
Polio eradication program faces hard choices as endgame strategy falters - pseudolus
https://www.sciencemag.org/news/2019/12/polio-eradication-program-faces-hard-choices-endgame-strategy-fails
======
jessriedel
As late as 1980, Polio was crippling 300,000 children every year. It's now
down to a few hundred, at a bargain price of order $10B (total, not per year).
It's natural to wonder whether it makes sense to push to fully eradicate the
disease (which will cost billions more) rather than simply controlling it
(presumably at a substantially lower cost) for a few decades until the regions
become wealthy enough that eradication is cheap (at least relative to the
local economy). This is not at all an obvious question; for organizations that
are somewhat economically rational like the Gates Foundation, billions spend
on eradication is billions _not_ spent on other developing world interventions
that might save more lives.

Here's the economic case for eradication:

[http://polioeradication.org/wp-
content/uploads/2016/07/Econo...](http://polioeradication.org/wp-
content/uploads/2016/07/EconomicCase.pdf)

~~~
phkahler
>> This is not at all an obvious question

It is obvious in my mind. Vigilance is the only reason it's so close to
eradication. Not completing the eradication risks enormous consequences. Not
if, but when. The cost of eradication is thought to be in the billions of
dollars. A pittance compared other government spending around the world.

I say just get it done so we dont have to deal with it any more. Unfortunately
the plan seems to have some problems.

~~~
hanniabu
Once it's eradicated what are the chances it has a resurgence vs is gone for
good? Can it have a resurgence?

~~~
ovi256
The other answer has covered resurgence from natural reservoirs.

I'll cover man-made resurgence. There are copies of it in all major countries'
virology labs. Furthermore, it can be synthetised from scratch since 2002, see
NYT.

NYT: [https://www.nytimes.com/2002/07/12/us/traces-of-terror-
the-s...](https://www.nytimes.com/2002/07/12/us/traces-of-terror-the-science-
scientists-create-a-live-polio-virus.html)

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bobbiechen
I've read that polio eradication efforts in Pakistan were set back by CIA
efforts to find Osama bin Laden, of all things.

 _Between 2004 and 2012, the number of polio cases in Pakistan closely
mirrored the number of drone strikes. But from 2013 onward, polio cases
increased while drone strikes fell.

This can be explained by the CIA's use of a fake immunization campaign in a
failed attempt to obtain the DNA of Osama bin Laden's relatives prior to his
assassination in 2011. This seemingly vindicated militants' suspicions that
vaccination programs were a cover for espionage. Militants consequently
intensified their disruption of immunization campaigns, resulting in an
increase in polio cases in Pakistan, as well as in Afghanistan, Syria, and
Iraq._

[https://www.ncbi.nlm.nih.gov/m/pubmed/28764582/](https://www.ncbi.nlm.nih.gov/m/pubmed/28764582/)

~~~
hanniabu
You either die a hero, or live long enough to see yourself become the villain.

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nobrains
This ([https://www.theguardian.com/world/2011/jul/11/cia-fake-
vacci...](https://www.theguardian.com/world/2011/jul/11/cia-fake-vaccinations-
osama-bin-ladens-dna)) did not help, adding to the already severe skepticism,
and eventually that skepticism led to a backlash
([https://www.nationalgeographic.com/news/2015/02/150227-polio...](https://www.nationalgeographic.com/news/2015/02/150227-polio-
pakistan-vaccination-taliban-osama-bin-laden/)).

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trianglem
Would going back to the trivalent solve all of the problems?

~~~
marcinzm
According to the article, the trivalent vaccine is a live virus and
occasionally reverts to a virulent strain. So while the trivalent vaccine can
generally stop outbreaks it also paradoxically causes them in a tiny
percentage of cases. Using it means you cannot eradicate the virus entirely as
the vaccine itself causes new outbreaks.

~~~
trianglem
I wonder if there is any sort of genetic basis to who might get sick from the
trivalent in the small percentage of cases. Not that it’s a viable strategy
but then you could selectively give those people only the trivalent.

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macintux
Depressing read. I knew the effort was facing PR challenges in South Asia, but
I didn’t realize the tricky problems outside that region stepping down from
the old vaccine.

~~~
makomk
It doesn't exactly seem to be widely advertised, and a lot of the press
coverage is misleading. There was some (rather confused) discussion of this
problem on HN a month or so ago:
[https://news.ycombinator.com/item?id=21730795](https://news.ycombinator.com/item?id=21730795)
That article, like others, made the horrendously wrong claim that types 2 and
3 of the poliovirus had been eradicated. They hadn't. The original wild
versions had, but vaccine-derived versions of them which were every bit as
dangeorus as the originals were in increasingly widespread circulation - the
only difference, as far as I know, is that we can use genetic testing to trace
their lineage back to the vaccine.

The slightly better publications like Ars Technica qualified this by saying
that this only applied to wild-type polio viruses and did mention vaccine-
derived polio, but they severely downplayed how much of a problem this was for
the campaign to eradicate polio.

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caiobegotti
> Some experts fervently hope to avoid reintroduction of the trivalent
> vaccine. “It would be an enormous blow to the polio program and to
> international public health,” says Nicholas Grassly, a modeler and
> epidemiologist at Imperial College London

It's sorta disgusting to see someone on the other side of the world
considering it to be a PR disaster instead of just doing damage control if you
must but do effing go back to the trivalent vaccine known to be effective.

~~~
tempestn
The problem is the effect of the 'bad PR'. The end of the article goes into
the struggles involved in distributing the vaccine and making sure it's used.
If the program loses credibility, those struggles could increase to the point
where it's no longer effective.

Honestly what's surprising to me is that they're able to overcome that
resistance at all. Imagine trying to distribute a vaccine in the US that is
known to trigger outbreaks of the virus it's supposed to protect against.
Regardless of the fact that things would be far worse without it, all the
evidence in the world wouldn't be enough to convince many people.

~~~
gvjddbnvdrbv
People used it in the past. If your child has a real risk of contracting polio
you would do anything to get them that vaccine.

The anti vaccination movement has only survived because most of these diseases
are so rare. If we see a return of diseases like polio the anti vaccination
movement would disappear fast.

~~~
derekp7
So it's basically like seatbelt use. There are certain types of crashes where
a seatbelt could cause more harm than good (such as crashing into a lake, the
seatbelt gets stuck, and the victim can't get out). However these are rare
enough, that the benefits of seatbelts far outweigh the risk, that most people
decide to wear them (including the benefit of not getting a seatbelt violation
ticket).

