What’s it Worth to Cure Polio?

If you’re Bill Gates, the answer came last week when the Gates Foundation released its annual letter. Front and center is the world’s quest to end polio. This is a big deal. Since 2005 Gates has spent $1.3 billion on polio eradication, and the world as a whole has spent $9 billion since 1988. In that timeframe, polio cases have dropped from 350,000 a year to under 1,500 in 2010.

Eradicating 99% of polio cases has saved millions of lives, and averted incalculable suffering from a painful and paralyzing disease. Yet the last 1% of polio is proving tough to crack. Poliovirus cases have floated between 1,000 and 2,000 annually over the last ten years. Polio is a hydra of a disease – it mutates and pops in countries where it had previously disappeared, and four countries – Nigeria, India, Pakistan, and Afghanistan – have never freed themselves of the disease.

Providing every child in the world with pink polio drops or vaccine injections is a challenge of science, peoplepower, and local politics – but it’s first a question of money. The Gates Foundation, Rotary International, the WHO, the CDC, and UNICEF have raised much of the $9 billion spent on polio, and they are fundraising aggressively to tackle the disease’s last 1% – an investment they estimate at over $1 billion per year.

While nobody discounts the achievements of the polio campaign, this price tag is raising eyebrows.

Following Gates’ letter, the New York Times ran a story expressing skepticism at the cost-effectiveness of eradication. Among others, the Times quoted The Lancet editor Richard Horton, saying, “Bill Gates’s obsession with polio is distorting priorities in other critical BMGF areas. Global health does not depend on polio eradication.”

This is a strong critique of a foundation that prizes utility and whose mantra is that “every life has equal value.” To get a response I contacted Dr. Robert Scott, Chairman of Rotary International’s PolioPlus Committee. Rotary has mobilized over $1 billion toward eradication since 1985, and I asked Dr. Scott why he thinks eradication is worthwhile despite the cost. He wrote back:

Polio is one of the few problems we face as a global community that has an inexpensive, easy, effective, and permanent solution. While the short term cost of reaching the remaining 1% requires significant investment, studies project that this cost is still far less than the cost of returning to a control strategy, both in terms of the amount that will still be needed to immunize children and the long term care costs for polio survivors. It is unacceptable to allow that to happen again, especially now that success is within our grasp. Abandoning the goal of eradication is unacceptable to me, and to other Rotarians who have dedicated more than twenty years and $1 billion to this effort.

I find this persuasive on a few accounts.

First, Dr. Scott is right to note that Rotarians and others worldwide have spent many years, countless hours, and $9 billion dollars working toward eradication. This effort has built infrastructure that increases the marginal impact of subsequent dollars spent, and carries a powerful emotional weight as well.

Second, there is strong data that the benefit of eradication outweighs the cost, and that control of a contagious disease like polio is more expensive in the long run. To wit, Vaccine recently published a study claiming that eradication will net an economic benefit between $40 and $50 billion through 2035, while averting 8 million cases of polio paralysis.

Lastly, and also to me quite persuasive, is the value of beating a big disease. In global health we face enormous challenges – ones like AIDS, child mortality, a lack of water and sanitation, and silent killers of non-communicable disease. We seldom win. In particular to those who work and fund at the outskirts of global health and may doubt such mountains can be climbed, eliminating polio would prove powerfully that success is possible.

For me, this is a strong argument when combined with the data on the value of full eradication. But it does seem like the polio community has a closing window to break through its plateau on annual cases before the strategy of eradication vs. control comes into further question. The Global Polio Eradication Initiative has set an eradication goal of end-of-2012, and let’s sincerely hope we meet it.

Readers – what’s your take? Is polio eradication “worth it”? What’s the value of beating a disease?

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