Some romantic victory over a single virus

Helen Epstein in the New York Review of Books says polio eradication campaigns aren’t such a good idea. Even if they weren’t mixed up with CIA spying, they wouldn’t be such a good idea, she says. They might might seem like a good idea, but…

The killings in Pakistan—which played out in a series of attacks in several different cities on December 18 and December 19—were heinous. But they also point to some serious problems with the heroic approach. For one thing, in conflict areas where the US is trying to route out insurgents with drone strikes, the UN is often not seen as neutral. But more fundamentally, the lavishly funded, multiple immunizations the polio program requires don’t always make sense—to local political leaders and warlords, or to ordinary poor people who are struggling just to keep their children alive. In order to avoid further tragedies, donors should work more closely with local people to improve the health of children in general, rather than strive for some romantic victory over a single virus alone.


She may have a point, but “romantic” is insulting. As she says, polio is horrible. Improve the health of children in general by all means, but also get rid of polio. Most countries in the world have done it; Pakistan and Afghanistan and Nigeria should do it too.




  1. says

    It took more than 100 years for American to institute universal sewerage. And America still had polio cases because polio spreads by standing water too as well as by the air.

    The standing water thing was a problem because of an American Pastime that was common in the summers. Swimming pools were the vector for polio…

    It’s not romantic to kick it’s head in. It’s something we can actually bloody do. It’s something within our technological and physical capacity if it wasn’t for those pesky warlords… Does this woman think these same warlords will let you give people Internet, Sewers, Education and Clean Drinking Water or do you think those facilities are going to be blown up?

  2. Hamilton Jacobi says

    I think she has a very good point, that polio vaccinations can be made more acceptable to the target populations by packaging them as only a small part of an overall health campaign. She certainly stepped in it by dismissing polio eradication campaigns as “romantic”, but her overall concept is a good one.

  3. says

    But more fundamentally, the lavishly funded, multiple immunizations the polio program requires don’t always make sense…to ordinary poor people who are struggling just to keep their children alive.

    So these parents, who are just struggling to keep their children alive, don’t understand the point of eradicating a disease that kills children.

    Yea. Makes sense.

  4. says

    Seems to me you’re sneering at people who are suffering. Not particularly cool. If you go further into the article, you find this:

    While the UN concentrates on this one cunning virus, the rate of child mortality in the tribal areas of Pakistan is greater than 10 percent; polio, even before the special campaigns, has always accounted for a tiny fraction of this. Most child deaths are caused by diarrhea and pneumonia, often exacerbated by malnutrition. These diseases are easy to cure if basic health care is available, but often the only thing people see the government doing is intensive polio vaccination.

    Preventing polio is awesome… but if it is done instead of treating something that kills more children and can be dealt with for cheaper, then preventing polio is the wrong priority.

  5. John Morales says

    Improbable Joe:

    Preventing polio is awesome… but if it is done instead of treating something that kills more children and can be dealt with for cheaper, then preventing polio is the wrong priority.

    Well, is it [done instead] or isn’t it?

  6. philipc says

    I think there’s a huge difference between “preventing polio” as a kind of local healthcare measure and eradicating polio. Eradicating it will benefit people for decades, not just in the last corners of the world to have done so, but everywhere. We’re so used to annual numbers that long-term benefits don’t quite register: childhood diarrhea can only be prevented one child at a time, while measles, once it’s gone, will be gone for all children, everywhere, (all but) forever.

    Measles, polio, and dracunculiasis are all nearly gone, and it would be a huge tragedy if even just one of them came back. There’s nothing romantic about that, or about the decision to eradicate all three. Giving up on polio would be a horrible mistake. There’s nothing romantic about comparing the numbers for a few decades rather than just next year: that’s science.

  7. anthrosciguy says

    Sure, if you can’t do everything, do nothing instead. That’s certainly an extremely non-romantic message.

  8. Maureen Brian says

    Well, she’s wrong on one thing – the original target date for global eradication of polio was 1979. I know: I was there raising money for it.

    I wonder if Ms Epstein can grasp that in this instance the US is playing exactly the role of yet another pesky warlord. Any real improvement in public health demands both stability and time. It is not foolish for local health workers to do everything possible to maintain existing health programmes, even under pressure. I, after all, had my early vaccinations during WWII. Should that programme have been stopped?

    What really is foolish is for the US to imagine it can conduct a war without harming the civilian population and to get all whingy when news of those harms makes it, all too infrequently, back to the US.

  9. Cassanders says

    Apparently Helen Epstein and several commenters have missed an important point. Let me for the discussion accept the characterization :lavishly funded (compared to the input in other health issues in the area it likely is corret). But neither WHO nor the other (presumeably private) funders are spending this money simply because polio has the largest health impact in the area or that they have a “romantic” view of polio per se. The rationale for spending (for the time being , and locally) larger rescources on polio is the prospects of finally erradicating it GLOBALLY (as for smallpox). Erradicating polio will BOTH have substantial benefits ridding the local population for a dreadful disease AND will allow health rescources to be better alocated locally AND globally.

    In Cod we trust

  10. chrisdevries says

    I agree with Cassanders.

    It’s all well and good to improve the health of impoverished Pakistanis, and perhaps more money and resources should be put into programs that reduce infant mortality, or maybe aim to combat more prevalent diseases like typhoid. But polio is both an unusually devastating ailment, and one which has been pushed to the brink in the developed world. Polio eradication campaigns won’t do much to improve the health of Pakistanis in the short term, but nobody ever claimed this was the principal goal of the vaccination programs. The main purpose of the eradication campaign is to reduce the number of communities worldwide where polio is found (eventually to zero), denying the virus a host. As long as there is an incidence of polio anywhere on Earth, the populations of countries where there is no such incidence (and therefore no longer any widespread vaccination programs to speak of) are at risk of contracting the disease. It’s much cheaper to target nations such as Pakistan for universal polio vaccination than to immunize the entire developed world against polio.

    Therefore, polio eradication programs in the developing world are designed to benefit the entire human population, making them ostensibly more important and a higher priority than programs that only help individual communities. I don’t see anything remotely “romantic” about ensuring that nobody suffers the crippling, painful effects of polio infection ever again. However, this shouldn’t be an either-or situation: including universal polio vaccination in a larger campaign to improve the quality of life of inhabitants of countries like Pakistan would be the ideal way to help.

  11. says

    “the US is trying to route out insurgents with drone strikes…”

    We are? Well that’s damned silly.
    Clearly all they need to do is provide them with some maps and road signs.

    (btw I really fucking hate the term “insurgents.”)

  12. raymoscow says

    It is a terrible disease that is now easily prevented, or rather would be except for religious nuttery and paranoia. There’s nothing romantic about the attempt.

  13. chrislawson says

    For crying out loud! There is *nothing* defensible in Epstein’s quote.

    (1) Eradicating polio is good for local communities and for the global community.
    (2) It is “lavishly funded” because it is a major health goal that is eminently achievable.
    (3) The areas of local opposition to polio vaccination have nothing to do with locals feeling left out or patronised — all the eradication campaigns in history have worked with local leaders and community groups — the problem is that a group of anti-secular religious leaders are blocking vaccination as exercise in power-building.
    (4) The UN has never been seen as neutral by all political/religious groups, and yet we managed to eradicate smallpox from 1950-1977 with international co-operation at the height of the bloody Cold War.
    (5) There are no “better” health priorities, Improbable Joe — in terms of public health, eradicating polio is up there at the very top of the tree for cheap, achievable, effective interventions. The only reason locals may feel polio vaccinations are not a good option is because they have been lied to by their religious leaders.
    (6) And if anyone thinks the UN is *only* doing polio vaccinations, then they haven’t been paying attention. The UN has been working hard to provide clean water and health care around the globe. If the infant mortality is 10% in these areas despite the UN’s best efforts, might that not have something to do with those same leaders who are blocking polio vaccination also blocking efforts to build wells/filtration facilities?

  14. chrislawson says

    Oh yes, I forgot…

    (7) The reason polio is no longer a major cause of infant mortality even in Pakistan is because it has already been eradicated in most parts of the world, so even the loony anti-vax areas are partially protected by the fact that the rest of the world worked hard to wipe it out. This opposition to vaccination threatens to reverse a lot of that good work.

  15. Kimpatsu says

    “It’s not romantic to kick it’s head in. ”
    Jesus, Avi, when are you going to learn to use apostrophes correctly? Are your medical notes like this as well?

  16. bad Jim says

    Epstein is not the average ignorant journalist. She’s a scientist, and epidemiology is her specialty. Don’t be so quick to dismiss her. Her point clearly is that polio isn’t the most pressing health concern in this part of the world and that the immunization campaign has been so compromised by American war on terror that the risk to health care providers isn’t worth the benefit, for now.

    Why the anger at the word “romantic”? Would it have been less objectionable if she’d used the roughly synonymous “heroic” or “idealistic” instead? Of course we want to see polio eradicated, but is it reasonable to prioritize vaccination over more immediately life-saving measures in these regions? Say you’re crazy enough to volunteer to provide care there; do you choose to dare the militants to kill you in order to vanquish a rare and ancient threat, or do you save as many lives as quickly as you can, including your own?

  17. 'dirigible says

    The fact that Epstein is a specialist in epidemiology doesn’t exactly make her use of cheap pop psychological sneering more excusable.

    And people have already tackled the priorities canard.

  18. chrislawson says

    bad Jim,

    Anyone who says that eradicating polio is not a high enough priority has abandoned the right to be respected for their qualifications in epidemiology.

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