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Some questions for Bill Gates and co about the global push to eliminate polio

A global push to wipe out polio is facing some interesting challenges and questions. Croakey’s Washington correspondent, Dr Lesley Russell, reports that polio cases are down 99 percent since 1985, and eliminating the last 1 percent has been described as “like trying to squeeze Jell-O to death”.

Lesley Russell writes:

In the New York Times of February 8 there are two letters – one from violinist Itzhak Perlman and another from FDR’s grandson James Roosevelt – urging that international efforts to finally wipe out polio not be abandoned.  Behind these letters are some interesting challenges.

Bill Gates and the Gates Foundation are leading an effort to make one more big push to wipe out world polio, with help from long-time partners in this area, Rotary International and the World Health Organization.  Although that battle began in 1985 and Mr Gates started making regular donations to it only in 2005, he has emerged in the last two years both as one of the biggest donors – he has now given $1.3 billion, more than the amount raised over 25 years by Rotary International – and as the loudest voice for eradication.   He has recognised and supported the grinding work that must be done on the ground to tackle the new outbreaks.

He also uses his high profile and access to press political leaders.  He recently went to Davos to ask global leaders to pledge more money, and got such agreements from Britain and Canada.  Rich Gulf nations have been criticized for giving little for a disease that now chiefly affects Muslim children (the effort to eradicate polio is hurt by persistent rumors that it is a Western plot to sterilise Muslim girls).  When the Pakistani president, Asif Ali Zardari, went to Washington for the funeral of American diplomat Richard Holbrook, Mr Gates offered him $65 million to initiate a new polio drive. Twelve days later, publicly thanking him, Mr Zardari did so.

However, Mr Gates now faces a hard question from some eradication experts and bioethicists: is it right to keep trying?  

Polio cases are now down 99 percent since 1985, and eliminating the last 1 percent has been described as “like trying to squeeze Jell-O to death”.  Polio now kills or disables far fewer people than malaria, measles and tuberculosis.  To date the effort has cost US$9 billion, and each year consumes another US$1 billion.  In contrast, the 14-year drive to wipe out smallpox cost only US$500 million.

One of the key critics is Dr Donald Henderson, the WHO officer who was a key organizer of the smallpox effort. He has argued so outspokenly that polio cannot be eradicated that he said recently in an interview: “I’m one of certain people that the WHO doesn’t invite to its experts’ meetings anymore.”

The editor of The Lancet said: “Bill Gates’s obsession with polio is distorting priorities in other critical [Gates Foundation] areas. Global health does not depend on polio eradication.” Others are arguing that control of disease outbreaks is the best that can be achieved.

Proponents of eradication counter that it would be terrible to waste the $9 billion already spent, and a new analysis has concluded that eradication, if successful, would save up to $50 billion by 2035.

A key problem is that while one vaccination is prevention against smallpox, children need multiple doses of the oral polio vaccine. In the Indian states of Uttar Pradesh and Bihar, increasingly those infected have been vaccinated many times. The vaccine’s inability to elicit immunity is thought to be a product of malnutrition, immune suppression caused by other diseases and possibly genetic factors.  The WHO has just closed a call for research proposals to find out why, part of an ongoing large investment in improved vaccines.

Dr Lesley Russell is a Senior Fellow at the Center for American Progress in Washington DC.  She is a Research Associate at both the Menzies Centre for Health Policy and the US Studies Centre at the University of Sydney.

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