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.