Monday, March 7, 2011

Drops Not Drones, Vaccines Not Marines

You are likely to be judged by the company you keep. In Osama bin Laden's case, the isolated mountains of tribal Afghanistan and Pakistan provide a perfect safe haven for him and for polio. Thirty years of conflict and low economic development have resulted in security and health infrastructure that is inadequate for deploying an effective regional eradication program. Thus the Af-Pak borderlands remain one of only a handful of places (including India and Nigeria) where polio is endemic, though flare-ups also occur across Africa and Central Asia due to importation.

As the Afghan war moves into its tenth year and intensifies to ten airstrikes per day, the time is beyond ripe to question whether we're packing the right payload. The United States spends more than $100 billion per year executing the war in Afghanistan, while Afghan GDP is around $15 billion. Clearly this is unsustainable.

Compare this to the figures required for global health and development. Bill Gates said recently that $2 billion is needed for polio eradication over the next two years, while the campaign is currently experiencing a $700 million shortfall. In a speech at the former Roosevelt home in New York, Gates delivered his annual foundation letter in which he outlines his strategy for charitable giving. Polio eradication is the key focus this year, and his rationale centers on four points:

1. We are close to eradication: There are only about 1,000 cases left per year globally;
2. Eradication will permanently free up resources for other vaccination and health campaigns;
3. The affected regions will benefit in terms of economic productivity; and
4. Eradication will provide a motivational victory for the health industry, driving further hope and investment.

As polio is just one affliction of poverty among many, it's important to consider the opportunity costs. Critics such as D. A. Henderson, the leader of the team who eradicated smallpox, feel that dumping billions into polio eradication is a misallocation of funds. Polio is difficult to kill because of a number of combined factors: the variety of strains, asymptomatic carriers, a vaccine that is not 100 percent effective, parental refusal, a lack of infrastructure, and management problems in organizing all the national campaigns. It is very much a door-to-door endeavor, but so was smallpox eradication.


A point in favor of financing polio eradication is that the vaccine can be viewed as a gateway process leading to routine immunization services for more common diseases. One-fifth of children today don't have such access. Beyond the obvious health consequences, lack of access also presents an organizational problem in the fight against polio because it leads to underreporting and thus keeps the virus elusive.

There is also the issue of innovative and appropriate technologies: Something as simple as camel-portable refrigerators could go a long way toward keeping vaccine doses fresh. If the U.S. military is deploying innovative solar modules to replace the generators that power air conditioning at its forward operating bases in Afghanistan, then clearly some of these technologies can be repurposed for more benign operations.


At the Bill Gates event, David Oshinsky, author of Polio: An American Story, said we need to motivate a new March of Dollars to "get kids interested in the moral dimension" of helping other kids around the world. The original March of Dimes organized by the National Foundation for Infantile Paralysis was able to finance research for the polio vaccine through a flood of small private contributions.

But it was much easier to motivate Americans to donate when their classmates were leaving behind empty school desks. Gates attributes the moral gap today to this physical proximity problem. Even with his computer software stitching the world together, polio mostly kills and maims people outside the eye of the rich world's collective consciousness. Few things illuminate the power and puzzle of globalization more than the world's richest man reaching out to help some of the poorest. His ethical sense drives him to do it.


Gates has collected allies along the way. The British government has pledged to double its funding to $60 million from $30 million as a matching grant conditional on contributions from other donor governments. Sheikh Mohammed bin Zayed al-Nahyan of Abu Dhabi recently contributed $50 million, and the government of Pakistan announced an emergency response to the increase of cases in its territory.

So whose side are we on? In one corner we have Robert Gates and the U.S. Department of Defense dropping bombs from drones. In the other corner we have Bill Gates asking the world to spend more to save the most vulnerable. Send in the vaccines, or send in the Marines. It's a pretty stark simple choice.

[PHOTO CREDIT: Gates Foundation (CC).]

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