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Bill Gates says polio was excruciatingly close to eradication in the spring, before new outbreaks appeared in Africa and a man was paralyzed in New York. Now the billionaire’s philanthropic foundation is pledging $1.2 billion to complete the mission.
The Bill & Melinda Gates Foundation announced its largest-ever financial commitment to the Global Polio Eradication Initiative in Berlin on Sunday. The money will help fill a funding shortfall that, along with floods in Pakistan, the war in Ukraine and the Covid-19 pandemic, has thwarted a 35-year effort to rid the world of the crippling disease.
“About six months ago, it was the closest we’ve ever been,” said the Microsoft Corp. co-founder. in an interview Thursday. For more than a decade, eradicating polio has been a top priority of the foundation he co-chairs with his ex-wife Melinda French Gates. The Seattle-based nonprofit, with an endowment of about $70 billion, has donated nearly $5 billion directly to the cause.
“We’re very involved,” Gates, 66, said. “I can’t say forever, but giving up would mean hundreds of thousands of children being paralyzed.”
Since the World Health Organization declared the international spread of wild poliovirus a global health emergency in 2014, cases worldwide have declined from 359 to just 29 in 2022. During the same period, cases linked to a mutated strain obtained from the oral polio vaccine , have jumped from 56 to 398 after the pandemic forced a four-month pause in 2020 immunization and disease surveillance campaigns.
The current five-year eradication program strategy needs $4.8 billion to reach 370 million children a year with polio vaccines and other essential health services by 2026. As of last week — before Gates’ latest pledge — there were indications of just $2.2 billion in support, after the UK and Norway, historically key donors, cut their planned contributions. Gates said he hoped the gap would be narrowed when Germany hosts a promising event at the World Health Assembly on Tuesday.
“We are a little disappointed that some of the other donors are not as generous as they have been in the past,” Gates said. “There are so many distractions right now that it’s more of a challenge than you would think given the value of doing this eradication.”
The UK government made a commitment to the polio program before reducing its aid spending to 0.5% of gross national income from 0.7% in 2021. “Some things they prioritized and some things they didn’t,” Gates said. “But this one seems pretty urgent.” It is somewhat ironic that we now have samples of poliovirus in environmental samples not only in London but also in New York.
Wastewater testing can detect the presence of the virus in an area.
Eradication of the disease
Smallpox remains the only human disease ever eradicated. World health leaders took on polio in 1988, expecting to complete the task within 12 years, the same time it took to defeat smallpox. Ending polio, however, proved a more elusive goal.
Almost $19 billion in financial support and heroic efforts to vaccinate hundreds of millions of children have reduced polio cases by 99.9%. This leaves Pakistan and Afghanistan as the only two countries where the ancient enemy has never been stopped. From this stubborn stronghold, wild poliovirus has spread back into Southeast Africa.
In May, it led to Mozambique’s first outbreak in 30 years, prompting three national vaccination campaigns targeting more than 4.5 million children.
“Even though these viruses exist all over the world, the whole world is at risk,” said Carol Pandak, Chicago-based director of Rotary International’s PolioPlus program, whose members launched an immunization campaign in the Philippines in 1979 that helped inspire the Global Polio Eradication Initiative nine years later. “It is in our own interest to see this through to eliminate this risk for all populations.”
Gates focused on Pakistan, where eradication has become “super close,” with only one strain circulating in an area of Waziristan, a mountainous region bordering Afghanistan. In recent months, floods have inundated a third of the country, displacing millions of people and fueling the spread of the poliovirus.
“Unfortunately, this has now flourished and spread back to other parts of the country,” Gates said. “And with the floods, it is likely to appear fairly widely around Pakistan.” Vaccinations are expected to resume in Waziristan next month once the acute challenges posed by the floods are overcome, he said.
Gastrointestinal tract
Poliomyelitis, medically known as poliomyelitis, is a highly infectious disease caused by one of three types of poliovirus that multiply in the human gastrointestinal tract. Infected people excrete the virus in their feces, which allows it to spread easily in areas without good sanitary and hygienic conditions. It is difficult to eradicate because fewer than 1 in 100 people who catch it show signs of illness or are aware of the infection, allowing them to quietly pass the virus on to others.
Smallpox, by comparison, is easily recognized by the characteristic red rash it causes, prompting the identification of outbreaks and the initiation of response vaccination programs. The cowpox-based vaccine used against smallpox protected almost everyone after a single shot, while the oral polio vaccine — used in about 150 countries as of 2016 — required three or more doses to fully protect 85 percent of children.
This vaccine, developed by Albert Sabin, uses a live, attenuated form of the poliovirus. If the weakened virus is passed from person to person over an extended period of time in an undervaccinated community, it can undergo genetic changes that revert it back to the form that causes paralysis. Such a strain caused polio in an unvaccinated man from Rockland County, New York, in June.
Most cases worldwide are caused by a derivative of the oral poliovirus type 2 vaccine. The Gates Foundation helped fund the development of a newer version that cannot revert to its pathogenic form.
The WHO authorized the emergency use of the new vaccine almost two years ago. Since then, almost 500 million doses have been administered in 25 countries, said Hamid Jafari, the Amman-based polio eradication director for the WHO’s Eastern Mediterranean region. It offers the best weapon yet to stem vaccine-caused cases and end polio transmission by the end of next year, he said.
“We are on track to end polio by the end of 2023,” Jafari said in an interview. “A lack of funding would be very tragic.”
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