How to Finish the Last, Hard Path to Polio Eradication

The end of polio is in sight. Last year, there were fewer cases of the disease -- 223 -- in fewer endemic countries -- three -- than ever. Still, the eradication campaign can seem like Achilles’ effort to outrun the tortoise in Zeno’s paradox: There’s always a little more ground to cover.

The goal can be achieved only if health workers can find and inoculate the last unvaccinated children on earth. That’s going to take an estimated $5.5 billion (in addition to the $9 billion spent so far), a huge commitment from endemic-country governments and a push by Muslim leaders to counter anti-vaccination extremists.

In the past, funding shortfalls have led to outbreaks that in turn have made eradication more expensive. In a plan released this week, the Global Polio Eradication Initiative estimates that, with steady financing, infections can be eliminated by 2018. The initiative links national governments with the Bill & Melinda Gates Foundation, Rotary International, Unicef, the U.S. Centers for Disease Control and Prevention and the World Health Organization. (Among the many donors is New York City Mayor Michael Bloomberg, majority owner of Bloomberg LP, parent of Bloomberg News.)

According to a 2010 study, net benefits from reduced costs for polio treatment and increased productivity would amount to $40 billion to $50 billion through 2035.

Even if funding comes together, structural and social challenges remain. In the endemic countries -- Afghanistan, Nigeria and Pakistan -- heads of state have established their own task forces and made district chiefs, rather than health officials, accountable for polio vaccine coverage. This approach helped India, once considered the toughest case for eradication, wipe out endemic polio two years ago, and it’s working in Pakistan too. Local government efforts have been less consistent in Afghanistan, where parts of the country are beyond the capital’s writ, and in Nigeria, where a federal system limits the central government’s reach.

These countries need a different strategy. In Nigeria, this means making sure traditional leaders attend district-planning meetings. In Afghanistan, it means negotiating the specifics of campaigns with Taliban leaders.

The thorniest problem -- disruption by Muslim extremists -- is linked to a 2011 CIA attempt to confirm Osama bin Laden’s presence in Pakistan by using a polio vaccination campaign as a pretext to collect DNA samples from his family. Since then, Pakistan has seen a handful of deadly attacks on polio vaccinators. In Waziristan, a warlord has ordered immunizations stopped unless the U.S. calls off drone strikes in the area -- depriving 240,000 children of polio drops. In Nigeria, militants have killed polio vaccine workers in attacks on medical centers.

The new polio plan includes ways of improving security for health workers and containing any potential spread of the virus from Waziristan. Yet only Muslim leaders can address the problem head-on by denouncing violence and embracing vaccination campaigns. Some are doing just that. Local imams in Pakistan have been taking up the subject during Friday prayers and issuing pro-vaccine rulings.

At a recent meeting of Muslim scholars, Ahmad Al Tayyeb, the grand imam of Cairo’s influential Al-Azhar University, said Muslim communities were obligated to have their children vaccinated against polio. With the world aligning against polio, it’s possible that eradication of the disease could come down to a few words.

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