Polio eradicated worldwide, except for four countries

From Newsweek:

On its face, it looks like a success story: polio, a disease that paralyzed 1,000 children per day in the mid-1980s, has now been driven out of all countries in the world except four where it's still endemic—and even there, things are improving.

In India, the two states that are usually hot spots for the disease have not had any cases in the past six months. Nigeria, which had 312 cases by this time last year, has reported just three. It's impressive, given that Bill Gates, whose philanthropic foundation is a major funder of efforts to fight polio, was expecting Nigeria to make the least progress of the four remaining disease-carrying countries. All told, the incidence of polio worldwide is down 99 percent since the '80s. So, as world leaders gather in Geneva today to launch a new strategic plan for fighting the disease, shouldn't they be celebrating?

Not necessarily. For global health advocates, polio is the kind of disease that breaks hearts, because every time it seems to be going away it ends up coming back. The past year may have been a good one, but look at the year before: 15 African countries that had rid themselves of the disease saw it return. Earlier this year, Tajikistan, which had been polio-free since 1997, had an outbreak imported from India that paralyzed 239 kids.

According to The New York Times, culture is partly to blame: Many of the recent outbreaks occurred in "places where many Muslims have resisted vaccines because of rumors that vaccine efforts are a Western plot to sterilize them." But there's also a deeper trend at work, one that's all too familiar to public health policymakers: the moral hazard. If an infectious disease is brought down to low levels in the population, a given individual's risk of catching it will be lower—and that individual may be less likely to bother getting vaccinated against the disease because it doesn't seem like the threat it once was. Of course, if enough people reject vaccination, the risk of catching the disease goes right back up.

"The reason why sustaining childhood immunization requires so much work is that if a mother has not seen a disease, it can be very hard to convince her that there is a risk," says Regina Rabinovich, the Gates Foundation's director of infectious disease programs. That's what is apparently happening with measles (driven by parents' fears of the MMR vaccine and its purported, discredited link to autism), and it's likely part of what's happening with polio, too.

The "meh" response to a disease that's been largely brought under control can even happen on a macro level. Last month, the World Health Assembly got a sneak peek at the strategic plan that’s being formally introduced today. It praised the plan itself but wasn't sure about pulling it off, because currently, there's not enough money. To execute the plan, global health agencies need about $2.6 billion over the next three years. They have only half that.

For now, the funding shortfall doesn't seem to be having any ill effects: in 10 of the 15 previously polio-free countries that became re-infected, the outbreaks have stopped. But until polio is truly eradicated – no more cases, anywhere, with Nigeria, India, Pakistan and Afghanistan finally cleared of the disease – there will always be the risk of it rearing its head again. Pathogens don't respect borders. Complete elimination everywhere is the only way to ensure the safety of any country. That's why now – with polio in retreat and eradication in sight – is the most crucial time to pour money into defeating it once and for all.