Disinvestment

GPEI began in 1988. The polio eradication programme involved administering multiple doses of the oral polio vaccine to all children in affected areas. The doses were administered in pulses: all children below the age of three in an area were inoculated simultaneously. US $5 billion have been spent under the programme. Consequently, 190 countries are poliofree. The disease remains endemic in four countries: India, Afghanistan, Pakistan and Nigeria. These countries have spread polio to 12 other countries which had freed themselves of polio. This year, these countries accounted for only 8 per cent of all polio cases: a significant drop from the 60 per cent last year.

But the four high-risk countries have a put a spanner in GPEI’S works. In 2003, only 784 polio cases were reported all over the world. But the incidence of the disease has risen to 1,763, this year with more than 1,654 of them in the high-risk countries. Since 2003, around US $50 million has been used to carry out control measures in these countries, says WHO spokesperson Sona Bari. For example, it took US $6.1 million to control the epidemic in Namibia, where even adults were found susceptible (see map: 1,763).

But now funds seemed to be drying out (See graph: Going Dutch). The agencies at the helm of GPEI had estimated that governments in a polio-free world would save around US $1.5 billion in vaccine, treatment and rehabilitation costs each year. That western Europe would save US $200 million a year and the savings for the US would amount to US $230 million a year. This was a major motivation for the developed countries to put in money in the project. Globally, the cost-effectiveness ratio of polio eradication was estimated at an impressive US $ 52.50 per disability-adjusted life year (DALY) saved. It was also estimated that failure to root out polio would result in at least 10.6 million new cases of polio worldwide in the 40 years since 1988, representing the loss of 60 million DALYS—nearly all in poor developing countries. Donor agencies also believed that polio could be rooted out in a manner similar to small pox (see box: Smallpox vs poliovirus).

Strained money bags

Once a country is declared polio free, GPEI discontinues its aid to vaccination campaigns. Most times, the countries lack internal funds to continue with the programme. So people there become vulnerable. The disease’s resurgence has dampened donor enthusiasm. Compare this with the donation in December of US $476 million into the global fight against bird flu, as pledged at the global bird flu summit in Africa. Polio no longer gets the investment required to deal with the disease: efforts to control the epidemic in Namibia this year took a total of US $6.1 million, of which US $5.4 (90 per cent) came out of the poor country’s kitty. The financial requirements for 2006 are estimated at US $705 million, but there is a funding gap of US $50 million. This money is urgently needed by December 2006 for expenditure in the first half of 2007. The funding gap for 2007-2008 is pegged at US $390 million. GPEI requires US $130 million for emergency response to importations in 2006-2008. The funding gap would have the worst effect on India, which requires US $180 million for the year 2006-07. In donor circles, it is felt that governments of the affected countries should put in more money. Countries like Nigeria and India are seen as self sufficient in meeting part of the money needed for the cammpaign.

“The Indian government has had to pay money for the programme for the first time in 2006. The funding agencies today don’t believe the claims of WHO and other orgnaisations that the disease can be eradicated,” says Onkar Mittal of Swasthya Neeti Samvad, a health discussion forum. For the year 2006-2007, the Indian government has commited US $210 million for the programme. Aylward asserts that the funding gap is only a matter of perception: “The funding gap is almost entirely due to the delay in polio eradication in the four remaining endemic countries.” Deepak Kapur, chairperson of Rotary International’s India National PolioPlus Committee, is steadfast about his organisation’s support to the campaign. “Donor fatigue will always be there, since the programme is huge and has taken longer than expected. Rotary shall continue to raise funds across the world for this initiative,” he says.