a day over sixty-nine. Aside from a pronounced limp on her left side, caused by polio, Mum is the picture of health. The disease hasn’t defined her life, but it has been a presence. A spectre at the feast, if you will. Mum gives it a curt nod when it rears up and gets on with her day, as she has done since she was seven.
Margaret Crawford has just started at a new school in Paramatta, a big suburb in Sydney, Australia. For a girl who loves books and learning — and is starting to harbour an ambition to become a schoolteacher — going to school isn’t a hardship. But one warm Spring day, Margaret is confused. Yesterday, walking wasn’t painful. Today, hurrying to get to school, her left leg is dragging — it just won’t move properly — and her younger brother refuses to slow down. The bell rings just after Margaret hobbles through the school gates, exhausted. Later that day, to her mortification, Margaret wets her pants. By home time, Margaret is almost too tired and upset to tell her mum. It is 1956 and Australia is near the tail-end of its last polio outbreak.
Over the next couple of days, the pain sharpens, the leg becomes heavier. The wife of the headmaster is in the playground and notices Margaret struggling with her leg. Her own daughter had contracted polio earlier in the outbreak and she raises the alarm. Quite quickly, Margaret is carried to the Doctor’s clinic down the road, then the Royal Alexandra Hospital for Children in Camperdown. Margaret is tested and doesn’t like it. She is told to use a potty in the middle of a room with other people, the doctors and nurses. Even seven-year olds have a sense of dignity, but no one seems to understand that. The tests confirm polio. Margaret Crawford has polio. There is no need for the question “Is there a cure, doctor?” because Margaret’s mum, a former nurse, knows the answer. No. There is no cure. There is observation. There is treatment. “Take little Margaret home and let her rest.” Little? Margaret grumbles to herself. I’m one of the tallest in my class, thank you very much. They go home and Margaret is helped into bed, unhappily. The dull pain slugging its way up and down the lazy left leg two days ago becomes paralysis.
Knowledge about polio — or Poliomyelitis, to give it its drag name — took a long time to grow. There is evidence that it has bothered humanity for thousands of years, but the first recorded case of the virus is that of Sir Walter Scott in 1773 who contracted polio as a young child and remained lame for the rest of his life. The first clinical description of polio emerged in 1789 from the work of the British physician Michael Underwood. In 1840, a Dr Jacob von Heine theorised that the disease may be contagious. But it wasn’t until 1908 that Austrian physicians Landsteiner and Popper concluded that polio was caused by a virus. Compare that timeline to Coronavirus and we might have a little more patience for the apparently slow-moving immunology train.
I feel sorry for us right now, because with such strong, complex health systems — including immunization programmes — in Europe, Australasia and North America, we’re not used to disease disrupting our way of life. We’re not used to hearing news of hundreds of people dying every day from the same disease. We’re more likely to shake our heads in detached sorrow at the shocking fatalities of an Ebola outbreak in West Africa or express mild concern about SARS or Swine flu on the other side of the world. Or perhaps we look back with safety at the distant history of the Spanish Flu pandemic (which actually started in the USA) in 1918–20 or the Great Plague of London (1665–66) or the Black Death in the 1300s. But considering them altogether and what is happening to us now, it’s not so far-fetched to suggest that, along with conflict, diseases — how they behave and how we react to them — shape the history of humanity.
Margaret and her parents don’t know — and will never know — exactly how she caught polio. It isn’t talked about much because in 1950s Australia it’s a little bit shameful. Everyone knows that you catch polio by touching an infected person who hasn’t washed their hands after going to toilet. Or by eating food and drinking water touched by such a person. Margaret’s mum is perplexed; as a former nurse she keeps the house cleaner than a hospital. Could it have been when Margaret and her brother stayed on their Grandparents farm in Mittagong over the holidays before school began? Her Grandparents take such good care of them, but they have an outside toilet and no running water. They’d have baths heated by a chip fire. Or could it have been someone at the new school? It can take up to three weeks for an infected person to show symptoms, so who knows? Margaret is not immunized. The Salk vaccine — the first of its kind for polio — had been developed just months earlier and Margaret was not one of the first to receive it.
Just missed it! For Mum, this is one of history’s frustrations. But the vaccine worked for the kids to follow: 1956 was the last of Australia’s polio outbreaks and thanks to a national immunization programme, the last polio case was reported in 1972. Indeed, the vaccine put pay to outbreaks in most Western countries. Salk’s product was replaced in the 1960s with the development of the oral Sabine vaccine, which was easier to administer; just a couple of drops in the mouth of a child and that’s it (My UK friends tell me that they were given a sugar cube to remedy the bitterness of the vaccine, a treat hardy Aussie kids clearly didn’t need). Australia was among 37 Western countries to be declared polio-free in 2000.
Any new parent would probably be able to reel off the vaccination schedule for their newborn’s first twelve months. Other vaccinations then follow throughout childhood. Some vaccines offer lifelong protection, some need to be boosted throughout our lives. Starting immunization efforts early means starting protection — and protective behaviours — early. This is another way disease can shape lives: requiring us to develop behaviours that distance us from the threat.
However, immunization is not just about protecting individuals. It is about protecting susceptible populations. During the coronavirus pandemic, some governments discussed ‘herd immunity’ as a strategy to manage an outbreak or as a ticket out of lockdown. For many watching the news at home, this may have been the first time they heard this phrase. Put simply, herd immunity (we, the people living near each other, are the herd) is reached when the majority of the population are immune to the disease, so there is less opportunity for the disease to spread to those who are not immune. The chain of infection breaks. This strategy is used effectively all over the world through vaccinations. The percentage required for protection varies depending on how contagious the disease is. It’s around 80 per cent for polio and as high as 95 per cent for measles. There have been estimates of around 70 per cent for coronavirus. Herd immunity helps to protect the most vulnerable. For example, twenty years ago, a sudden, acute health issue left one of my best friends with a compromised immune system. Doctors have advised her against ever having vaccinations, even for the flu. Herd immunity helps protect people like her. This is something that anti-vaxxers struggle to comprehend. Or they may simply take advantage of it, using the logic that their child does not need to be vaccinated because most other children have been. Herd immunity starts to fall down if more and more people take that attitude. I don’t mean to dismiss the integrity of personal choice, but it’s important to stress that sound public health is not built on an individualistic culture.
From the above definition, we might start to think that using herd immunity as a strategy to deal with a new disease like coronavirus — the immunology of which is largely unknown — is a risky little game. Using that logic, my Mother was part of herd immunity by default, which cost Mum the use of her legs for a year as a child and untold physical pain and embarrassment for years to come. Herd immunity as a result of immunization campaigns, working towards a percentage of the population, is predictable because it is controlled and does not involve people suffering from the disease. That is how diseases are controlled — and sometimes even eliminated entirely.
2020 will be a year that we remember for years to come. It should have been the year that marked polio being declared eradicated around the world. This has come about through a multi-billion-dollar initiative over several decades.
Margaret screams. She doesn’t want to — it’s not nightmares — but the pain is too much. A constant, terrible pain that, like a monster under the bed, becomes worse at night-time. Her mum comes in, gently cradling her crying little girl, pushing pillows under the leg, shifting her position slightly to take the pressure off and helping her sip water to ease the pain. None of it helps. The leg just aches and aches and aches. There is no medicine, no paracetamol (it’s only just become available and isn’t widely used yet). This goes on for a long time.
Mum or dad carries Margaret upstairs to bed. If it’s mum, it’s a piggyback, which at least is a little bit of fun. Margaret also needs help in the bath, which is infinitely better than the bed baths she had to endure in the first few months of the paralysis. But the Robur tonic continues for ages. It’s a thick, gloopy malt mix served on a dessertspoon and Margaret can’t help but pull a face when she slurps it up. It makes a sticky coating on her tongue.
Day times are different. The pain is less intense; more like an annoying little brother, present but not troublesome. Her mum is doing parish work in a small room off the kitchen and Margaret lies down on a day-bed, doing work sent from school or reading a book, with Henry the cat for company. On weekends, the cousins sometimes pop in to play, but Margaret stays in the corner with her colouring book or novel. No one can really understand how it feels. Margaret is lonely.
The doctors check fairly regularly, but there is nothing they can do. One day, Margaret’s dad and mum drive her to the clinic for a check-up. He gets out of the car and dashes across the busy road. Margaret watches him go and she can’t — she just can’t — move. He’s forgotten that she can’t walk and he looks back with a quick, anguished look. He dashes back and picks Margaret up. They make their slow way over.
On one trip to the hospital, Margaret is waiting while her parents talk to the doctors. Looking around her, she sees some other children, but they’re wearing splints and walking with crutches. Peering over the window behind her chair, Margaret notices a child wearing braces on her legs in bed. When she asks her mum on the way out, she tells her that those kids had polio too. At least I can go home, Margaret thinks to herself, and holds her dad tighter as he carries her out. A bit later, Margaret learns about the iron lung — a huge contraption that helps people to breath. The polio had all but paralysed their lungs.
One of Margaret’s great passions is Ancient Egypt. The extraordinary burials of their kings and queens fascinate her. The intricate death masks and detailed sarcophagi. And the storytelling hieroglyphs; not just pretty pictures, but individually rendered figures. The Anubis, the god come to welcome the king into the afterlife, the Queen of a neighbouring country with a fat leg — likely a depiction of elephantiasis. And there, on the funerary stelae of a priest, about 3,500 years ago… a male figure with a withered limb, leaning on a crutch. Margaret does more reading. They think it’s a depiction of a man with polio. Imagine that.
As a global initiative, polio eradication started fairly slowly.
There is noticeably little historical information about the spread of polio in Africa, South America and Asia. Whereas outbreaks in the US and Australia made the news, polio was a silent epidemic in poorer parts of the world, as with most public health crises. Disease surveillance in these areas was limited and health services were basic and not part of national health systems. It wasn’t until the 1970s that lameness surveys showed that polio was prevalent in developing countries. In 1974 the World Health Assembly created the Expanded Programme on Immunization (EPI) to bring vaccines for major childhood illnesses — including measles, pertussis and polio — to the world’s children. Cases of polio in the Western world had dwindled considerably, thanks to these national immunization programmes, supported by strong health systems. While these efforts doubtless spared millions of children from catching polio, more than 1,000 children were catching polio worldwide every day well into the 1980s in 125 countries.
In 1985, Rotary International launched an eradication programme, ‘PolioPlus’, the first internationally coordinated private sector campaign for a public health initiative. The campaign was based on the WHO-led efforts against smallpox, a disease which was eradicated in 1979. In 1988, the World Health Organization followed suit, passing a resolution to eradicate polio by the year 2000, joining forces with Rotary, other donors, NGOs and UN agencies to form the ‘Global Polio Eradication Initiative’ (GPEI).
In July 1957, Margaret goes back to school. Her legs are still crampy — and will be for some time — but she can just about walk. School has changed, though. She isn’t able to join in many sports, just tunnel ball and captain ball, both of which don’t require much movement. This goes on for most of Margaret’s schooling. And the sports teachers are unforgiving. Nobody seemed to understand that physically she just can’t do it. “I’m not lazy! I want to do it,” Margaret feels like saying but doesn’t. Margaret comes to hate PE.
One of the first symptoms — the incontinence — also lingers. For most of her school years, Margaret is unable to control her bladder. It is dreadful, embarrassing, mortifying. The muscles simply can’t be controlled. Looking around at the other kids, Margaret doesn’t feel like them. It’s a strange feeling, like she’s not whole or something. Yes, that’s it: not whole. No one says anything, not even her quick-witted brothers. It’s just a private feeling. Margaret is lame and not whole. Later, she would think, this is what it’s like to feel like a damaged person.
Margaret’s mum and dad buy her a second-hand bike — at the recommendation of the doctor — to help strengthen her legs. It doesn’t really help much, but it’s a sort of freedom, so Margaret does what she can. They don’t know this now, but the polio has permanently damaged the muscles in Margaret’s legs. Movement will ameliorate a bit and the pain will eventually disappear for a time, but there is no reclaiming the atrophied muscle fibres. But the muscles that can still work slowly become stronger.
By her final years at school, Margaret can play tennis and softball and even impressed a family friend on a special treat to the golf course with her brothers. “Margaret has the best swing in the whole family,” he says. There is also a traditional Parramatta High School march through the town to their athletics carnival that her mum and baby brother come to see. This is something I can do now, Margaret thinks, waving at her mum. She comes last in the races, but it doesn’t matter: this is the furthest Margaret has walked and run since the polio.
Mum had the best care available with the knowledge that was available at the time, but there was no cure. Similarly, the NHS in the UK is providing world-class care to acute sufferers of coronavirus. Health systems in mum’s childhood Australia and in the UK are well-established, with years of accrued convention, knowledge and skills. Even now, a lot of countries in Africa, Asia and South America do not have this.
Measles, malaria, diarrhoea, pneumonia, prenatal complications and acute respiratory infections still kill children in many countries in Africa, south-east Asia, the Pacific Islands and South America. While all of these things also kill children in Europe, Australasia and North America, they do so at much lower levels. Measles outbreaks in the UK, US, Albania, Czechia and Greece have happened recently where immunization rates have lowered — usually where parents choose not to protect their children. The main reason children in the West are at much lower risk of dying of the above conditions is that these countries have robust health systems in place that children and parents can access quickly and — in most cases — at low or no-cost. Even in the UK where the efficacy of the National Health Service has been eroded by successive governments, the health system boasts low infant, child and maternal mortality rates. For many communities in developing countries, this is not their reality.
In the 1980s, so-called Structural Adjustment Programmes — conservative economic policies instituted by the IMF and World Bank — required governments in Africa, south-east Asia, the Pacific Islands and South America to increase privatization, liberalise trade and foreign investment and balance the deficit in exchange for loans. This clever-sounding plan resulted in massive debt — which many third sector voices demand to be cancelled — and very little, if any, economic growth. Invariably, social spending was slashed, collateral damage of the austerity required to balance the books. This drop in expenditure meant that there was limited investment in health systems, which eventually contributed to the poor local response to the HIV epidemic, particularly in Africa, and the Ebola crisis. Guinea, Sierra Leone and Liberia had scant domestic capacity with which to respond.
With weak health systems in place, the impact of disease is much greater in low-income countries. Indeed, when the GPEI was set up, it was designed as a vertical programme. That is, it was focussed solely on polio and every part of the programme design was intended only to fight polio. It was single-minded and relentless and expensive. And very effective. The programme established everything from policy, to procurement, to training, to the cold chain. The cold chain is the chain of facilities that keep the vaccine at its requisite temperature from the lab where it’s made to the end-user, the child. This includes refrigerated containers for transit, refrigerators at national warehousing level to cold boxes and motorbikes for transportation to the village. The programme also brought hygiene and sanitation messages to communities — handwashing being one way to limit the spread of polio and, as we know, a raft of other diseases. In other words, the GPEI established a mini-health system in each country of operation. Inevitably, other health services started piggy-backing on the systems, structures and mechanisms the polio campaign maintained, especially other vaccinations, including measles and pertussis.
Immunization was at the heart of the polio eradication efforts. Specifically, the game changer for eradication has been National Immunization Days (NIDs), which aimed to vaccinate all children in any given country on a single day. NIDs relied on a fully functioning cold chain and volunteers, trained by healthcare professionals. Critically, it also relied on effective community mobilisation: the health experts reaching out to village chiefs, religious leaders and local government to help them promote vaccination in communities; and to educate parents on the importance of protecting their children. Sometimes even warring factions called a truce to enable these NIDs to go ahead. In 1999, for example, the UN Secretary General negotiated a truce in the Democratic Republic of the Congo for immunization. In a country still ravaged by war, DRC has not reported a wild poliovirus case since 2000.
Despite polio having disrupted so much of her schooling, Margaret won a scholarship to university. There is so much to look forward to: studies, parties with friends and a drink (or two). Becoming an adult seems to mean becoming polio-free. But even these new, would-be carefree years are coloured by the condition. Before studies start for her teaching degree, Margaret’s leg is tested. The embarrassment of her polio years returns and Margaret focuses on keeping her dress with little pink flowers down as a doctor pumps the left leg up and down to test its mobility.
Upon graduating and entering the teaching profession with an initial commitment of five years — as is the done thing in these days — Margaret is told that her superannuation would be penalised, simply because her polio makes her a liability. For how long could a polio-sufferer contribute to the workforce? What a memory this will be when retirement taps cheerily on the shoulder some forty years later.
No other public health initiative has so successfully accessed the most vulnerable and hardest to reach children, despite armed conflict, migrating communities and natural disasters. For example, in the Republic of South Sudan “polio vaccination campaigns are the best planned public health arrangements in the country, covering [over] 80 per cent of the population” while similar programmes cover between just two to ten per cent. As a true testament to the commitment of these campaigns, South Sudan has not reported a case of wild poliovirus since 2009, despite a war raging in most parts of the country.
I travelled to South Sudan two years ago as part of the polio initiative. The GPEI had already starting ramping down its huge amounts of funding. With an original target date of 2000, it was at that point already well overdue. The timeline for withdrawal of funding was not long. Within a few years, South Sudan would be without the GPEI funds. Due to the other health programmes that had been taking advantage of the polio programme — hygiene messages through community mobilisers, other vaccinations using the cold chain, basic training for health workers — the end of the polio money represented the collapse of the entire health system.
South Sudan is one of the poorest countries in the world. Infrastructure is limited, social services rely entirely on external support, mostly through foreign aid, and even local private sector — business and philanthropy — is scant. Not all countries in Africa, Asia and South America face the same level and complexity as this one, the world’s youngest country, but their health systems are basic and therefore less able to accommodate the acute health care needs that may be required in the case of successive waves of coronavirus outbreaks.
The impoverishment of health systems such as South Sudan’s brings into sharp relief the gap between rich and poor nations. The withdrawal of US support for WHO — easily the biggest funder of public health in the developing world — will directly affect the capacity of low- and middle-income countries to respond to coronavirus and other public health priorities. While the US could benefit from the global experience and repository of knowledge WHO has, it does not need WHO for operational support. Most countries in Africa do. WHO is positioned within the Ministry of Health in these countries — that is how they operate — and in some case, they lead public health systems, such as they are, in poorer countries. Withdrawing US funding — which compromises a not insubstantial portion of WHO resources globally — can only serve to diminish capacity in the neediest countries. If that happens, there is a risk of coronavirus going unchecked in many African countries, as polio was before it.
The original ambitious target year of 2000 to eradicate polio has come and gone. One benefit has been that newer donors have come to the party, including the Bill and Melinda Gates Foundation, ensuring funding didn’t dip and the end-goal remained achievable. Some setbacks, however, were unavoidable and included a series of conspiracy theories and ignorant trash-talk of anti-vaxxers.
At the risk of displeasing the current President of the United States of America, fake news was not invented during the 2016 Presidential campaign. It has been around since the first bipedal humanoid (or since Adam and Eve — you decide) and it has left several marks on the polio eradication initiative. In northern Nigeria, for example, polio campaigns were suspended for just over a year from September 2003 when some clerics spread the rumour that the polio vaccine was laced with hormones to cause infertility as part of a US-led plot to reduce the Muslim population. This led to a rise in new infections and transmission of the virus to neighbouring countries that had been declared polio-free. It took US$ 500 million to get the rates back to where they had been prior to that time. But the rumours did not abate. In 2013, ten vaccinators were shot dead during a polio National Immunization Day due to similar rumours.
These sad stories point to the pressing need for transparency in public health initiatives and to ensure open communications with the public at every stage. It is easy for white, well-educated people like me to sneer at people who believe in conspiracy theories and circulate information that is not supported by science, but the fear is real, particularly when it is something so shockingly outside of our control.
I’m less sympathetic to the efforts of anti-vaccination campaigners and their abject refusal to consider the scientific evidence of the effects of immunization. Anti-vaxxers come from different walks of life and perhaps would have been contained as an ignorant minority were it not for a man named Dr Andrew Wakefield. His story is a saga. The Lancet published his 2001 paper that alleged a link between the Measles, Mumps, Rubella (MMR) vaccine and autism in children, causing a media sensation and widespread panic among parents. When his study was tested, no scientist could replicate his findings, which he later admitted to fabricating. The Lancet apologised and the good doctor was struck-off. But that part of the story remains in the shadow. Some people still take it as gospel that MMR is linked to autism, even though no replicable study has proved this point, such is the power of fake news. This case saw a discernible dip in immunization across the Western world and continues to fuel fear among the ignorant.
In all likelihood complacency played a part in this dip too. Immunization rates in the Ukraine, for example, have been going down in the Ukraine since 2015. It may also be a case of some parents, not having been exposed to disease outbreaks themselves, having little understanding of the critical importance of immunization for the health of their child and community. This may be symptomatic of complacency that comes with living in a heavily protected public health bubble. With the coronavirus knocking on every door, this is could well change.
Thankfully, anti-vaxxers have had little, if any, impact on the polio eradication campaign. Just to be clear, I have no vested interest in the vaccine business. I’m just the son of a woman who has suffered greatly for want of a vaccine. I have also witnessed the life-saving efforts of vaccination programmes. Immunization is very simple: it is about honouring public health obligations all governments owe to their citizens.
We’re at the beginning of our relationship with the coronavirus. Thanks to the Global Polio Eradication Initiative we are all but at the end of our relationship with polio. Almost, but not quite. This means that at this moment, there is a little girl somewhere in northern Nigeria or Pakistan or Afghanistan who has recovered from polio. In some sixty years’ time she might be telling her story of polio to her son. Similarly, you might be telling your grandchildren about the time the world stood still, waiting for a new virus to pass. And I’ll continue to tell the story of when my colleague put a live chicken in the back of our car in Sudan the same day that a bird flu case had been reported just across the border in Egypt.
Two decades physically untouched by polio. That was unexpected. And most welcome. In her twenties, Margaret discovers the joy of high heeled shoes and skirts that go above the knee. These legs feel no pain, these shoes cause no pain. Friends comment on the best legs in Western Sydney (and a blushing Margaret stands a little taller). A career, a romance, a wedding and three healthy children. Each event is a gift.
Then one day, not long after Margaret has turned 40… A neighbour: “why are you limping?”. A colleague: “Looks like the arch has collapsed on your foot, Marg, your shoe’s falling off.” An embarrassment: tripping over on the footpath at school. Initially, Margaret doesn’t think of the polio. It’s now been out of her life for longer than it was in it. The first doctor has no idea what is wrong, lazily suggesting that Margaret should lose some weight. The next doctor, while sympathetic, can shed no light.
And then a year or so later the pain begins in the legs, usually at night-time. It is a pain that Margaret’s body has not forgotten, although she hasn’t felt it in thirty-odd years. Only this time, it’s adult-sized. And paracetamol is available over the counter.
The third doctor knows exactly what it is. Post-polio syndrome. It is 1996 and “we don’t know much about it”. An orthopaedic specialist fashions an orthotic for Margaret’s shoe and she has a dreadful realisation: those lovely high-heeled shoes are no longer an option. Out they go. Sensible, hardy lace-ups take their place. Just what every stylish person wants to hear. Well then. It’s back, Margaret thinks. A dull thud of disappointment in her gut, then resolve to get just get on with it.
Pain management. Really, that’s all that could be done. A good orthotic to help Margaret’s walking, strong painkillers, a foot and leg massage from a loved one, and rest. It is only after the late-effects polio kicks in that the doctors are able to tell Margaret with certainty that parts of her muscles had atrophied and there is no coming back from that. Margaret’s spine had been damaged by the original infection, manifesting itself in a lame left leg. This leg drags more now than it did, making steps difficult and even door frames present a tripping hazard. Falls have been known, causing sprains, a left heel bone break and knee wounds, all because of a weak left leg. Margaret thinks of it as her “sinister side”.
Margaret and her doctors seem to be learning about post-polio syndrome at the same time. How is works, what is does, etc. In church one Sunday, Margaret — known for her beautiful soprano floating up from the middle pews — notices that her breath no longer carries all the way through each verse line. A quick intake halfway through is the new norm. Is this just age, she thinks, or the post-polio? With the spinal damage the latter is entirely possible, and the doctor agrees. Margaret is alert to the possibilities that polio continues to offer. If the pain weren’t quite so intense, post-polio syndrome would be almost fascinating. The legacy lives on.
While polio has all but been eradicated, a cure has never been found. However, polio eradication efforts have not only ended polio in 122 countries but also created health systems for tackling myriad other health priorities, such as Ebola. Countries through Africa, Asia and South America have professionals and volunteers who are trained on the functioning of the cold chain, health promotion, vaccine procurement and vaccine administration. Polio work has helped to put in place widespread public health measures, such as disease surveillance and cross-border information-sharing, critical to further disease prevention and response. As the director of public health in South Sudan said to me “disease knows no borders, requires no visa”. Critically, the story of polio proves that getting rid of smallpox wasn’t a fluke of history: diseases that effect — and sometimes take — lives can be eradicated.
This coronavirus may one day be consigned to Mum’s history books. When a vaccine is found and if the virus doesn’t mutate into new strains every year, it could be eradicated. Or it could become like the common flu, with epidemics avoided by a rigorous annual immunization programme. In any event, we will all now be telling the story of this pandemic. All of our stories will be different. Some will regale each other with lockdown tales of haircuts, weight-gain and boxsets. Others will forever mourn the premature deaths of loved ones. Frontline workers will reel from the unprecedented demands on their capacity and, hopefully, be proud of surviving professional tests that they couldn’t have imagined before the crisis.
I suffered from some childhood illnesses as a baby — before I was old enough to be given vaccines. I caught both measles and whooping cough before I was one year old. Like polio, they are contagious diseases. Unlike polio, they seem not to have had a lasting impact on my health. Every day — even before coronavirus — our lives are touched by disease. Our childhoods are spent with other people trying to protect us from or help us get over disease, a responsibility that we take on ourselves as adults. The history of disease is the history of humanity, just as conflict — over borders, resources or ideology — defines our world.
Recognising that does not mean giving up and letting it happen — it will anyway — but it is about acknowledging that disease is not an aberration from our perfect lives. It is part of life and we can do something about it because we have done it before, and we must do it again. Accept the reality of disease and get over it. Make it better. What is it we’re living for — working, earning, spending — if not to make life better for ourselves and each other? That means investing in the arts, spending time with loved ones, and ensuring that there are sufficient resources for our physical, mental, social, and emotional well-being.
Mum is clear that she would rather not have had polio. Among other things, Margaret Gibbs may still be wearing those high-heeled shoes she loved so much. Going for long walks might be nice as would crouching down to hug the smaller grandchildren. I’d like to be able to suggest reasons why polio has been a gift. But having lifelong effects of a disease is not a silver-edged cloud story: having polio was a pain and that’s that. For me, the gift is having a caring, beautiful human being for a mother. Mum survived polio and that is a wonderful gift. And in surviving, mum has been able to tell her version of a story that people have been telling for years.
Mum and I have been chatting about this on the sunny verandah that stretches around the gorgeous pad in which my retired parents have nested. “Hang on a moment,” Mum says as she gets up from her sun chair, grimacing slightly as her left leg bears weight again. Popping inside for a few minutes, mum remerges with her Joan Collins sunglasses and an ancient history book. She flicks it open to a well-worn page and points to a hieroglyph of the person on crutches. “See? That’s me. But four thousand years ago.”
 Transition Independent Monitoring Board, The End of the Beginning