Polio's Last Mile

This past week, Bill Gates has appeared just about everywhere to talk about his push to eradicate polio. Since 1988, polio has been reduced from over 350,000 cases in 125 countries to about 1,000 cases in four countries today. Only Afghanistan, India, Nigeria and Pakistan stand between complete eradication of the disease.

Why the push for eradication? According to the foundation's annual letter, "eradication could save the world up to $50 billion over the next 25 years." Besides the eradication of a terrible disease, the economic burden on families to treat polio -- as well as the funds spent by governments and NGOs -- could be significantly alleviated. Gates also says that he hopes the "success will energize the field of global health by showing that investments in health lead to amazing victories."

The problem is that the last mile is not so easy. To achieve complete eradication a significant increase in financial support will be needed. Gates knows this. He went to Davos to reveal his plan and asked for the globe's leaders to pledge more money. Leading the way, Gates said he would provide an additional $100 million. Not to be outdone, British Prime Minister David Cameron pledged £40 million over the next two years and Canadian Prime Minister Stephen Harper said that the government would provide purchasing enough oral polio vaccine for 250,000 children a year in Bangladesh.

However, some are downright skeptical. For example, a recent article in the New York Times highlighted the reasons why it might not be worth all the money and the effort. It discusses the cost ($1 billion a year), how hard it will be to achieve and the relative impact of polio to other diseases. In short, the article suggests that it might cost too much and there are probably more important global health priorities.

Karen Grepin, an assistant professor of Global Health Policy at the Robert F. Wagner Graduate School of Public Service writes:

Polio eradication is certainly one of the risky investments but the high-risk-high-reward model has paid off for [Gates] in the past, and it might play out here as well. Of course, we should not just let the mission of one individual hijack the global public health apparatus but I truly believe that this is one program where it might be worth taking the risk.

Nobody seems to be saying that polio eradication isn't possible, but the tricky part is the last mile. Sendhil Mullainathan, a Harvard behavioral economist, is featured in a talk at TEDIndia and he discusses how there are many things that can prevent us from finishing the final stretch.

As an example, he discusses how efforts to reduce diarrhea-related deaths have been stalled. When surveyed, 35 to 50 percent of women would reduce the intake of water for infants experiencing diarrhea. Mullainthan points out that this makes logical sense since it was the water which likely caused it in the first place, so many assume it will be made worse by giving the infant water.

Vaccines can be viewed in a similar way. Here in the United States, there was a recent rise in accusations that vaccines caused autism. Similar to the mothers in India, it's reasonable to cut out what we have been putting into our bodies in order to prevent it from getting worse. So, what will it take to finish and eradicate polio? Is Gates right? Or would it be a better use of money by spending $1 billion a year to cure HIV/AIDS?

Right now, the money is going into polio. So, we will have to be a bit patient and see what happens. Until then, take the time to watch Sendhil Mullainthan's talk. He is a fun speaker.