13 ms·

As late as 1980, Polio was crippling 300,000 children every year. It's now down to a few hundred, at a bargain price of order $10B (total, not per year). It's

As late as 1980, Polio was crippling 300,000 children every year. It's now down to a few hundred, at a bargain price of order $10B (total, not per year). It's natural to wonder whether it makes sense to push to fully eradicate the disease (which will cost billions more) rather than simply controlling it (presumably at a substantially lower cost) for a few decades until the regions become wealthy enough that eradication is cheap (at least relative to the local economy). This is not at all an obvious question; for organizations that are somewhat economically rational like the Gates Foundation, billions spend on eradication is billions not spent on other developing world interventions that might save more lives. Here's the economic case for eradication: http://polioeradication.org/wp-content/uploads/2016/07/EconomicCase.pdf http://polioeradication.org/wp-content/uploads/2016/07/Econo...

throwaway2048 7y ago
The fact that it cost merely 10B to get polio infections to this point is an depressing indictment of the greed that consumes the modern world. How else could 10B save or massively improve tens/hundreds of millions of lives.
- allovernow 7y ago
  Seems your underestimating how much research and infrastructure was required for eradication. This isn't just evil greed money going straight to the pockets of cold CEOs. All those scientists, doctors, lab techs and everyone associated with the manufacture of vaccines/drugs have to eat.
  - throwaway2048 7y ago
    What im saying is it cost _only_ 10 billion, meanwhile 10s of billions are regularly spent on things of comparatively trifling consequences.
    - beambot 7y ago
      Like $13B per aircraft carrier: https://en.m.wikipedia.org/wiki/Gerald_R._Ford-class_aircraft_carrier https://en.m.wikipedia.org/wiki/Gerald_R._Ford-class_aircraf...
      - wolco 7y ago
        I'm selling the most expensive sandwich for 11B if anyone is interested.
      - im3w1l 7y ago
        Safeguarding freedom and democracy is not a small trifle.
        toomuchtodo 7y ago
        Indeed, which is why you should spend the money judiciously, instead of on something wildly expensive vulnerable to a relatively inexpensive supersonic cruise missile.
        s1artibartfast 7y ago
        Being wildly expensive and vulnerable does not necessarily mean it can't provide $13B of value
        toomuchtodo 7y ago
        Sure, but evidence is required said value is being provided. Otherwise, you’re arguing a rock is providing safety against tigers because there are no tigers around.
    - pkaye 7y ago
      Like $100m that was ~~~spent~~~ wasted on Juicero. I was listening to the scientist working on the UCSF kidney project and he was estimating it would cost around $100m to successfully get his project through FDA testing. And it was a long rocky road for him to get where it is now. https://www.crunchbase.com/organization/juicero https://www.crunchbase.com/organization/juicero https://pharm.ucsf.edu/kidney https://pharm.ucsf.edu/kidney
- marcosdumay 7y ago
  That's a great question, and there are very likely a few places we can throw 10B on and completely change the fate of Mankind, but we don't do that because the gains are not excludable.
  - zozbot234 7y ago
    The gains of polio eradication are not excludable, either. The effort is being funded by governments and charities, not profit-driven actors.
    - maxerickson 7y ago
      Governments and charities should be acting in an economically rational manner though. For instance, if they can spend $1 for $2 of benefit, they should probably do that before they spend $2 for $3 of benefit. This is kind of a slippery point, because they are often engaging in activities where the benefit is hard to measure, but their activities should still appear rational relative to their best measures of the benefits.
      - im3w1l 7y ago
        A government would do both and borrow. It's when you have programs costing $2 for $2.05 benefit that people start thinking twice.
      - selimthegrim 7y ago
        An issue now in the (former) tribal areas of Pakistan is that people are using their kids as bargaining chips with the government for other services they feel are due to them https://www.aljazeera.com/indepth/features/pakistan-polio-comeback-vaccine-boycotts-191226142838246.html https://www.aljazeera.com/indepth/features/pakistan-polio-co...
    - catalogia 7y ago
      Governments around the world spend almost two trillion dollars a year on militaries. With only a tiny fraction of that you could blanket regions suspected of harboring Polio with para-dropped doctors. So much for the "knapsack" problem mentioned elsewhere in this thread. But governments around the world care more about shaking big sticks at each other than eradicating polio.
- deleted 7y ago
  [deleted]
zozbot234 7y ago
They're having trouble even controlling these type-2 outbreaks. The fear is that attempts to do so by deploying live type-2 vaccine in the surrounding areas may instead be triggering a positive feedback loop, with more rather than fewer infections over time. This would be a clearly misguided response, even before you account for opportunity costs - which is not easy, because letting things be and hoping that the outbreaks will die out on their own has costs as well.
tempestn 7y ago
The problem with simply controlling it is that you're asking real people to give their children a vaccine that has a non-zero chance of actually giving them polio. When the disease is already well controlled, who would want to do that? And how would those who do feel if their child does get the disease from the vaccine? There are good non-economic reasons to push for eradication.
- zozbot234 7y ago
  There's an injectable vaccine that doesn't contribute to reactivated polio. Also, the oral vaccine doesn't "give" polio to the recipient. The person stays immunized, but then in rare cases may be spreading reactivated polio to third-parties. So it seems like the injectable vaccine will be strictly preferable if the nOPV strategy fails. It's only disadvantage is that it does not prevent the recipient from spreading polio to others if they become infected, and it looks like that disadvantage may have been illusory anyway.
  - makomk 7y ago
    No, both the vaccine receipient and third parties are at risk of getting a full-on paralytic polio infection from the oral polio vaccine. When this happens to the recepient it's called vaccine-associated paralytic polio. See for instance https://www.cdc.gov/vaccines/vpd/polio/hcp/vaccine-derived-poliovirus-faq.html https://www.cdc.gov/vaccines/vpd/polio/hcp/vaccine-derived-p... It's also worth paying attention to the precise distinction between vaccine-derived poliovirus, which is the problem this article was about, and VAPP. VDPD is basically equivalent to normal wild-type poliovirus in terms of its infectivity and effects, but only happens once the vaccine poliovirus has been circulating and mutating for a while and can be protected against via vaccination. VAPP is caused by vaccination and can affect the recipients or those around them, but unlike VDPD the people who suffer from it shouldn't pose any more danger to others than any other vaccine receipient.
    - zozbot234 7y ago
      > No, both the vaccine receipient and third parties are at risk of getting a full-on paralytic polio infection from the oral polio vaccine. That seems like it would make the oral vaccine even worse, compared to the injected vaccine. Again, I'm not sure why they think reintroducing traditional type-2 OPV is a good idea if the injected form that won't cause vaccine-derived outbreaks is so easily available. (Of course nOPV is expected to be better than the former OPV, but it's yet to be available.)
Spooky23 7y ago
You’re assuming a rational world, which we do not live in. People will believe all sorts of stupidity, and if anything, as poor countries get richer and more communicative, they’ll invent conspiracies and other reasons to avoid vaccination.
- jessriedel 7y ago
  I am not assuming that, I'm looking at the overwhelming historical data that polio was eradicated everywhere that became rich.
phkahler 7y ago
>> This is not at all an obvious question It is obvious in my mind. Vigilance is the only reason it's so close to eradication. Not completing the eradication risks enormous consequences. Not if, but when. The cost of eradication is thought to be in the billions of dollars. A pittance compared other government spending around the world. I say just get it done so we dont have to deal with it any more. Unfortunately the plan seems to have some problems.
- JohnJamesRambo 7y ago
  “For Isildur would not surrender it to Elrond and Círdan who stood by. They counselled him to cast it into the fire of Orodruin.”
- hanniabu 7y ago
  Once it's eradicated what are the chances it has a resurgence vs is gone for good? Can it have a resurgence?
  - justin66 7y ago
    Once it's gone, it's gone for good. It can cross the species barrier between us and monkeys, but monkeys have never been found to be natural hosts of the virus.
  - ovi256 7y ago
    The other answer has covered resurgence from natural reservoirs. I'll cover man-made resurgence. There are copies of it in all major countries' virology labs. Furthermore, it can be synthetised from scratch since 2002, see NYT. NYT: https://www.nytimes.com/2002/07/12/us/traces-of-terror-the-science-scientists-create-a-live-polio-virus.html https://www.nytimes.com/2002/07/12/us/traces-of-terror-the-s...
- jessriedel 7y ago
  Obvious to your mind, huh? Great news! You don't have to wait for the Gate foundation or your government. You can donate directly: http://polioeradication.org/financing/donate/ http://polioeradication.org/financing/donate/
AstroJetson 7y ago
I have a friend who was one of the last few cases in the 60's to get polio. It's something that I wouldn't wish on anyone. So the downside of not spending the effort to eradicate it is that someone's child will get it. I'd hate to think that some Billionaire like Larry Ellison would get to pick another mega yacht, rather than doing this.
- StavrosK 7y ago
  You're thinking about it the wrong way. Why spend $X saving ten polio children and not the same amount to save a hundred dengue fever (or whatnot) children? At some point, you get diminishing returns, and the amount of lives saved per dollar drops below some other cure's.
  - refurb 7y ago
    This is the key. We have limited resources, so any decision is always a trade-off. If you do X it means you can’t do Y. A big killer of children is diarrhea. 800,000 die each year and treating it cheap and preventing it is just access to clean water. You can get a huge bang for your buck by spending money on it.
    - deleted 7y ago
      [deleted]
    - refurb 7y ago
      You’d be surprised. Even digging a well (as opposed to surface water) is very possible for not a lot of money. And as a result, an entire community can have access to clean water.
      - thaumasiotes 7y ago
        > Even digging a well (as opposed to surface water) is very possible for not a lot of money. > And as a result, an entire community can have access to clean water. Well, no. All communities have water sources. Where digging a well is cheap, the community will have one or more. The problem digging a well solves is that there wasn't enough water. That's not the problem a community with endemic diarrhea has. Their problem is that they're not keeping their water clean. The new well is unlikely to be different.
justin66 7y ago
> It's natural to wonder whether it makes sense to push to fully eradicate the disease I don't follow this area very closely, but I bet it's not natural and I suspect it's a genuine minority position.
thatcat 7y ago
Yea, but if controlling it allows a mutation that makes it more difficult to control it could cost significantly more; plus you get to say you eradicated polio without having to take R/D risk.
Tempest1981 7y ago
Every year, the countries of the world spend $1.5 trillion on military. If we could find 1% of that to re-purpose...
- seagullz 7y ago
  And $0.7 trillion alone spent by the US

throwaway2048 7y ago

The fact that it cost merely 10B to get polio infections to this point is an depressing indictment of the greed that consumes the modern world. How else could 10B save or massively improve tens/hundreds of millions of lives.

allovernow 7y ago
Seems your underestimating how much research and infrastructure was required for eradication. This isn't just evil greed money going straight to the pockets of cold CEOs. All those scientists, doctors, lab techs and everyone associated with the manufacture of vaccines/drugs have to eat.
- throwaway2048 7y ago
  What im saying is it cost _only_ 10 billion, meanwhile 10s of billions are regularly spent on things of comparatively trifling consequences.
  - beambot 7y ago
    Like $13B per aircraft carrier: https://en.m.wikipedia.org/wiki/Gerald_R._Ford-class_aircraft_carrier https://en.m.wikipedia.org/wiki/Gerald_R._Ford-class_aircraf...
    - wolco 7y ago
      I'm selling the most expensive sandwich for 11B if anyone is interested.
    - im3w1l 7y ago
      Safeguarding freedom and democracy is not a small trifle.
      - toomuchtodo 7y ago
        Indeed, which is why you should spend the money judiciously, instead of on something wildly expensive vulnerable to a relatively inexpensive supersonic cruise missile.
        s1artibartfast 7y ago
        Being wildly expensive and vulnerable does not necessarily mean it can't provide $13B of value
        toomuchtodo 7y ago
        Sure, but evidence is required said value is being provided. Otherwise, you’re arguing a rock is providing safety against tigers because there are no tigers around.
  - pkaye 7y ago
    Like $100m that was ~~~spent~~~ wasted on Juicero. I was listening to the scientist working on the UCSF kidney project and he was estimating it would cost around $100m to successfully get his project through FDA testing. And it was a long rocky road for him to get where it is now. https://www.crunchbase.com/organization/juicero https://www.crunchbase.com/organization/juicero https://pharm.ucsf.edu/kidney https://pharm.ucsf.edu/kidney
marcosdumay 7y ago
That's a great question, and there are very likely a few places we can throw 10B on and completely change the fate of Mankind, but we don't do that because the gains are not excludable.
- zozbot234 7y ago
  The gains of polio eradication are not excludable, either. The effort is being funded by governments and charities, not profit-driven actors.
  - maxerickson 7y ago
    Governments and charities should be acting in an economically rational manner though. For instance, if they can spend $1 for $2 of benefit, they should probably do that before they spend $2 for $3 of benefit. This is kind of a slippery point, because they are often engaging in activities where the benefit is hard to measure, but their activities should still appear rational relative to their best measures of the benefits.
    - im3w1l 7y ago
      A government would do both and borrow. It's when you have programs costing $2 for $2.05 benefit that people start thinking twice.
    - selimthegrim 7y ago
      An issue now in the (former) tribal areas of Pakistan is that people are using their kids as bargaining chips with the government for other services they feel are due to them https://www.aljazeera.com/indepth/features/pakistan-polio-comeback-vaccine-boycotts-191226142838246.html https://www.aljazeera.com/indepth/features/pakistan-polio-co...
  - catalogia 7y ago
    Governments around the world spend almost two trillion dollars a year on militaries. With only a tiny fraction of that you could blanket regions suspected of harboring Polio with para-dropped doctors. So much for the "knapsack" problem mentioned elsewhere in this thread. But governments around the world care more about shaking big sticks at each other than eradicating polio.
deleted 7y ago
[deleted]

zozbot234 7y ago

They're having trouble even controlling these type-2 outbreaks. The fear is that attempts to do so by deploying live type-2 vaccine in the surrounding areas may instead be triggering a positive feedback loop, with more rather than fewer infections over time. This would be a clearly misguided response, even before you account for opportunity costs - which is not easy, because letting things be and hoping that the outbreaks will die out on their own has costs as well.

tempestn 7y ago

The problem with simply controlling it is that you're asking real people to give their children a vaccine that has a non-zero chance of actually giving them polio. When the disease is already well controlled, who would want to do that? And how would those who do feel if their child does get the disease from the vaccine? There are good non-economic reasons to push for eradication.

zozbot234 7y ago
There's an injectable vaccine that doesn't contribute to reactivated polio. Also, the oral vaccine doesn't "give" polio to the recipient. The person stays immunized, but then in rare cases may be spreading reactivated polio to third-parties. So it seems like the injectable vaccine will be strictly preferable if the nOPV strategy fails. It's only disadvantage is that it does not prevent the recipient from spreading polio to others if they become infected, and it looks like that disadvantage may have been illusory anyway.
- makomk 7y ago
  No, both the vaccine receipient and third parties are at risk of getting a full-on paralytic polio infection from the oral polio vaccine. When this happens to the recepient it's called vaccine-associated paralytic polio. See for instance https://www.cdc.gov/vaccines/vpd/polio/hcp/vaccine-derived-poliovirus-faq.html https://www.cdc.gov/vaccines/vpd/polio/hcp/vaccine-derived-p... It's also worth paying attention to the precise distinction between vaccine-derived poliovirus, which is the problem this article was about, and VAPP. VDPD is basically equivalent to normal wild-type poliovirus in terms of its infectivity and effects, but only happens once the vaccine poliovirus has been circulating and mutating for a while and can be protected against via vaccination. VAPP is caused by vaccination and can affect the recipients or those around them, but unlike VDPD the people who suffer from it shouldn't pose any more danger to others than any other vaccine receipient.
  - zozbot234 7y ago
    > No, both the vaccine receipient and third parties are at risk of getting a full-on paralytic polio infection from the oral polio vaccine. That seems like it would make the oral vaccine even worse, compared to the injected vaccine. Again, I'm not sure why they think reintroducing traditional type-2 OPV is a good idea if the injected form that won't cause vaccine-derived outbreaks is so easily available. (Of course nOPV is expected to be better than the former OPV, but it's yet to be available.)

Spooky23 7y ago

You’re assuming a rational world, which we do not live in. People will believe all sorts of stupidity, and if anything, as poor countries get richer and more communicative, they’ll invent conspiracies and other reasons to avoid vaccination.

jessriedel 7y ago
I am not assuming that, I'm looking at the overwhelming historical data that polio was eradicated everywhere that became rich.

phkahler 7y ago

>> This is not at all an obvious question It is obvious in my mind. Vigilance is the only reason it's so close to eradication. Not completing the eradication risks enormous consequences. Not if, but when. The cost of eradication is thought to be in the billions of dollars. A pittance compared other government spending around the world. I say just get it done so we dont have to deal with it any more. Unfortunately the plan seems to have some problems.

JohnJamesRambo 7y ago
“For Isildur would not surrender it to Elrond and Círdan who stood by. They counselled him to cast it into the fire of Orodruin.”
hanniabu 7y ago
Once it's eradicated what are the chances it has a resurgence vs is gone for good? Can it have a resurgence?
- justin66 7y ago
  Once it's gone, it's gone for good. It can cross the species barrier between us and monkeys, but monkeys have never been found to be natural hosts of the virus.
- ovi256 7y ago
  The other answer has covered resurgence from natural reservoirs. I'll cover man-made resurgence. There are copies of it in all major countries' virology labs. Furthermore, it can be synthetised from scratch since 2002, see NYT. NYT: https://www.nytimes.com/2002/07/12/us/traces-of-terror-the-science-scientists-create-a-live-polio-virus.html https://www.nytimes.com/2002/07/12/us/traces-of-terror-the-s...
jessriedel 7y ago
Obvious to your mind, huh? Great news! You don't have to wait for the Gate foundation or your government. You can donate directly: http://polioeradication.org/financing/donate/ http://polioeradication.org/financing/donate/

AstroJetson 7y ago

I have a friend who was one of the last few cases in the 60's to get polio. It's something that I wouldn't wish on anyone. So the downside of not spending the effort to eradicate it is that someone's child will get it. I'd hate to think that some Billionaire like Larry Ellison would get to pick another mega yacht, rather than doing this.

StavrosK 7y ago
You're thinking about it the wrong way. Why spend $X saving ten polio children and not the same amount to save a hundred dengue fever (or whatnot) children? At some point, you get diminishing returns, and the amount of lives saved per dollar drops below some other cure's.
- refurb 7y ago
  This is the key. We have limited resources, so any decision is always a trade-off. If you do X it means you can’t do Y. A big killer of children is diarrhea. 800,000 die each year and treating it cheap and preventing it is just access to clean water. You can get a huge bang for your buck by spending money on it.
  - deleted 7y ago
    [deleted]
  - refurb 7y ago
    You’d be surprised. Even digging a well (as opposed to surface water) is very possible for not a lot of money. And as a result, an entire community can have access to clean water.
    - thaumasiotes 7y ago
      > Even digging a well (as opposed to surface water) is very possible for not a lot of money. > And as a result, an entire community can have access to clean water. Well, no. All communities have water sources. Where digging a well is cheap, the community will have one or more. The problem digging a well solves is that there wasn't enough water. That's not the problem a community with endemic diarrhea has. Their problem is that they're not keeping their water clean. The new well is unlikely to be different.

justin66 7y ago

> It's natural to wonder whether it makes sense to push to fully eradicate the disease I don't follow this area very closely, but I bet it's not natural and I suspect it's a genuine minority position.

thatcat 7y ago

Yea, but if controlling it allows a mutation that makes it more difficult to control it could cost significantly more; plus you get to say you eradicated polio without having to take R/D risk.

Tempest1981 7y ago

Every year, the countries of the world spend $1.5 trillion on military. If we could find 1% of that to re-purpose...

seagullz 7y ago
And $0.7 trillion alone spent by the US