Saturday, January 12, 2013

Chasing polio: Is eradication the right goal?

Last week, I discussed some of the aspects of the disease of polio and the history of the eradication campaign after the recent deaths of aid workers in Palestine prompted people to examine the campaign.

So, should polio be a global health priority?

Very few people die of polio. Very few (relatively) actually show any signs of polio. While the symptoms can be very dramatic and heart-wrenching, they are not common. I am not diminishing the suffering of those who are afflicted. But as I previously pointed out, so few people are actually afflicted.

Compare the number of people with polio to the number of people who die from just plain, old, standard diarrhea. While it’s difficult to measure (since it’s difficult to classify whether it’s ‘diarrhea’ or ‘bad day’), WHO estimates there are approximately 2 billion cases of diarrhea every year. 1.5 million children die every year of just diarrhea. It’s the number two killer of children under five (second to respiratory illness), and costs countries millions of dollars every year in healthcare and lost man hours. Vaccines do not address any of this. Sanitation does. Instead of spending vast quantities of social and financial capital trying to eradicate a disease that is not that fatal, perhaps the resources are better spent addressing larger structural inequalities that create these huge differences.

Do I sound like a broken record? Probably. Sanitation is important, and polio is another disease that emphasizes this. Structural methods, such as sanitation and water infrastructure, are more difficult, complex, and expensive to implement, and it is so much more difficult to tally the lives saved. Yet these sorts of long-term solutions are the way to make long-term, significant, and sustainable solutions to health problems.

Yet, if we give up, what is risked? There is the fear that if people give up on the polio campaign, then donor agencies will see the money as wasted, that these groups (whether governmental or nongovernmental) have given up and are not worthy of more funds in the future. There is a sense that enough money has been sunk into polio, that we need to keep spending or none of it will have been worth it. We like eradication. We like checking diseases off of our list, and we don’t get to do that very often. And yet, with the speed that diseases evolve and that people reproduce, we may have to face the fact that eradication is not the right goal. Instead, we should focus on improving whatever health issue is the most salient in the particular community.

~Public health priorities is an incredibly complex topic, and I have only just started to scratch the surface. For more information on polio in Pakistan and global health institution culture and politics, check out Svea Closser’s book Chasing Polio in Pakistan.

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