01/03/11

Is polio the next Netscape?

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.

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This post was published on 01/03/11 in Science.

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  1. Comment by Cybertiger, 02/03/11, 10:58:

    Here is an fascinating video between the ‘Master’ (Good ol’ Bill Gates) and CNN’s Sanjay Gupta MD,

    http://cnn.com/video/?/video/health/2011/02/04/gupta.gates.vaccines.cnn

    The following opening dialogue was particularly interesting.

    “Dr. Sanjay Gupta: Ten billion dollars [pledged] over the next 10 years to make it “the year of the vaccines.” What does that mean exactly?

    Bill Gates: Over this decade, we believe unbelievable progress can be made, in both inventing new vaccines and making sure they get out to all the children who need them. We could cut the number of children who die every year from about 9 million to half of that, if we have success on it. We have to do three things in parallel: Eradicate the few that fit that profile — ringworm and polio; get the coverage up for the vaccines we have; and then invent the vaccines — and we only need about six or seven more — and then you would have all the tools to reduce childhood death, reduce population growth, and everything — the stability, the environment — benefits from that.”

    Reducing population growth? What can ‘Good ol’ Bill’ possibly mean? The rest of the interview was entrancing too … especially the bit about Andrew Wakefield … and other child killers …

  2. Comment by Ant, 22/03/11, 02:57:

    cybertiger. Regarding your question on reducing population growth, isn’t Bill Gates just referring to the association between high child mortality and larger family size? (the suggestion being that improving the health of the children will have a knock on effect of reducing the family size and therefore reducing population growth etc).

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