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andré picard's second opinion

Is there an ethical obligation to complete polio eradication?

That is the question asked by Peter Singer and Claudia Emerson, ethicists at the McLaughlin-Rotman Centre for Global Health of the University of Toronto, in a compelling article in the current issue of The Lancet.

It is a timely matter because the World Health Assembly will meet May 17-21 and be presented with a plan designed to wipe out polio within three years.

Surprisingly though, the question is not entirely a rhetorical one, and the plan to make a final push for eradication is not being universally embraced.

As efforts to eradicate polio have stuttered and costs have soared, there are increasingly loud voices advocating for "effective control" (accepting that there will be a limited number of cases indefinitely) rather than eradication.

Dr. Singer and Dr. Emerson argue convincingly that there is a moral imperative to pursue the eradication of polio, particularly given that we have capacity and opportunity to do so.

But before delving further into their treatise, a little background is in order.

More than two decades ago, public-health officials made a bold promise: to eradicate polio from the face of the Earth.

Despite the enormous challenge, the backers of the plan - the World Health Organization, Unicef, Rotary International and countless other smaller groups - have come tantalizingly close.

The annual number of cases of the crippling disease fell as low as 483 in 2001, from 350,000 at the outset of the campaign in 1988. In 1988, there was polio in 125 countries. That fell to four.

It took only a decade to eradicate smallpox, a program that was launched in the 1970s. With the experience, better technology, better transportation (to access remote areas), more money and greater awareness of public-health issues, tackling polio should have been easier.

But poliomyelitis - the name of the disease caused by the virus - has proved a wily foe that preys on the vulnerable and re-emerges where there is war, famine, poverty and the accompanying breakdowns in public health.

In 2009, there were a discouraging 1,606 cases in 23 countries, all of them in Africa and the Indian subcontinent.

Eradication efforts have cost more than $6-billion (U.S.) to date and the bill grows by about $600-million a year.

Increasingly, the question is being asked: Why are we spending a lot of money and effort on polio at a time when there are much bigger problems - lack of clean water, HIV-AIDS and drug-resistant tuberculosis, to name only a few.

Dr. Singer and Dr. Emerson point out that, in recent years, the debate about polio eradication has centred largely on questions of economic and technical feasibility.

What is rarely mentioned is that the alternative to eradication is accepting that about four million children will contract polio and suffer its devastating effects in the next 20 years.

Further, if polio is eradicated, it would garner savings of about $1.5-billion a year, money that could be used for other pressing public-health challenges.

Still, examining only the economic aspects of eradication overlooks an "important moral calculation: the human cost of failing to eradicate," the authors write.

"This is the cost of lives not saved, the lives afflicted by polio (including those family members who care for paralyzed children), and the impact of those lives on the future of the broader community," Dr. Singer and Dr. Emerson argue.

It is an enormous cost.

Infectious diseases remain among the biggest killers in the world.

Controlling the spread of illness with vaccination and other public health measures (sanitation, clean water, bed nets and so on) is a necessity and it will be a reality for decades to come.

But, in some cases, eradication is possible.

In addition to polio, there is a continuing campaign to eradicate dracunculiasis (guinea worm) in humans and an almost-complete push to eradicate rinderpest (a viral disease in cattle). Other infectious diseases have been identified as candidates for eradication and, in some cases, efforts have been made, albeit half-hearted ones. These include yaws, hookworm, yellow fever and malaria.

Even some widespread illnesses are potentially eradicable such as measles, mumps, rubella, tapeworm and filariasis.

The potential there is enormous and the challenges more so.

But first things first: polio, the horrific crippler of children.

Deadlines have come and gone too many times. The World Health Assembly (and its member countries) has the opportunity - and the moral obligation - to endorse, fund and otherwise ensure that the job gets done and quickly.

The evocative power of eradication would be great, but the practical benefits even greater.

"We are on the last kilometre of a marathon," Dr. Singer and Dr. Emerson write. "Surely it is worth crossing the finish line?"

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