A case for stepping up aid efforts to eradicate Polio

Written by Jonathan Pryke

Poliomyelitis is a crippling and potentially fatal infectious disease, still striking children mainly under the age of five in countries in Asia, Africa and the Middle East. Historically, polio has been the world’s greatest cause of disability and can cause paralysis within hours that is almost always irreversible. Because there is no cure for polio, the best protection is prevention, which can be provided to children through a US$0.60 vaccine. The effort to eradicate Polio began in 1985 with the creation of PolioPlus, an initiative of Rotary International. Three years later a global effort, known as the Global Polio Eradication Initiative (GPIE) began, led by the World Health Organisation, UNICEF and the Rotary Foundation.

The global effort has seen the reduction of Polio cases globally reduce from over 350,000 in 125 countries in 1985 to 1,300 recorded cases in 20 countries in 2010, with only four countries in the world reported to have endemic cases of Polio (Nigeria, India, Pakistan and Afghanistan). Since the beginning of the effort the America’s, the Western Pacific Region (including China) and Europe have all been classified Polio-free. By 2010 around 2.5 billion children have been immunised against polio in 120 countries, sparring an estimated 5 million children from a lifetime of paralysis. The successes of the campaign have been immense, however since 2001 there has been no further eradication in annual cases despite extensive immunisation efforts, with the total cost of the initiative now reaching $9 billion, with yearly incremental costs of $1 billion going towards vaccinations.

With the cost of combating the disease continuing to grow and an apparent freeze in the progress towards eradication, the debate about the cost-viability and potential of the campaign to eradicate Polio is now becoming heated. Critics of the campaign to eradicate polio; including Dr. Donald A. Henderson, the former WHO officer who began the drive to wipe out smallpox; Richard Horton, editor of The Lancet medical journal, and Arthur L. Caplan, director of the University of Pennsylvania’s bioethics center, argue that the campaign against Polio should shift to one of containment (for more information see this NYTimes article). A shift away from eradication and a focus on aggressive vaccination towards one of containment could lead to an explosion of outbreaks in these regions and the acceptance of 100,000 to 200,000 crippled or dead children a year. Sceptics acknowledge this risk but argue that it is the price to pay for shifting the $1 billion spent towards other measure that can prevent millions of deaths from pneumonia, diarrhoea, measles, meningitis and malaria.

Proponents of the campaign, currently led by Bill Gates who has personally contributed $1.3 billion to the campaign through the Bill and Melinda Gates Foundation (tackling polio has now become Bill Gates flagship campaign for 2011), argue that the long-term net benefits of polio eradication are worth the cost. An independent study published in the leading medical journal Vaccine in November 2010 estimated the economic benefits of the (GPIE) at between US$40-50 billion based on activities from 1988 through 2035 (assuming eradication of wild polioviruses in 2012 or shortly thereafter), with low-income countries accounting for approximately 85% of the net benefits. A movement away from eradication towards a policy of containment, and the subsequent explosion of recorded cases to near that of 1985 levels in more concentrated areas, would also mean the wasting of the $9 billion that has been contributed to the cause over the past 25 years. Like Smallpox, supporters argue that the last 1% is always the hardest, but is well worthwhile in the long run.

The continuing commitment to the eradication of Polio would also help to demonstrate the investment value of foreign aid – highlighting the life-changing impact aid dollars have and emphasising the importance of increasing domestic aid contributions. A successful eradication effort would also demonstrate the potential of global collaboration and give international cooperation a massive boost. Its eradication would also be a major landmark in the fight against global diseases; marking the first time since 1979 that mankind has wiped an infectious disease off of the face of our planet.

The arguments for and against polio remain heated, however the commitment of international donors has not only remained steadfast but, under the leadership of Gates, is steadily growing. Gates and other major donors are arguing that a last big push is needed to eradicate Polio.  The GPIE estimates a funding gap of US$720 million to meet the requirements of complete polio eradication. This year alone Britain has pledged to double its US$30 million contribution to GPIE and the UAE has contributed US$100 million to the cause. The eradication of Polio will draw a line in the sand as an example of what can be achieved through a concentrated commitment of foreign aid. Australia currently has no commitments to the GPIE effort, but should this remain the case or should Australia, with its privileged position of overseeing a rapidly expanding aid budget, join the last ‘big push’ to reach this landmark achievement?

Jonathan Pryke is a Research Associate with the Development Policy Centre.

Jonathan Pryke

Jonathan Pryke worked at the Development Policy Centre from 2011 as a Research Officer and Blog Editor, and left in mid-2015 to take up the position of Melanesia Fellow at the Lowy Institute. He has a Master of Public Policy/Master of Diplomacy from Crawford School of Public Policy and the College of Diplomacy, ANU.

4 Comments

  • Jonathan, I note that you cite a particular New York Times article about skeptics of the campaign to eradicate polio, which include Dr. Donald A. Henderson, the former WHO officer who began the drive to wipe out smallpox, amongst its ranks.. You should amend your blog to say that Dr Henderson ‘used’ to be a skeptic.

    Check out this later NYT article by the same reporter who wrote the one you cited above: http://www.nytimes.com/2011/02/15/health/15polio.html?ref=donaldgjrmcneil

    It appears Dr. Henderson has changed his mind:
    “I see as much greatly augmented the probability that we can stop wild polio virus,” he said Wednesday in a follow-up interview — the opposite conclusion to the one he had given to the same reporter on Jan. 26.

    “I apologize,” he added. “It’s not my wont to turn on a dime like this. I don’t think I’ve done anything like this before.”

    Also, the point of extended immunisation is about more than reducing case load this year. It reduces life-long case load, and prevents breakouts. Note the measles break out in Australia right now – you may go years without a disease, decide not to immunise, and then there’s a single importation that can cause an epidemic. Keeping cases below 2000 a year is a massive achievement, and slowly, it enables you to close the net. I think the better thing to look at is the case load in endemic countries – as they’re the source of all imported cases, and if we can reduce endemic countries, then breaks out are less likely. And there, there’s huge and exciting news with potential announcements around Nigeria and India. The recent article in the New Scientist is a good insight into this – http://www.newscientist.com/article/mg20928050.100-dont-let-polio-eradication-slip-away-again.html

  • Michael thanks for the correction. It seems the UAE contribution resulted in an adjustment of the funding gap since the start of the week. Progress is being made as we speak!

  • The eradication of polio is necessary for other communicable diseases to be tackled in such a way as to provide any real long term benefit- these countries need to strengthen their economies in order to provide sanitation and healthcare- they cannot do this with rampaging infectious disease.

    Due to the prevalence of other diseases in polio stricken areas I don’t know how it is possible to predict such economic benefits directly from the eradication of polio, as these individuals are at high risk of other more common infections.

    However it seems shortsighted to argue to shift funding elsewhere as Henderson does, because these epidemics are huge and $1 billion annually would easily be swallowed. In my opinion tackling one thing at a time and unlocking international funding is the only way to begin to solve such problems- ruthless though it may seem when so many are dying of other ailments, it is how the world, and politics, work.

  • Thanks for this well argued and well written blog Jonathan. Just want to point out that the funding gap is now actually $665M — see http://www.polioeradication.org/Financing.aspx.

    There are a couple of further points I’ll post about later on. In the meantime, your readers might want to check out the campaign the Global Poverty Project are currently running on polio eradication. We recently met with the Prime Minister to discuss the oppourtunity we have to eradicate polio forever. See how the meeting went at: http://globalpovertyproject.org/blogs/view/355

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