Gates wants last push to finish off polio

For countries plagued by instability and violence, a disease that strikes less than 1,000 people worldwide would hardly seem to be a national priority. But Bill Gates is trying to push polio eradication to the top of the health agenda in places such as Pakistan, Afghanistan and Congo.

Why?

For one thing, after 22 years and more than $6 billion spent trying to wipe out the disease, the world is on the cusp of realizing that goal, he said. Falling short means polio could spread back into countries where it was once eliminated and waste that effort.

But another reason is that Gates sees demonstrating success in polio as crucial for the foundation's global-health agenda. The final push to eliminate polio will test whether the world's largest charitable foundation and its partners can eventually eradicate other major killers, such as malaria, and influence how much faith donors and the public have in its ability to achieve audacious goals.

"Success will energize the field of global health by showing that investments in health lead to amazing victories," Gates, co-chair of the Bill & Melinda Gates Foundation, wrote in an annual letter released Monday.

In an interview, he said polio already has been eliminated in some of the toughest places in the world, such as Sudan.

"Of all the things you can do in a tough country, polio and other vaccinations are the things that absolutely can get done," he said. "It's a matter of finding all the kids and giving them a few drops."

The crippling, sewage-borne disease remains stubbornly persistent. Pockets of polio entrenched in four countries have helped transmit it to other countries that were previously free of it.

It costs about $1 billion a year to fund vaccination programs. Some health experts had questioned whether the value of eradication justified the ongoing expense.

Only once in history has a global vaccination campaign successfully eradicated a human disease — smallpox.

Dr. Donald A. Henderson, who led that program at the World Health Organization (WHO), doubted that it was possible to eradicate polio. He argued that a more realistic approach would be to continue vaccinating against it like other childhood infections.

But Henderson, a resident scholar at the University of Pittsburgh's Center for Biosecurity, said he changed his mind six months ago because of the push by Gates and Ciro de Quadros, an epidemiologist who helped eradicate smallpox from Ethiopia and is now a member of the Polio Eradication Independent Monitoring Board (IMB).

"I would say there certainly is a chance this can be achieved," he said in an interview. "We have invested this much time, effort and energy. I think it would be prudent to invest an additional dollop of energy and money to see if we can't get this last bit done."

However, with foreign-aid budgets in danger of further cuts, few countries have stepped up.

For this year and next year alone, there is a funding gap of $720 million, Gates said.

Rotary International has made polio-vaccination campaigns the focus of its service work for 20 years.

In the U.S., polio infections peaked in the 1950s at 52,000.

The disease remains endemic in just four countries: Afghanistan, Pakistan, India and Nigeria. Worldwide, there were about 1,600 cases in 2009 and 946 in 2010.

The number is likely to increase because of a recent outbreak in Congo.

"You don't have to be sick to spread the virus," said Walter Orenstein, the Gates Foundation deputy director for immunization programs. "As long as we have these countries in the world that are reservoirs for polio, nowhere is safe."

To help close the funding gap, last week Gates announced another $100 million in partnership with Sheikh Mohammed bin Zayed Al Nahyan, crown prince of Abu Dhabi, and British Prime Minister David Cameron, who agreed to double Britain's commitment this year to about $62 million.

With governments everywhere tightening their budgets, Gates made the case that vaccines are the best investment to improve the human condition. The foundation committed $10 billion over the next 10 years for a "decade of vaccines."Gates said some long-term benefits of healthier children might not be obvious, such as encouraging smaller families.

"While it might seem logical that saving children's lives will cause overpopulation, the opposite is true," he wrote. Many poor families elect to have more children because they believe not all of them will survive.

Henderson knows firsthand how challenging it can be to banish a disease.

The WHO smallpox-eradication program seemed comparably easy for the first six years, but in the final three years "we came very close to failure," he said.

Smallpox was reduced to just four countries: India, Bangladesh, Ethiopia and Somali, he said. The president of Bangladesh was assassinated, and civil war and famine raged in Ethiopia and Somalia. As smallpox spread through Somalia, the fear was that it could be carried into Saudi Arabia during the annual pilgrimage to Mecca and then spread throughout the world again.

Health officials worked desperately to try to stop it, Henderson said. They saw the last case of smallpox on Oct. 26, 1977, with just two months to spare.

"The problem is both money and commitment and a certain amount of luck," he said.

As for stamping out polio, "Can it be done? I'd like to think it would or could, but I think it hangs in the balance."

Gates, who once predicted the virus would be gone by 2013, did not have a timeline.

"We're kind of in the endgame, but we can't say exactly where the finish line is."

Kristi Heim: 206-464-2718 or kheim@seattletimes.com