Wiping out diseases: it’s a seductive goal. And like many of the best serial seducers, it’s ultimately hard to pin down. The eradication fashion item for this season is polio, the Lothario sporting it is Bill Gates.
Mr. Gates says we can eradicate polio in two years; that just a fifth of the time that it took his Internet Explorer to eradicate Netscape.
Gates has certainly put his (foundation’s) money where his mouth is, some 300 million dollars over the next couple of years. And he has some very good brains working on crushing the bug. But my own feeling is that the virus will be rather harder to wipe out than the browser that we all loved so well.
As I imply in an essay in this month’s Prospect, I suspect the only way we’ll achieve Mr. Gate’s goal is by defining “eradication” as wiping out wild-type polio. But that leaves us with the quandry of what to do about the weakened-but-still-live virus in the oral vaccine, the only vaccine we can afford to use in the countries where polio still circulates. Once re-established among kids who weren’t properly immunised despite dose after dose of vaccine (usually because they shit it straight out with their chronic diarrhea), it can revert to become as virulent as it ever was in the wild.
To get rid of that we need to switch to expensive, cumbersome injectible vaccines, or develop a killed vaccine that is cheap and easy to deliver. It’s not clear that it’s worth spending money on either. As richer countries re-evaluate their development spending (as the UK did today — nicely summarised by IDS’s Lawrence Haddad) we need to focus on what delivers greatest bang for buck. Hunting down the polio virus that hangs out in guts, drains and labs and crushing it makes jobs for epidemiologists, but it sucks time and money from other things that kill, maim and ruin the lives of far more than the 1,000 or so people who now get polio each year. Improving drains, making roads safer and diagnosing treatable infections earlier aren’t as sexy as wiping out polio, but we should allow ourselves to be seduced by them more often.