The prospect of disease eradication
🌐 A quest for dominance keeps faltering.
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Is it so last century?
Earlier this month, the New York Times ran a feature about the hope of eradicating malaria raised by the rollout of two new vaccines. Philip Welkhoff, director of malaria programmes at The Gates Foundation, which is known for trading on optimism based on technological tools, suggested an eradication campaign might be launched in a few years.
This has been tried before, without success. And an earlier suggestion of going for zero, made about three years ago, exposed a split within the malaria community.
It turns out there’s a lot in the ‘reality check’ box that needs to be weighed against optimism.
I hadn’t given much thought to the idea of disease eradication until I began looking into it earlier this year for a feature published a few weeks back in Nature Medicine. It then became fascinating very quickly.
Fundamentally, the quest to eradicate a disease aims to wipe out every last of the pathogens that cause it from the face of the Earth*.
*Here I have to point out—as did the feature—that definitions vary, and they matter: sometimes eradication refers to pathogens, sometimes to a disease, sometimes to a disease as a public health problem, etc.
Once you stop and think about that, it’s really an astonishing goal. It’s also one that harks to notions of human dominance over disease—and by extension, nature—which are certainly enduring in their allure, though more questionable in their wisdom.
Yet—it’s very difficult to argue against a drive that can rid the world of disease and suffering. Especially when it’s fuelled by the successful wipeout of smallpox in the 20th century. It’s a feat that fuels the optimism, and shows that it can be done. And since then, polio and Guinea worm eradication programmes have made huge gains.
That kind of hope is often pinned on the biological and technological tools that can make a breakthrough. For the Nature Medicine feature, my editors wanted us to look past the technical and explore the socio-economic aspects of these kinds of efforts.
They were right: what we found is a 21st-century world very different from the one that succeeded with smallpox.
Polio is a case in point.
I kept having to email my editor with updates before the piece was sent to print, just because things were evolving so quickly.
It started in February 2022—less than 2 years after the WHO declared Africa polio-free—when Malawi reported its first case of wild poliovirus in three decades. It turned out to be the first sign of a comeback that puts more pressure on this 30-year eradication campaign, which is the one closest to its zero goal.
Three months later, a similar strain was linked to a case of wild polio in Mozambique. In Pakistan and Afghanistan, the last places where the wild virus has remained endemic, cases also began to rise this year.
Then there’s vaccine-derived polio, which emerges when the live virus used in the oral vaccine mutates to a point where it’s capable of causing paralysis. A problem confined to Africa until recently, this has now cropped up in Israel, London and New York.
When I was conducting interviews for the piece, we were only aware of the case of Malawi. But that was signal enough for people in the know. I was lucky to find a balanced, sober (and sobering) viewpoint from Muhammad Ali Paté, a medical doctor who leads health programmes at the World Bank and a former health minister of Nigeria. He told me:
“The Malawi outbreak shouldn't by itself throw the whole baby of eradication [out] with the bathwater.”
That’s a view you might expect from someone who is also a member of the independent monitoring board of GPEI, the Global Polio Eradication Initiative. But then came the note of caution: that a push for eradication would now be a hard sell, even when it is biologically feasible.
“You saw what happened with COVID-19 vaccines, where the global consensus was just not there even for a disease that was ravaging the world in the form of a pandemic. Even the best idea would be difficult to have traction given the direction that the world is in.”
The caution isn’t just about waning multilateralism.
There’s more detail in the piece, but here are the reality-checks I found, in a nutshell:
Global budgets are falling under severe strain, as the pandemic and the war in Ukraine pile on worrying levels of debt in poorer countries. Although development aid for health has been rising overall, there are signs that such spending on programs other than COVID-19 is decreasing. […] Climate change will probably change the epidemiology of some infectious diseases, potentially giving eradication a moving target. Conflict impedes access to disease hotspots. Vaccine skepticism is widespread.
The conditions for wiping out smallpox seem favorable by comparison.
It’s a divisive debate, and has been for a while.
There’s funding at stake.
The ambition and noble goals embodied by eradication make for an advantage when seeking support, political attention or media coverage.
But there are counter-arguments. One is that the substantial sums of money being spent to wipe out a single pathogen—through so called ‘vertical’ programmes that deal with a single disease—could be better spent on ‘horizontal’ programmes that strengthen the health system to deal with a range of diseases. Vertical programmes tend to move from the top-down, which means imposing global initiatives on individual countries—and that’s connected to another argument against eradication: that it diverts resources of governments in poorer countries from more pressing local problems.
There are also lives at stake.
Proponents of eradication argue that abandoning the goal means accepting that—in the case of polio, for example—debilitating disease will continue to exist in some developing countries. It means accepting selective suffering. It sometimes even becomes a statement about the world we want be living in.
At some point during the writing it seemed tempting to frame the disputes as a battle between optimism and pragmatism. But that just didn’t seem to get to the heart of what’s at stake.
As one of my sources pointed out, what it boils down to is this: What’s the best thing to do to protect people from infections? It’ll remain tempting to shoot for the stars of a landmark public health achievement. And whether it’s worth it will remain contentious.
I’ll close this as I closed the feature, with the measured words of Paté:
I think it will be a remarkable achievement for public health to knock off a disease like malaria. But we should not go in there naively. And polio has not yet been eradicated. So that's also something that we have to finish.
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Story Threads
In recent Briefings ($) we covered the aftermath of the series of economic jolts since the pandemic began, what Brazil’s election means for the planet, rifts emerging at the UN General Assembly, and more—follow WorldWise on Twitter for threads on what we’re tracking each week.
Three stories you may have missed:
On October 4th, Bangladesh suffered its worst blackout since 2014—and a report in Quartz suggests it’s at least in part down to gas supplies that were previously heading to Asia now being diverted to Europe.
Cases of cholera around the world have surged this year, especially in places facing poverty and conflict, according to a Reuters report. Outbreaks have been reported in 26 countries—a typical year sees fewer than 20—and fatality rates are rising “sharply”. Haiti has recorded deaths from the disease for the first time in 3 years.
Cubans have voted in a referendum to legalise same-sex marriage through a new ‘family code’ that’s among the most progressive in Latin America, report the Washington Post and Reuters. It also allows same-sex couples to adopt children, and promotes equal sharing of domestic rights and responsibilities between men and women.
Media Insider
I’m producing a couple of sessions during the third edition of the Science Journalism Forum (SJF), which is taking place on October 29th to November 4th this year. It’s a global, multilingual online event that brings together science journalists, writers, publishers, scientists, students, and academia for a rich programme of talks and workshops on a range of topics related to science journalism. On Monday, October 31st, we have a stellar panel in place to discuss Science and global crises: hot topics to cover around the world. And on Sunday, October 30th, you can join a workshop on How to publish a newsletter (like this one!). There’s 50% off the ticket price for subscribers with promo code Anita50 🎟
Opportunities Closing
For those of you looking to support journalism or audiovisual projects—here’s a selection of opportunities with fast-approaching deadlines first shared in the Media section ($):
Journalists from Kenya, Uganda, Tanzania or Rwanda, who are interested in creating in-depth biodiversity and conservation features in any medium, can apply for the East Africa Biodiversity Story Grants. By Earth Journalism Network—closing October 15.
Filmmakers around the world can document challenges that the world’s largest cities face ( like transportation, education, refugees, health, climate change), and what initiatives are underway to tackle these environmental and social issues. By Megacities Shortdocs—closing October 15.
Journalists in Columbia, Kenya and the Philippines can enter their stories into the WHO Violence Against Children Reporting Contest to increase awareness around this underreported issue. By International Center For Journalists and WHO—closing October 16.
Mid-career professionals with experience in human rights and the promotion of democracy can apply for the Reagan-Fascell Democracy Fellowship, an international exchange programme that allows scholars to conduct original research for publication. By National Endowment for Democracy—closing October 17.
Journalist teams from at least two countries in continental Europe can apply for the European Cross-Border grants to pursue projects and ideas aimed at cross-border investigation and networking. By Journalismfund.eu—closing October 20.
Filmmakers from Ethiopia, Tanzania and Uganda can apply for funding and training for their projects through the DW Akademie Film Development fund. By DW Akademie—closing October 26.
Documentary filmmakers and other content creators from Sudan can submit short works captured on a mobile camera to the Khartoum International Mobile Film Festival for cash prizes. By Khartoum International Mobile Film Festival—closing October 27. (Arabic)
Journalists from Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua or the Dominican Republic can submit their print, audiovisual and digital works on post-pandemic economic recovery and related topics for a chance at the CMCA Economic Journalism Award. By The Executive Secretariat of the Central American Monetary Council—closing October 28. (Spanish)
Experienced journalists in Malaysia who are fluent in both English and Malay and who have excellent writing and digital investigation skills can apply for a position in Kuala Lumpur with Agence France-Presse. By Telum Media—closing October 29.
Arab documentarians can submit their work dealing with honest and realistic portrayals of the culture, history and politics of the Arab world to the San Diego Arab Film Festival. By The San Diego Arab Film Festival—closing October 31.
Female journalists working in either print or multimedia who need support for their work can apply for the Georgina Henry Award for Digital Innovation. By Women in Journalism—closing October 31.
Science writers working anywhere in the world, with less than two years of professional experience, can apply for a ten-month fellowship to develop their skills and pursue their passions under the guidance of a mentor. By The Open Notebook—closing October 31.
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