By Mason Quah
WILD Polio’s eradication from Africa was rightly hailed as a huge success.
Soon it may be eliminated from Pakistan and Afghanistan, the last two endemic countries.
The resources and personnel invested into this campaign have come at the cost of allowing greater threats to persist.
The near full elimination of a disease is nothing to sneeze at. The last patient to acquire smallpox before it’s eradication was Ali Maow Maalin, a Somalian health worker.
After his recovery from smallpox he went on to contribute to Somali’s Polio eradication campaign under the World Health Organisation. In 2013, while distributing Polio vaccines, Maalin contracted malaria and died as a result.
Ali’s case is not unique but it demonstrates a wider issue: funding given to Polio eradication is funding not given to malaria and cholera control.
Tracking down and cataloguing the last few hundred cases of active Polio is an endeavour that draws healthcare resources from much more immediate threats and thus comes at a cost of human lives.
In the case of Polio eradication this is a decision that comes from the top, under the administration of the World Health Organisation and more frequently, the Gates Foundation.
Global healthcare is not something that can be dealt with as a checklist, vaccinating against diseases one at a time and eliminating diseases in alphabetical or chronological order. It is an undertaking in which all threats must be controlled, regardless of the publicity given to any one disease.
Eliminating Polio and Smallpox in destitute communities is a meaningless and self-aggrandising gesture for white saviours if those same people die a month later from preventable cholera.
The Polio Eradication Initiative reported a total of 176 cases of Wild Poliovirus in 2019, all from small clusters in endemic countries.
While the elimination of the remaining cases is important in preventing a resurgence the billions of dollars spent on the pursuit would produce orders of magnitude more benefit on programmes targeting large numbers of more prevalent disease.
The issues of Polio eradication funding versus other preventable illnesses is only one in a long line of similar cases, where the disproportionate media attention of causes prompts philanthropists to donate their money to the most visible instead of the most effective projects.
The Polio campaign has been criticised previously over its focus on technological interventions as opposed to social and infrastructure changes.
Vaccine distribution has always been the forefront of the Polio campaign, with billions of vaccine doses administered. When Polio is eliminated, great expense and care will be needed to carry out the safe disposal of surplus vaccine and laboratory strains.
An additional critique posed towards the initiative is the ignorance its administration held towards local circumstances and political realities.
The initial goal of Polio Elimination by 2000 was significantly set back by military conflicts in Afghanistan and Pakistan. In West Africa it was held back by Boko Haram.
These do not explain other pockets of Polio persisting long beyond the 2000 goalpost.
It is possible that the Polio campaign will sleepwalk into future political blunders in the future.
While billions of dollars have been spent eliminating the last single digit of Polio cases, the food security of millions in West Africa is currently being threatened by a massive upsurge in locust populations in Somalia, Ethiopia and Kenya.
The circulating vaccine derived strains that persist in the region pose a diminished but ongoing threat that must be dealt with, in the midst of an unprecedented regional crisis.
Food security in the region was already a constant issue and vaccines provide little in the way of nutrition.
Eradication of Malaria in Europe did not come about from the development of a vaccine: It occurred because Europe dragged itself out of poverty with industrial and colonial wealth, the increasing living standards making the transmission of malaria impossible.
HIV, similarly, was not cured. The current goal for 2020 is not elimination but to achieve 90% diagnosis, treatment and viral suppression.
This long term project requires not just the administration of medication, until recently ineffective at stopping transmission, but public engagement campaigns to teach safe sex practises and long term changes to medical infrastructure to ensure continuous access to diagnosis and treatment.
Where Polio missed its target of global elimination by the year 2000, many nations are on track for their 90-90-90 HIV goals. This is not due to the invention of a vaccine or wonderdrug, but due to the amazing diversity of methods used globally to combat HIV in different medical and social circumstances.
176 cases of Polio in the year 2020 is a tragedy. 405,000 malarial deaths in 2018 is a statistic. 9,000,000 annual deaths to starvation is a travesty.
Solving the economic inequalities of the developing world will do more to improve global health than any vaccine in history.
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