Critics and fans spar on Bill Gates’ anti-polio push

UNICEF

Child receives polio vaccine

Huh, we still have polio?

That’s the first problem with the polio story.

This is often the public reaction whenever there are news stories about the long-running — and, lately, increasingly frustrating — effort to rid the world of this crippling disease.  As recently as 1988, polio afflicted nearly half a million kids worldwide every year and killed maybe 5-10 percent of them.

The second problem with the polio story could be what I will call, by inventing a new German word, Glitz-Schadenfreude — the enjoyment of witnessing a rich or famous person getting taken down a notch.

Bill Gates, as we have been reminded over and over the past week, has made polio eradication one of his causes célèbres (sorry, switching to French). It’s a natural psychological tendency — this Glitz-Schadenfreude — for some of us to enjoy seeing Gates defend himself against those who would criticize his judgment on this, if not his role as humanitarian-in-chief.

Polio is today down to maybe a few thousand cases in a handful of mostly poor countries, thanks to a global vaccination campaign and in some cases improved sanitation.

Gates Foundation

Polio cases worldwide

The polio virus could (and does, on occasion) come back with a vengeance. We don’t worry about it here in the U.S. because we’re a wealthy country.

We would not stand for anyone telling us that, on balance, we need to accept a few more crippled and dead kids rather than waste money fighting a disease that so rarely plagues us anymore.

That’s what the critics of Bill Gates’ big push to eradicate polio sometimes sound like they’re saying. They’re not really, but it sounds like that.

So, we have these two basic problems going in to trying to tell the story of the global campaign to end polio, ignorance and Glitz-Schadenfreude.

And, perhaps as a result, end up with two basic media narratives: The cheerleaders and the cynics.

Most of us (I include myself) in the media tend to be cheerleaders for this cause:

Bloomberg: Gates, U.K. Boost Polio Spending to Speed End of Crippling Virus

NPR: Gates Calls for More Money to Stamp Out Polio

Me: Gates Pushing Us to Push Polio Into Oblivion

Then, there were the narratives of the cynics:

Financial Times: Gates Polio Goals Questioned

The Chronicle of Philanthropy: Gates-led Polio Push Attracts Criticism

LA Times: Is Bill Gates Fight Against Polio Quixotic or Impractical?

And then there are those who can’t seem to make up their mind whether or not they think Bill Gates’ anti-polio push is good or bad, wise or unwise:

Dr. Donald Henderson led the successful smallpox eradication campaign (so far, the only disease to be eradicated) for the World Health Organization. Henderson has long said polio eradication is not possible and we should opt for the less-costly and consuming goal of simply trying to keep it under control. He’s cited in the cynical narratives above. Here’s what the Financial Times’ wrote:

The “father” of smallpox eradication has cast doubt on whether the same can be achieved for polio, even as Bill Gates steps up a campaign with other donors to raise billions of dollars to tackle the disease…. He told the Financial Times that polio eradication had “become more of a ‘movement’ than a public health initiative capable of being examined by objective judgment”. He called instead for a cheaper but sus­tained control program­me with annual immunisations.
Yet in an interview this week with The Seattle Times, Henderson is quoted saying just the opposite:

Henderson, a resident scholar at the University of Pittsburgh’s Center for Biosecurity, said he changed his mind six months ago…. Henderson says polio eradication has a fighting chance and it’s worth a try. “I would say there certainly is a chance this can be achieved.”

Even the New York Times seemed confused about the message it was trying to send on the headline of Don McNeil’s article on Gates and the polio campaign.

When the NYTimes story first came out online, the headline read “Critics Say Gates Anti-Polio Push is Misdirected.” This was was later changed, without alteration to McNeil’s story insofar as I can tell, to the more neutral (if not cheerleading) “Gates Calls for Final Push to Eradicate Polio.”

  • Gates Keepers

    A better word for ‘cynic’ is ‘sceptic’. Even better is ‘aware’.

    Gates Keepers

    • http://humanosphere.kplu.org Tom Paulson

      HI Gates Keepers,

      Yes, I weighed the two words. But I believe Henderson’s (anti-polio) narrative over the years has come closer to cynicism than skepticism (e.g., calling it a ‘movement’ as opposed to evidence-based public health).

      And since Henderson is the defacto leading spokesman for those who question the eradication approach to polio, I felt cynical was the better description. I would agree that some of the detractors are just skeptics (which is how we spell it in the U.S. … you’re starting to reveal yourself, at least geographically) and that they make legitimate points.

      I guess we’ll have to wait a few years to see who turns out correct.

      Thanks for checking in.

      • Kristi Heim

        Hi Tom I talked to Donald Henderson again after reading your post. He maintained that what he said to me Monday is accurate. He admitted that he changed his mind recently after conversations with Dr. Ciro de Quadros about the focus of the eradication efforts on wild poliovirus, which Henderson said is appropriate.
        “It’s still tough but I think it’s doable,” he said.
        However, Henderson told me longer term he remains concerned about the possibility of vaccine-derived polio from the live oral vaccine being distributed. Developing countries can’t afford the inactivated vaccine that we get here.

        • http://humanosphere.kplu.org Tom Paulson

          Thanks Kristi,

          The remaining weirdness is that Henderson was also attributed as this week saying just the opposite — that polio eradication is misguided — to other reporters in recent interviews (Financial Times and NYTimes).

          I’m sure you reported what he said to you accurately. But I suspect Andrew Jack at FT and Don McNeil at NYT would say that what they reported Henderson telling them is also accurate.

          Yet he seems to be saying different things to different journalists.

  • http://mylocalhealthguide.com Michael McCarthy

    Hey, conspiracy theorist!

    Change in New York Times headline in Don McNeil’s article may have been done by editors simple to improve it’s SEO (search engine optimization).

    The web version of the headline is much more likely to come up higher in a search with the keywords “gates+polio+eradication” than would print version: Gates+anti-polio+push+misdirected”

    See lots of headlines change when stories go to the web to maximize SEO.

    Michael McCarthy

    http://mylocalhealthguide.com

  • http://humanosphere.kplu.org Tom Paulson

    Dear me Michael,

    Conspiracy theorist?

    I think my theory was more about confusion.

    Sure, you can assume that the NYTimes headline writers made the change to improve its Google-ability. Yet when they had the more critical headline, the NYTimes story was at the very top of the Google News search for stories on Gates and polio. After they changed to a blander headline, the story still ranked high but not quite as high.

    I suspect (but know as little as you do about the inner workings of the NYTimes) that Don McNeil, who is an excellent reporter, might just as well have suggested the headline distorted the nature of his story and that he asked for something a bit more balanced.

    I further suggest that Glitz-Schadenfreude is a common malady afflicting headline writers.

  • Paddy

    I feel this could do with a little evidence from both sides:

    Reasons to be pessimistic about the chances of polio eradication:
    - No reduction in the case count between 2000 and 2010, in spite of an ever-increasing budget.
    - Many new outbreaks in this time, some of which have remained sustained for a long time and continue (in Angola, the DRC, and Chad in particular).
    - With only ~1% of cases being symptomatic, there’s always the risk for further hidden transmission and new outbreaks elsewhere, and no chance of ring vaccination strategies, as used against smallpox.
    - The ever-present risk of vaccine-derived polio outbreaks (as continued at least up to last year in Nigeria and the DRC http://www.polioeradication.org/Dataandmonitoring/Poliothisweek/Circulatingvaccinederivedpoliovirus.aspx)
    - The difficulty in achieving the high levels of vaccine coverage and surveillance required in some of the remaining problem countries, such as the DRC, Afghanistan, etc.

    Reasons to be optimistic:
    - One out of three strains of polio (type 2) does seem to have been eradicated, aside from limited vaccine-derived spread as detailed above.
    - The new, bivalent (two-strain) live vaccine which the absence of type 2 polio has enabled does seem to work better than the old trivalent one.
    - There’s certainly no shortage of funds despite the current economic climate, and production of said new vaccine is being stepped up fast.
    - The two countries which between them have accounted for 50-90% of cases in each year from 2006-2009, Nigeria and India, showed impressive reductions in cases in 2010 and may yet be on course to achieve national elimination of polio.

    As for my own views on our chances, I confess myself thoroughly torn about polio eradication. Naturally, I hope it’ll succeed, but I also fear there’s a real chance we may be stuck; we’ve been told we’re a couple of years from eradication for ten years now, and it’s starting to wear a little thin. Also, it is a little bothersome that we don’t seem to have any exit strategy, especially if we are really running (and spending a billion dollars a year) just to stand still. But who knows… maybe the new vaccine etc. can still tip the odds.

  • Paddy
    • Kristi Heim

      Good for Donald McNeil for going back to clarify D.A. Henderson’s position. Henderson was saying different things, but at different times.

      • Paddy

        Indeed. It must have been quite some conversation to tip the scales like that, viewing the details of Donald Henderson’s previous position, as can be seen & heard here in a talk he gave three and a half years ago: http://www.johnsnowsociety.org/lectures/lecture2007.html