Now that humanity has beaten back and nearly eliminated the once-widespread threat of polio, Bill Gates wants to finish it off for good. To some observers, though, it's just not worth the money. The multi-billionaire recently issued his annual letter (pdf) through the Bill & Melinda Gates Foundation, outlining its goals. Gates has been a big donor to world health programs and fighting polio in particular, and his letter calls for eradicating polio once and for all.
There would be many benefits to eradicating the disease entirely, Gates argues -- not just medical and financial, but moral. "Success will energize the field of global health by showing that investments in health lead to amazing victories," he wrote. "The eradication effort illustrates so well how a major advance in the human condition requires resolve and courageous leadership. To win these big important fights, partnerships, money, science, politics and delivery in developing countries have to come together on a global scale." [Los Angeles Times]
Medical science, supported by billions of philanthropic dollars, has already cut down the specter of polio
around the world to a shadow of what it once was. The World Health Organization estimates that there were 1,500 cases of polio around the globe in 2010, down from 350,000 in 1988. To wipe out the last remnants of wild poliovirus, Gates proposes vaccinating youths under five in countries like Afghanistan and India where pockets of polio remain. The problem is that while cutting down polio cases has been a huge success, one could make the argument that trying to vanquish the tiny remainder is a waste of money—and not possible, anyway.
Getting rid of the last 1 percent has been like trying to squeeze Jell-O to death. As the vaccination fist closes in one country, the virus bursts out in another. In 1985, Rotary [International] raised $120 million to do the job as its year 2000 “gift to the world.” The effort has now cost $9 billion, and each year consumes another $1 billion. [The New York Times]
For one thing, absolute universal vaccination (especially in war-torn or inaccessible regions) is an impossible dream, and despite humanity's success against it, polio is great at seeking out the non-vaccinated. As Nature points out
, 100 percent eradication is not the end of the story, either.
Once the wild virus is eliminated, the weakened living virus present in the oral vaccine will persist. These are called "vaccine derived polio viruses" or VDPVs, and in rare cases they have reverted back to virulence and caused outbreaks. Between 2005 and 2009, Nigeria witnessed 292 cases of polio caused by VDPVs rather than the wild virus. In the post-polio era, VDPVs will be the new target. Vaccinations would need to switch from the oral polio vaccine to the inactivated polio vaccine, which contains dead virus. [Nature]
It all comes down to money: whether the symbolic and health value of eradicating the final 1 percent is worth the billions (or whether they'd be better spent someplace else). Gates' critics, like Richard Horton of the medical journal The Lancet, charge that Gates' focus on polio steers money and attention away from other global health problems like malaria and measles that desperately need both. Gates bristles.
“These cynics should do a real paper that says how many kids they’re really talking about,” he said in an interview. “If you don’t keep up the pressure on polio, you’re accepting 100,000 to 200,000 crippled or dead children a year.” [The New York Times]
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Image: Bill & Melinda Gates Foundation