The fight against Poliomyelitis in the world is about to end. This new world scenario, in which a healthier and more coherent life prevails, has only been the result of the joint work between several countries in the world, led by their governments, non-profit organizations and private entities, as has been exercised by the Center for Medical Research, Cevaxin, in Panama City. Poliomyelitis, being a viral, infectious and easily contagious disease, requires timely treatment to prevent its most severe form from causing nerve damage, paralysis and, in some cases, death. By presenting a real and harsh context for human life, the 20th century has shown that the desire for survival, development and progress have been fundamental pillars in the evolution of human beings as a society. Consequently, the work of local governments in sanitation has reinforced the fight against this disease. Good wastewater treatment and good food handling, based on optimal processes in cold chains, storage and shipping, are lessons that society itself has been acquiring and that have resulted in an early eradication of the disease in the world. In this sense, human progress has also been reflected in the scientific and technological advances that the medical environment has managed to develop in recent decades. Polio can be fought, and prevention through immunization has been the key to progress in the fight against the disease. The polio vaccine is capable of protecting the lives of human beings from an early age. Thus, the global plan to eradicate the disease, focused on prevention through immunization of infants, has forged a decline in transmission, which is reflected in several important milestones achieved throughout the process of combating polio. It is also vital to highlight the daily work and studies carried out at the Cevaxin Medical Research Center, since many of the data and results obtained have favored the growth of research and the development of new vaccines for the well-being of Panama and the world.

A bit of history

World Polio Day, a highly contagious disease caused by a virus that attacks the spinal cord, causing muscle atrophy and paralysis within hours of infection, is commemorated every October 24. Poliomyelitis can be traced back more than 3,000 years to an Egyptian engraving that describes the immobilizing effect of the virus on humans. At its peak, polio paralyzed and in some cases killed nearly half a million people a year, making it one of the most aggressive and lethal diseases in human history.

Although the disease has lived in human history for several millennia, it was not until the beginning of the 20th century that the virus was discovered, identified and associated, leading to the first developments of vaccines that have counteracted the disease. In 1908, physicians Karl Lansdteiner and Erwin Popper succeeded in isolating the poliovirus and, two years later, began to develop the first vaccines thanks to the results generated by the research carried out by physician Simon Flexner. Decades later, in 1935, two teams of scientists tested vaccines against poliomyelitis, obtaining negative results and causing the death of several test subjects. During the 1950s and 1960s, vaccines against the virus were developed, forging an effective starting point in the fight for the total eradication of the disease. In 1953, the first vaccine against poliomyelitis was created, thanks to the contribution of the American physician Jonas Salk, who used injected doses of inactivated virus. Years later, the Polish Albert Sabin developed the second vaccine against the virus, this time of the oral type and with attenuated virus. Its commercial use was authorized in 1962.

Although this disease cannot be cured, it can be prevented. As it mainly affects infants in their first years of life and in most cases without symptoms, the timely administration of the vaccine is of utmost importance for the well-being of the next generations. Thanks to immunization campaigns managed by the World Health Organization (WHO) since 1988, cases of infection have decreased by more than 95% worldwide, making polio the second infectious disease to be virtually eradicated, after the success against smallpox. In the history of mankind and specifically in the fight against this disease, it is of vital importance to highlight the work and studies of the virologist and bacteriologist Isabel Morgan in the 1940s. In her research work, the scientist managed to develop an effective and protective vaccine against poliomyelitis in the vital action of a species of monkeys. This work was indispensable for Jonas Salk to succeed in this endeavor years later.

 Major milestones

Progressive advances in the fight against diseases harmful to human beings have shown that consistent leadership and factors such as innovation are categorical and decisive in detecting and stopping these types of diseases. The fight against polio is a great example for humanity in terms of joint work, common good and global health.

The successful coordination of initiatives by countries in different regions of the planet to counteract problems such as population movements, immunization processes in minors, conflicts between governments, problems arising from insecurity and limited access to health services, is a true representation of human courage and the search for a better quality of life.

Since 1985, more than 35 years ago, the first initiatives began to develop between countries with the goal of eradicating the disease in different regions of the world. In 1988, the Global Polio Eradication Initiative was born, led by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Rotary International and the U.S. Centers for Disease Control and Prevention (CDC). The initiative has also received support from the Bill & Melinda Gates Foundation and millions of volunteers worldwide.

The last case of Poliomyelitis in the Americas was detected in Peru in 1991 thanks to research and the implementation of effective and timely immunization processes in the region. Panama is a world reference as one of the main countries in the world in eradicating the disease in its entirety. The last case registered in the country was in 1972, establishing the country as a pioneer in the research and use of the inactivated polio vaccine.

In 1994, Latin America was declared free of wild poliovirus circulation, while the Western Pacific and European regions achieved this goal between 2000 and 2002. Thanks to Cevaxin's ongoing work, research studies on vaccines for disease prevention have had an impact on the well-being of life not only in Panama, but also in many other countries in the region and around the world.

As of 2021, polio continues to exist in countries such as Afghanistan and Pakistan, as Nigeria has been certified as free of circulating polio. These are the only countries on the planet that have not succeeded in interrupting transmission of the virus, although experiments, studies and progress continue to be made in this regard. At this moment (December 2021) Afghanistan is about to join the list of countries free of circulating polio, while Pakistan is still positioned as a polio "reservoir". This achievement represents a medical breakthrough towards total polio eradication, as more than 95% of the world's population lives in regions certified for polio eradication and suppression.

During this process, three types of the virus have been detected: wild poliovirus one, two and three. Currently, transmission of both wild poliovirus type two and type three has been eradicated. The latter has been achieved thanks to the progress and eradication of the virus in Nigeria. For their part, and taking into account the more than three decades that have elapsed since the creation of the initiative, the organizations that have participated in the fight and eradication process estimate that more than 15 million people have been spared from suffering from any disease derived from the virus. According to Unicef data, systemic vitamin A administration programs during immunization and activation processes have prevented the death of more than 2 million people.

Some worldwide figures

The fight against polio is still ongoing, but the next generations are close to living in a world without the disease. As of 2021, global cases of the disease have declined by more than 99%, from an estimated 350,000 cases in more than 125 countries in 1988, to 1,352 cases reported in 2010. In 2016, 36 cases of wild polio were reported, while two years later, in 2018, 33 cases were reported.

Wild poliovirus type two was completely eradicated in 1999 and the last case of wild poliovirus type three was recorded in Nigeria in November 2012. Therefore, the only avenue of protection for humans is immunization and the conscious use of vaccination. Studies conducted since Cevaxin and, in general, since Panama, have contributed to the global eradication process. The data collected in these studies have not only served as a basis for research, but have also served as input and reference for research on other diseases that continue to affect the quality of life in the world.

Cevaxin and Panama as agents of change

Cevaxin, as a Clinical Research Center for vaccine-preventable diseases, has positioned itself as a leader in different areas of the medical and health environment in Panama. Thanks to this, the work and work done since its creation in 2013 has transcended internationally, becoming a benchmark for the region and the world. Throughout this time, the implementation of standardized processes with high rigor and quality, has resulted in the coverage of innovative solutions for the Panamanian society and for scientific progress in the world. 

With five sites in Panama, a specialized medical team and processes with international scientific rigor, the coverage of clinical and epidemiological studies has covered the treatment of diseases such as poliomyelitis, dengue, respiratory syncytial virus, norovirus, pneumococcus, hepatitis A, meningitis, pertussis, chicungunya and currently COVID-19. At each stage of the research, the Ethics Committees and the Ministry of Health must give their approval to facilitate the approval of the process. 

Consequently, thanks to the research work and the immunization campaigns managed by Cevaxin in the last decade, the mentality regarding the care and welfare of Panamanian society has changed positively. The world scenario presents Poliomyelitis and this fight as a next achievement for humanity, taking into account the triumph acquired in other processes against infectious diseases.

The development of vaccines against Poliomyelitis and other diseases has facilitated the notion that has been acquired of these diseases, as well as the knowledge of their behavior and evolution in humans. The presence of Cevaxin, as a clinical research center, has been strengthening research in Panama, Latin America and the world, contributing to the welfare and quality of life of Panamanians and the vast majority of people affected in the world.

Latin America is a world leader in the process of fighting for the eradication of poliomyelitis in the world. In this context, Panama has made constant progress. Having registered the last case of the disease in 1972, the country has not stopped and thanks to the talent, work of national specialists and scientists, the implementation of initiatives by Cevaxin with international support (Bill & Melinda Gates Foundation), continue to contribute to a global environment without the existence of polio and other diseases.

That is why, based on clinical research on polio vaccination and the results obtained from it, managed by Panamanian scientists and supported by the Bill & Melinda Gates Foundation, predictions indicated that the world is just a few years away from the total eradication of the disease. The joint work between Cevaxin, the Children's Hospital and the Ministry of Health demonstrated that Panama is at the forefront of innovation, clinical studies and vaccination. With almost 10 years of experience in the country, Cevaxin has established itself as an expert in conducting vaccine research studies in Panama, the region and the world.

En ciertas cuentas, es fundamental reafirmar que el trabajo continuo y benévolo, sumado al apoyo de donantes, gobiernos locales, empresas privadas y organizaciones sin fines de lucro, ha logrado un contexto global libre de poliomielitis, construyendo una sociedad más consciente en torno a los procesos de inmunización y por ende mejores y más saludables formas de vida.