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Straightening out our public health priorities

a/Off the Board/Opinion by

The world has been focused on the eradication of polio since the launch of the Global Polio Eradication Initiative (GPEI) in 1988. The campaign is backed by massive funding from private philanthropists such as Bill Gates, and by the Global Alliance for Immunizations and Vaccinations (GAVI). Today, only one wild type strain is still transmitted, and the entire world is certified polio-free, except for Pakistan and Afghanistan. The measles virus, meanwhile, proliferates freely in many developing areas, and causes the most vaccine-preventable deaths of any disease worldwide. While its average mortality rate is very low, the risk of death for children under five who have malnutrition is around 10 per cent. Despite the urgency of tackling measles, global public health efforts have remained focused on polio due to philanthropic stubbornness driven by a simplistic cost-benefit frame of reference that ignores the value of human life.

From an epidemiological standpoint, three criteria must be met to successfully eradicate a virus: Scientific feasibility, social cooperation, and—most importantly—political will. Gates and others, who have donated billions of dollars with the expressed goal of eradicating polio, aren’t going to move their support to measles with the task so close to completion. Economically, this perspective makes a lot of sense. The Gates Foundation estimates that the GPEI’s efforts will generate net benefits of 40 to 50 billion USD over the two decades following eradication. The bulk of this estimate is accounted for by the fact that, once fully eradicated, it will no longer be necessary to vaccinate against polio (as was the case with the successful eradication of smallpox and rinderpest). It’s simple arithmetic: The marginal benefit of lowering annual polio cases from 50 to zero is greater than the cost of neglecting the approximately 500,000 annual measles cases.

 

When a problem is approached with a strictly economic perspective, compassion doesn’t factor into the equation.

There are two harsh realities to take away from this situation. First, when a problem is approached with a strictly economic perspective, compassion doesn’t factor into the equation. The second is that you can’t bite the hand that feeds you; philanthropic efforts often lose sight of the bigger picture, but at the same time, their private nature makes them unreceptive and immune to criticism. One of the reasons given on the Gates Foundation website for the urgency of the cause is that “eradicating polio is also an important milestone for the Decade of Vaccines.” The implicit message here is that it’s an important personal milestone for Gates to satisfy his own desire to go down in history as the man who eradicated polio. It betrays a dangerous element of ego that may be clouding the philanthropist’s decision-making process.

It isn’t as if the measles effort has been completely abandoned—significant reductions in measles cases have been achieved since the turn of the century—but statistics have plateaued since 2010. Due to growing anti-vaccine sentiments among many religious communities, reported cases in North America have actually increased from 66 in 2005 to 19,898 last year.

Polio reduction statistics have also levelled off over that time period, due largely to a lack of social cooperation in Middle Eastern regions where anti-Western ideology creates a hostile and dangerous environment for both foreign and local immunization workers. Even with unlimited resources, it’s impossible to build a dam when you have a tiny leak. The funds that are being poured into what is at this point a controlled situation would be better utilized if reallocated towards providing accessible two-dose measles vaccinations worldwide. This shift would be eased by the fact that the measles effort could piggyback on much of the infrastructure put in place for polio eradication, such as safe vaccination centres in developing areas. The Gates Foundation and GAVI have accomplished incredible things since the GPEI was launched in the ’80s—and polio eradication is still important—but it’s time to step back and reprioritize.

Do you have thoughts on philanthropy, vaccinations, and global health? Send a message to [email protected].

 

 

 

 

 

Elie Waitzer is a fourth year economics student and baseball aficionado hailing from Toronto. He also enjoys baking in his free time.

 

 

 

 

 

 

 

 

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