April 23, 2010
“Bill Gates Rethinks His War On Polio”
Wall Street Journal, Friday, April 23, 2010
By Robert Guth
(Note: These are excerpts from an article that reinforces how important it is to include education on good sanitation and proper hygiene for the success of any major health program, including the eradication of a single disease like polio.)
Bill Gates walked into the World Health Organization’s headquarters in Geneva—for a meeting in an underground chamber where global pandemics are managed—and was greeted by bad news. Polio was spreading across Africa, even after he gave $700 million to try to wipe out the disease. That outbreak raged last summer, and this week a new outbreak hit Tajikistan, which hadn’t seen polio for 19 years. The spread threatens one of the most ambitious health campaigns in the world, the effort to destroy the crippling disease once and for all. It also marks a setback for Microsoft Corp. co-founder’s new career as full-time philanthropist.
Next week, the organizations behind the polio fight, including WHO, Unicef, Rotary International and U.S. Centers for Disease Control and Prevention, plan to announce a major revamp of their strategy to address shortcomings exposed by the outbreaks.
Polio is a centerpiece of Mr. Gates’s charitable giving. Last year the billionaire traveled to Africa, one of the main battlegrounds against the disease, to confer with doctors, aid workers and a sultan to propel the polio-eradication effort.
“There’s no way to sugarcoat the last 12 months,” Bruce Aylward, a WHO official, told Mr. Gates in the meeting in the underground pandemic center last June. He described how the virus was rippling through countries believed to have stopped the disease.
Mr. Gates asked: “So, what do we do next?” That question goes to the heart of one of the most controversial debates in global health: Is humanity better served by waging wars on individual diseases, like polio? Or is it better to pursue a broader set of health goals simultaneously—improving hygiene, expanding immunizations, providing clean drinking water—that don’t eliminate any one disease, but might improve the overall health of people in developing countries?
The new plan integrates both approaches. It’s an acknowledgment, bred by last summer’s outbreak, that disease-specific wars can succeed only if they also strengthen the overall health system in poor countries. Big donors have long preferred fighting individual diseases, known as a “vertical” strategy. The goal is to repeat 1979′s victory over smallpox, the only disease ever to be eradicated. By contrast, the broader, “horizontal” strategy has less well-defined goals and might not move the needle of global health statistics for years.
Experts commissioned by the WHO landed in Angola, Pakistan, Afghanistan, India and Nigeria to evaluate the polio program. In Africa, a team found that once polio had been ended in some countries, weak health-care systems let it return. In northern India, bad sanitation, malnutrition and other intestinal issues are believed to hurt the oral polio vaccine’s effectiveness.
These findings…marked a turning point among the Gates Foundation and other backers of the polio fight in the debate over whether the strictly “vertical” polio strategy could succeed. In October, the Gates Foundation summoned backers of the program, including Unicef, CDC and Rotary, to its Seattle headquarters for a major rethink. If approved in May by member nations of the WHO, the new strategy will set ambitious goals for getting close to eradicating polio by the end of 2012. The plan bolsters the core “vertical” approach of polio program but also adds a “horizontal” strategy, including training for health workers on topics such as hygiene and sanitation.