So near, yet so far
Jan 22nd 2009 | NEW YORK
From The Economist print edition
Global health campaigners try again to eradicate polio
HUMANITY'S greatest accomplishment of the past five decades, declared Bill Gates this week, is the reduction in the number of deaths among young children by half, to 10m a year in 2007. The world's most successful capitalist heaped praise on the World Health Organisation (WHO), while unveiling an ambitious new global scheme to eradicate polio within a few years. For his part, the agency's top polio man, Bruce Aylward, described the fight against the disease in the language of markets: "Eradication is the venture capital of public health: the risks are huge but so too are the rewards."
The use of this sort of language captures a change in public health in the past decade. The Gates Foundation, with its pots of money and businesslike approach (see article), has transformed the bureaucratic and demoralised world of public health. It has helped revive ailing campaigns, including the fight against polio. This will now get a fresh $600m-plus, from British and German taxpayers, from the Rotary Club International, as well as from the Gates Foundation ($255m).
The decline from 350,000 new cases in 1988 (when the goal of rapid polio eradication was first declared) to 2,000 cases now (chiefly in Nigeria, India, Pakistan and Afghanistan) looks like a near victory. But the final stretch is the hardest. Only one in 200 cases is readily susceptible to early detection (as opposed to most victims of smallpox, already eradicated). Polio is also far more infectious.
Other snags are that the usual vaccine has not worked well in densely populated, disease-ridden central India. Researchers are now trying to find a vaccine that fits those conditions better. Neal Halsey, of Johns Hopkins University, says the "live" vaccines used commonly today must be backed up with further doses of "inactivated" vaccines. These need to become cheaper.
The fighting in Afghanistan and Pakistan has hampered vaccination programmes there. So have rumours among Muslims in northern Nigeria that the vaccination programme was in fact a conspiracy to sterilise children. That allowed the polio virus to strengthen and spread. The Nigerian strain may have now reached a dozen other countries.
The final push towards eradication will certainly be costly, though several recent studies suggest that it is cheaper to spend money on a big eradication effort now than to pay the price later for sustained vigilance and health costs. The prospect of a global resurgence is concentrating minds. That is why, despite the daunting challenges and potential donor fatigue, the world may end up making a go of eradication this time.
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