A Different Healthcare Debate

Polio cases in 2009, WHO data

Resolved: Polio should be eliminated now, despite the fact that 20 years and $8.2 billion later, it persists.

In the affirmative—which touts what is known as the “vertical” strategy—we have Bill Gates, full-time philanthropist with $34 billion at his disposal, who aims to duplicate the 1979 eradication of smallpox, which is the only disease ever to have been completely eradicated. Because polio eradication is imminent, it should be a priority; the world has so much to gain from its eradication.

In the negative—the “horizontal” strategy—we have several parties, ranging from international development blogger Matt Collin to Dr. Muhammad Ali Pate, Nigeria’s head of primary health care, who claim that instead of waging war against individual diseases, global health proponents should focus simultaneously on broad health goals, such as improving sanitation and hygiene, supplying clean water and strengthening healthcare infrastructure.

A Wall Street Journal article delineates the Gates Foundation’s struggles with this debate that divides global health authorities. A WHO-commissioned study found that in developing countries where polio had previously been eliminated, weak healthcare infrastructure allowed the disease to return. Furthermore, poor sanitation and malnutrition undermined the oral polio vaccine’s effectiveness.

Upon discovering that despite its $700 million polio eradication investment, the disease actually managed an outbreak last summer, the Gates foundation revamped its action plan—to one that remains largely vertical, but acknowledges and incorporates elements of the horizontal strategy.

The Man Who Funded Health Systems for Fifty Years (photo: Domain Barnyard via Flickr)

As the article notes, the entrepreneur-tech geek in Gates has a penchant for technological solutions, which, according to Matt Collin at Aid Thoughts, accounts for his faith in vertical solutions. While admirable, the entrepreneurial spirit is more attuned to producing short-term, easily quantifiable results and therefore risks overlooking necessary long-term investments such as fortifying healthcare systems.

Collins also believes that ego also played a role, as “the man who funded health systems for fifty years” lacks the cachet of “the man that eliminated polio.”

Furthermore, the Foundation has large incentives to spend money quickly; Buffet requires that the previous year’s contribution be spent out. Gates’ entrepreneurial tendency, ego and Foundation spending requirements all favor fixing easily identifiable problems in an easily measurable method. Collins finishes by urging Gates to increase spending on Advance Market Commitments.

As polio shows, vertical solutions to pandemics are not the answer. The debate continues.


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