Who Are the Experts Who Don't Want to Eradicate Polio?

Posted by Ann Marie Gardner

FDR
Yesterday's optimistic but also sober panel discussion on polio eradication moderated by Diane Sawyer pulled every heart string.

Taking place in FDR's home, (journalists blogged from the bedroom where FDR struggled for years to relearn to crawl, then walk). Bill Gates and his team conveyed their passionate commitment to not only polio eradication but getting the message to the world that polio eradication is critical to the world for so many reasons.  Videos of children in Nigeria being vaccinated made you want to cheer, take out your checkbook, or get on a plane to help the vaccination teams. 

But the greatest challenges around polio eradication, according to Gates, is raising awareness and money for it. The panel concluded that it will take another several billion dollars in the next few years along with government leadership and country ownership to eradicate polio.

The New York Times reports today that Gates has already committed 1.3 billion himself to the eradication challenge and has raised 100s of millions more just last week:

Last week in Abu Dhabi, Mr. Gates and Crown Prince Sheikh Mohammed bin Zayed al-Nahayan jointly donated $50 million each to vaccinate children in Pakistan and Afghanistan. In Davos, Switzerland, Mr. Gates and the British prime minister, David Cameron, announced that Britain would double its $30 million donation. Last month, when the Pakistani president, Asif Ali Zardari, went to Washington for Ambassador Richard Holbrooke’s funeral, Mr. Gates offered him $65 million to initiate a new polio drive. Twelve days later, publicly thanking him, Mr. Zardari did so.

But the NYT article also suggested that polio cannot be eradicated and posed the question:

Mr. Gates faces a hard question from some eradication experts and bioethicists: Is it right to keep trying?

Although caseloads are down more than 99 percent since the campaign began in 1985, 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.

But are the naysayers quoted in Times piece hardly seem the most credible critics?  One is the notoriously contentious and controversial editor of the Lancet, Richard Horton, who has been accused of violating ethical standards in medical publishing. The other is ex-World Health Organization scientist, lifetime bureaucrat and academic Donald Henderson. McNeil writes:

Dr. Henderson has argued so outspokenly that polio cannot be eradicated that he said in an interview last week: “I’m one of certain people that the W.H.O. doesn’t invite to its experts’ meetings anymore."

How strange, then, that Henderson, now on the faculty at Johns Hopkins Bloomberg School of Public Health, is described on the University website as:

He came to Hopkins after directing the World Health Organization's global smallpox eradication campaign (1966-1977). Dr. Henderson was instrumental in initiating WHO's global program of immunization, which has vaccinated 80 percent of the world's children against six major diseases and has as a goal the eradication of poliomyelitis.

Whatever his motives for changing positions, it's probably safe to say that both men clearly disagree with Bill Gates, whose focus on polio is not the end point but a springboard to the introduction of other vaccines and the eradication of other diseases including pneumonia. Gates said yesterday:

We picked polio - it's a lot of fundraising, it’s a little improved science, and it’s a lot of execution. The disease was eradicated in 5 years in the US. With good management of funds in place and political will, we can eradicate this. 

Polio eradication will reinforce the overall health infrastructure and will include the other vaccines down the line. In America, the eradication of polio was followed by eradication of measles. If you look at this structure and infrastructure formed by vaccination and eradication campaigns, you create a culture of prevention. The benefit of polio eradication goes well beyond lives saved, and into creating long-term infrastructure.

Its seems strange to not embrace the herculean efforts Gates is making to step in where governments won't.  Why would you be in opposition to savings lives?  Is more bureaucratic handwringing really the most productive way forward.

Full disclosure: GOOD's health coverage is sponsored by the Gates Foundation.