Tuesday, March 8, 2011

Polio: To eradicate, or not to eradicate

Polio is one of the few human diseases that is on the brink of eradication. This article in the New York Times discusses the debate between Bill Gates, who has donated $1.3 billion for polio eradication, and public health experts who believe that polio eradication is not worth the cost. Gates points out that we have an effective and inexpensive vaccine, and that polio has been scaled back to just a few countries. Here's what some other experts say:

“Bill Gates’s obsession with polio is distorting priorities in other critical BMGF areas. Global health does not depend on polio eradication.” (The initials are for the Bill & Melinda Gates Foundation.) -- Richard Horton, editor of The Lancet

“We ought to admit that the best we can achieve is control.” -- Arthur L. Caplan, director of the University of Pennsylvania’s bioethics center, who himself spent nine months in a hospital with polio as a child.

Gates counters: “These cynics should do a real paper that says how many kids they’re really talking about. If you don’t keep up the pressure on polio, you’re accepting 100,000 to 200,000 crippled or dead children a year.”

Right now, there are fewer than 2,000. The skeptics acknowledge that they are arguing for accepting more paralysis and death as the price of shifting that $1 billion to vaccines and other measures that prevent millions of deaths from pneumonia, diarrhea, measles, meningitis, and malaria.

“And think of all the money that would be saved,” Mr. Gates went on, turning sarcastic. “It’d be like 5 percent of the dog food market in the United States.” (Americans spend about $18 billion a year on pet food, according to the American Pet Products Association.)

“If we fail, we’ll be consigned to continuing expensive control measures for the indefinite future,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, which leads the country’s effort.

The article also points out some of the differences between polio and smallpox that have made polio so much harder to eradicate.

One injection stops smallpox, but in countries with open sewers, children need polio drops up to 10 times. Only one victim in every 200 shows symptoms, so when there are 500 paralysis cases, as in the recent Congo Republic outbreak, there are 100,000 more silent carriers. Other causes of paralysis, from food poisoning to Epstein-Barr virus, complicate surveillance. Also, in roughly one of every two million vaccinations, the live vaccine strain can mutate and paralyze the child getting it. And many poor families whose children are dying of other diseases are fed up with polio drives.

Not an easy debate to choose a side in, at least for me...

1 comment:

John Latto said...

It is an interesting problem but for me the symbolic achievement of eliminating the disease means that persistence is warranted - even if in the final stages the money could be better spent elsewhere. Each time we eliminate a disease it seems to strengthen our resolve for the next task. If we can knock off both Polio and Guinea Worm soon then I think we could attack Leprosy, and even measles with a renewed enthusiasm.