Why is WHO crying wolf on polio?

The World Health Organization (WHO) recently declared polio to be a public health emergency, prompting fears and headlines about possible spread even to the United States. But the eradication goal actually sits closer than ever. The “emergency” comes not from health risk but schedule risk to the 2018 eradication deadline. Because polio is the number one priority of Bill Gates, WHO now invokes the specter of polio outbreaks, a ploy to galvanize the public reminiscent of weapons of mass destruction.

Polio is 99% wiped out, crushed over decades from hundreds of thousands of cases to fewer than 2,000 a year so far in the 21st century. Risk of spread has only gone down together with the fall in cases and countries with transmission. Today, in two of the three remaining polio endemic countries, Nigeria and Afghanistan, cases hover tantalizingly close to zero, unprecedented historic lows. Pakistan, the third endemic country, has wrecked eradication progress for years. But the ongoing shooting of vaccinators by extremists in Pakistan, for example, did not prompt the polio “emergency.” Instead, WHO cited an outbreak of 36 cases in Syria and the subsequent export of a single case to Iraq. But the Syrian outbreak has been snuffed and amounts to nearly a non-event in the annals of polio conflagrations. The year before, Somalia saw a much larger, 194-case detonation, large enough to reach Kenya and Ethiopia and paralyze two dozen more. Today, WHO reports the other cause for alarm is cross border polio transmission from Cameroon to Equatorial Guinea. However, the six cases so far, while tragic, are inconsequential compared to Africa as recently as 2011 when four countries leapt from zero cases to 41. The same year, China saw an unprecedented 21 cases. No emergency.

Polio does not even merit consideration for emergency status. Swine flu occasioned WHO’s last emergency declaration in 2009, prompted by a rapid accumulation of 1,003 cases in 20 countries on four continents. Flu can spread swiftly, directly from human to human, unlike polio which usually comes from contact with feces-contaminated water. Wealthy nations are already highly vaccinated against polio whereas swine flu vaccination necessarily followed the discovery of the new virus, H1N1. In the United States, the Centers for Disease Control (CDC) estimated there were 57 million H1N1 infections resulting in 11,000 deaths. Polio rarely kills.

However, eradication efforts cost $1 billion a year, a sizeable piece of the $30 billion spent on global health annually. Eradication dollars could be spent on increasing coverage of routine vaccinations, building hospitals and health systems, or providing clean water. But Bill Gates champions polio eradication. It is “the single thing I work on the most,” according to Gates. And it’s his show: Gates, not WHO, orchestrated funding of the $5.5 billion effort to eradicate polio by 2018. “We’ve raised three-quarters of that money,” Gates reported in 2013. But the Gates-approved plan calls for ending transmission by 2014, already impossible. Eradication has never been closer, but the schedule is at risk. Thus the theater of polio public health emergency.

As the Gates Foundation blog notes, “The sounding of an emergency often is seen as a sign of distress, and news of this announcement certainly communicated that.” Indeed, the announcement fueled headlines like “Polio, Spreading Abroad, Threatens US.” However, “what this alarm really signals,” continued the foundation’s blog, is doing “what it takes to end this disease as quickly as possible,” which includes stoking false fear. The CDC isn’t stockpiling oral polio vaccine to extinguish outbreaks. Instead, the CDC said of the polio declaration: “we do not believe this reflects an increased risk to the US.” But with deadlines looming, a WHO spokesperson stated: “we need to pull out all the stops, which is what the emergency should help us to do.”

The International Health Regulations on emergencies emphasize “public health risk,” not schedule risk. Whether technically legitimate or not, the polio “emergency” hides its real motivation and makes people afraid when actual polio risks are close to the lowest level in all of human history.

Eradicating polio, while a noble intention, distorts rational global health priority-setting. Eradication gives the wealthy world a trophy to brandish before its own citizens and taxpayers while ignoring and overriding the priorities of the developing world. The polio emergency wraps this distortion in deception. Bill Gates believes eradication will serves as a symbol and portent of further triumphs. But he has substituted symbol manipulation for the pursuit of optimal global health policy in open society.