Bill Gates throws his weight behind polio vaccination

With the launch of his 2011 annual letter in New York this morning, Bill Gates threw the weight of his $36 billion foundation behind the drive to eradicate polio. It’s a campaign that began more than 50 years ago, when Jonas Salk developed the first vaccine to combat the disease. Now, after numerous global pushes — by the March of Dimes, by the World Health Organization, and by Rotary International among others — the disease still remains endemic in more than a dozen countries. Gates’s hope? To bring that number to zero.  "The Gates foundation has made polio eradication its main priority," he opened his address this morning.

Polio is already history in much of the world — including here in the United States. But travel to pockets of West Africa and Central Asia, for example, and you’ll still see the victims of polio, crippled by the disease. In old French movies from places such as Senegal, the polio-stricken beggars, dragging their legs behind them as they crawl through the streets, were perennial characters — a sort of emobidment of poverty and pestilence in contrast to the colonialists’ opulence. Polio has always been an unfair disease. Its persistence among the poorest — in the most difficult countries — makes that ever more true today.

But why now and why polio? Gates’s argument is severalfold. First, he argued, if we don’t act now, the many millions of dollars that the world has spent fighting polio so far will be for naught as the disease creeps across borders. Second, finishing the job on polio would also free up "tens of billions of dollars" currently being spent on that vaccine and delivery — which could then be spent elsewhere. Finally, Gates hopes that ending polio would make a big difference in global health more broadly. Small pox, Gates argued, envigorated the drive to eradicate further diseases and increase vaccination rates. Polio could also give new energy for such global health initiatives. Plus, if vaccinations are done right, their introduction can actually help boost or even create local health infrastructure to administer future vaccines.

So, what’s the plan? How does the Gates foundation plan to succeed where so many have just barely failed? The announcement was a bit short on details — aside from talking about the money that will be needed.  Gates estimated that $2 billion would be needed to finish the push, of which $700 million still needs to be raised. Gates is paying 15 percent. The crown prince of Abu Dhabi offered a helpful $50 million last week, and Britain’s David Cameron also promised to boost his country’s contribution from $30 to $60 million.

The tricky part will be solving the politics. As uncontroversial and non-political as international vaccination schemes sound, they can actually churn up quite a lot of trouble. Smallpox was eradicated — an unmitigated international success — by doctors who knocked on the doors across the world. That’s not always as welcome as you might expect. In Northern Nigeria, one of the remaining pockets of polio, the vaccinations were rejected by locals as an effort to sterilize Muslims undertaken by the West. Obviously false, but also not so obviously crazy; just a few years before this rumor started circulating, a handful of children died in a Pfizer meningitis vaccine trial undertaken in the same communities. (Gates claims that Nigeria has not been "solved" — with political and religious leaders now actively dispelling the rumors.)

Another flare-up on polio this year in the Democratic Republic of Congo, almost certainly cropped up after political conflict there rendered health systems inept, under-resourced, and often non-existent altogether. The doctors might be apolitical, but the rebels and government forces fighting on top of a civilian population are not.

Which is why raising the money is probably the easiest part of this campaign. In truth, there has been money behind the campaign all along; Rotary International, for example, has poured millions into polio erradication in recent years as its signiture initiative. Gates seems to understand all this; he noted that patience and persistence will be needed to finish this fight. And yes, $2 billion certainly can’t hurt. But the real work will have to be left not just to the doctors but of the local politicians and community leaders who can really make polio erradication happen. Here’s hoping there’s a solid plan for that.