In the history of medicine, only one disease has ever been eradicated, but it was a terrible one. Smallpox, which claimed 2 million lives in 1967, was stamped out by 1980 through an enormous vaccine campaign.
Today the world has a shot at a second such triumph, this time over polio. It will take more than good medicine to succeed. It will also require good politics.
In 1988, polio was still afflicting 350,000 people worldwide. Since then, thanks in part to the remarkable efforts of a coalition called the Global Polio Eradication Initiative, that number has plummeted, to 1,000 last year. By financing vaccine efforts, the initiative has reduced the number of countries in which polio is endemic from 125 to just four.
In two of those countries, Afghanistan and India, progress is good, according to the most recent report of the initiative’s Independent Monitoring Board. Nigeria and Pakistan, however, have experienced setbacks. In both those countries, the incidence of polio in the first half of 2011 was significantly greater than in the same period last year. Pakistan, the report said, is at risk of becoming polio’s last outpost.
Vaccination teams have difficulty simply reaching children in remote or conflict-prone areas such as Pakistan’s northwest. Beyond that, they face persistent distrust. In 2003, conspiracy theories spread in Nigeria that the polio vaccine was a Western plot to sterilize Muslims. Families refused inoculation, a polio outbreak spread to eight countries, and the sterilization rumors jumped all the way to Pakistan.
Taking Polio Drops
The World Health Organization has worked to counter suspicions, with some officials publicly taking the polio vaccine, which is administered orally, to demonstrate its safety and other officials engaging religious leaders, occasionally turning them into vaccine advocates. Still, some Islamic leaders in Pakistan continue to denounce vaccination as unsafe or un-Islamic.
The CIA risked making matters considerably worse earlier this year when it covertly ran a vaccination drive for children in Abbottabad, the Pakistani city where U.S. forces later killed Osama bin Laden at his compound. In an operation revealed by the British newspaper the Guardian, a CIA-sponsored Pakistani medical team went door to door offering local children free hepatitis B vaccinations in an effort -- unsuccessful, it turned out -- to gather DNA to determine whether the children at the targeted compound were bin Laden’s.
That the scheme would eventually come to light, and possibly feed distrust about vaccination campaigns, was foreseeable.
Spying is a messy business that necessarily involves deceit, and U.S. intelligence operatives need latitude to do their work. In this case, however, the planners and approvers of the CIA operation didn’t appropriately calculate the possible consequences of their actions on an agenda that is as important to the world as fighting al-Qaeda.
The widespread deployment of childhood vaccinations is the most effective of all public health measures. Since 2000, the GAVI Alliance, a coalition of pro-vaccine groups, has reached 257 million children in poor countries, mostly with newer vaccines, saving an estimated 5.4 million lives.
Eradication of smallpox saves the world more than $1 billion a year, according to the WHO. If polio transmission can be stopped by 2015, the net benefit from reduced treatment costs and gains in productivity will be $40 billion to $50 billion, according to a recent study.
Of course, that’s just one way of measuring the benefits. Eliminating polio would also mean that never again would anyone suffer from the often crippling disease. Health workers would be inspired to reach for great new heights, just as they were after defeating smallpox.
These are goals worth investing in, and the U.S. government has done just that. Its share of the $9 billion in contributions and pledges to the polio eradication effort through 2012 is $2 billion. That investment needs to be protected. Future U.S. intelligence schemes should take it into account.
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