Polio and confidence

Maryn McKenna writes about a new report (PDF) on polio eradication at Wired’s SuperBug blog. The report comes from the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI). The GPEI has existed for 23 years now, and while they’ve made much progress (polio cases are down 99% since the campaign started) the campaign has repeatedly missed the deadlines it sets for itself for eradication. The latest goal is to interrupt polio transmission worldwide by 2012, and despite a recent infusion of funding and enthusiasm the campaign is — according to the IMB — likely to miss yet another of its own goals.

McKenna writes, “Possibly the biggest problem, the board concludes, is a get-it-done optimism so ingrained in the 23-year effort that it cannot acknowledge when things are not working.” She quotes the report to the same effect:

The Programme has an established narrative of positivity – a pervading sense of “nearly there”. The danger comes in how the Programme deals with information that does not sit well with this narrative. We have observed that the Programme:

  • Is not wholly open to critical voices, perceiving them as too negative – despite the fact that they may be reporting important information from which the Programme could benefit.
  • Tends to believe that observed dysfunctions are confined to the particular geography in which they occur, rather than being indicative of broader systemic problems.
  • Displays nervousness in openly discussing difficult or negative items.

This report is likely to ruffle some feathers as the public discussion regarding polio eradication often suffers from the same dearth of criticism. One reason for that — and likely for GPEI’s own “get-it-done optimism” — seems to be that polio eradication is an epic high-stakes gamble. If we can do it the benefits are huge: no more polio, and less need for continued vaccination (though much of the projected cost-savings are predicated on the idea that the US and other countries will stop polio vaccination, which is highly unlikely given fears of vaccine-derived strains or bioterrorism). But if we can’t do it then it might be better to spend resources on some other priority in global health; spend some lesser amount on polio, allow a bit of resurgence (but not too much), and focus resources on other vital needs. Thus the real battle is over the general donor consensus around whether polio eradication will be achieved soon. As soon as the global health donor community decides that eradication isn’t actually possible, that belief will become a self-fulfilling prophecy.

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10 2011

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  1. Ashton #
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    I don’t like the Wired article much. It quotes the report as saying “Case numbers are rising” when the report actually says “Case numbers are rising in five of the seven key countries.” The IMB report itself seems more based in reality. I don’t know anything about the organizational structure of the GPEI, but the report and the Wired article about it do not suggest turning away from eradication as a goal, just that the efforts need to be restructured. Yes, polio can be eradicated. Things are going quite well in some countries. In others not so much, but there has been a large dropoff in cases since last year and this year will likely see the lowest numbers since 2001 when vaccine fears arose. Even with any issues that GPEI has, tangible progress toward the goal has been made, albeit at a slower pace than desired.

    I don’t really see this effort as a high stakes gamble. One day, polio will be gone. It may not be the next disease to be eradicated (guinea worm first, maybe?) but vaccinating kids is hardly gambling. India has likely eliminated polio. Every country that does so is a victory. Allowing a bit of resurgence probably isn’t possible. Any resurgence due to fewer efforts would likely be massive.



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