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Experts Debate Whether Goal of Polio Eradication Can Promote Better Global Health Care - 2004-06-13

At this week's G8 summit of the world's leading industrialized nations, leaders committed themselves to eradicate polio by the end of next year. Vaccines developed in the 1950s and 1960s wiped out the disease in much of the world, and a worldwide campaign launched in 1988 has cut the number of yearly cases down to a few hundred. But after spending $3 billion to reach this point, will the polio campaign leave a lasting legacy of improved health care?

When a polio immunization drive comes to town, it's a big deal. This children's rally in India is just one of many activities that help mobilize parents to have their children vaccinated. Across the country this year, more than a million people will participate in national immunization days. The goal is to vaccinate every child in India. It's a huge job, it's labor-intensive, and it costs a lot of money. But program officials say it's worth it. Eradicating the crippling disease would be a humanitarian triumph. And India's polio eradication program director, Sobhan Sarkar, says it also makes good economic sense.

"Just imagine the amount of disabilities you have prevented," he said. "So if you look a the cost benefit side of it, we have probably already made enough profit in commercial terms through this program."

But critics say the benefits of the polio eradication campaign are too narrow.

"I don't think it's necessarily to the benefit of these countries to have this huge machinery addressing only one disease at a time," said Ron Waldman, deputy director at Columbia University's Center for Global Health and Economic Development

Dr. Waldman says that the progress made toward eradicating polio is a tremendous achievement. But in his opinion, putting more emphasis on strengthening basic public health care systems would still eradicate polio, plus much more.

But other experts point out that the eradication campaign is helping to build up public health systems.

"We'll never make the public health system strong enough, I fear," said Bob Keegan, deputy director of the Global Immunization Division at the U.S. Centers for Disease Control and Prevention, or CDC. "But I think that we can certainly say the health system will be much stronger because of polio eradication."

Mr. Keegan points to the network of informers created to extend the reach of the public health system. Informers in overcrowded cities and remote villages report suspected polio cases to the authorities.

An Indian health official opens a freezer bought with money from the eradication campaign. Around the world, the campaign has bought basic equipment to store and deliver polio vaccine that can also be used for other health projects.

The campaign has also created unique partnerships between governments and non-governmental organizations. Health expert Subodh Kumar is with CORE, an umbrella group of NGOs working on the polio campaign in India. He says the NGOs make the work easier.

"Everybody has a limitation. Government has its own limitations," he said. "If you totally rely on the government system, it's very difficult to reach all the villages. It's very difficult to reach every household. You can do it only with the help of various partners."

And Mr. Kumar says the experience with polio shows NGOs can be partners in many other areas as well.

But Dr. Waldman says it's not yet clear whether these partnerships, or the other benefits of the polio eradication campaign, will survive in the long run. On the other hand, he points out that the United Nations has set goals of reducing child mortality by two-thirds, and maternal mortality by three-quarters, by 2015.

"Polio eradication hasn't contributed to achieving those goals, specifically and directly," he said. "But the fact of having achieved polio eradication can and should tell us that those goals can be achieved."

They can be achieved, Dr. Waldman says, by focusing on basic health services that can deal not just with polio but with the broad range of diseases that today threaten public health.