Whether polio eradication should be pursued or whether it is central to global health are questions that should be and are asked by The New York Times in “Critics Say Gates’s Anti-Polio Push Is Misdirected.” However, the Times also contends that “Victory may have been closest in 2006…” when victory may be closer now than ever before. And the latest blast of polio funding and initiatives, described by the Times, comes not because the eradication effort is on its heels but because it’s going for the kill.
Eradication hinges less on the number of countries suffering polio cases than on knocking out the sources—or “reservoirs”—of the disease. The two largest such reservoirs are India and Nigeria. Today, both countries have historic, record low cases. The Times describes this as “doing much better.” Perhaps also underappreciated by the article, wiping out the reservoirs of polio will stop outbreaks. The Times mentions outbreaks in Nepal, Kazakhstan, Tajikistan, Turkmenistan and Russia. All originated from India.
Further, the case of India seems to demonstrate that there are no scientific or technological barriers to eliminating polio. In particular, the Indian states of Bihar and Uttar Pradesh once were the most impregnable redoubts for the poliovirus anywhere on the planet. Yet, because of the huge expense and exertions described by The New York Times, Bihar and Uttar Pradesh saw nearly zero cases even during the “high season” for polio. (See my Polio in Retreat: New Cases Nearly Eliminated Where Virus Once Flourished.)
In Africa, Nigeria has been the most intractable polio problem. No sooner is eradication on track in that nation, than new sources—Angola, Chad, Congo and Sudan—arose to continue infecting the continent. Indeed, Angola and Sudan have even reverted back into polio reservoirs, the disease spreading within and across borders. The Times properly draws attention to this indisputable, highly problematic regress. But the obstacles to eliminating polio in Angola do not compare with those of India where the degree of difficulty approached near impossibility. And Angola has gotten rid of polio before. How did it come back? Cases imported from India, a reservoir now drawn down to historic lows.
The New York Times represents a crucial exception to the influence of the Gates Foundation on global health coverage. It is important to question whether, in retrospect, polio eradication ought to have been undertaken, given all the costs. Also, whether today polio ought to be treated as the number one priority in global health is likewise a valid inquiry. And the Times is right that the Bill & Melinda Gates Foundation has doubled down on polio eradication several times before in the aftermath of setbacks to the program. However, the recent slew of polio announcements and initiatives is not in response to setbacks. It’s to unload a knock-out punch while the opponent is staggered. It might work.