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At What Cost?

The simplest definition of polio I could find (and that I trusted) was from PubMed: "Poliomyelitis is a viral disease that can affect nerves and can lead to partial or full paralysis." It is a disease I think many of us have heard about, but that I suspect many people don't know too much about. I don't, or didn't until I looked into it more.

The simplest definition of polio I could find (and that I trusted) was from PubMed: "Poliomyelitis is a viral disease that can affect nerves and can lead to partial or full paralysis." It is a disease I think many of us have heard about, but that I suspect many people don't know too much about. I don't, or didn't until I looked into it more. 

 
There are three types of polio infection: subclinical, nonparalytic, and paralytic. The majority of the infections are subclinical, in which there may not even be any noticeable symptoms. Nonparalytic and paralytic polio infections affect the central nervous system. From the names, it is pretty easy to tell the difference. Nonparalytic polio infections can cause an assortment of symptoms you can find on the PubMed website. Paralytic polio can cause breathing problems, difficulty urinating, muscle contractions and muscle pain, and muscle weakness, amongst other symptoms. In about 90% of the cases, the CNS is not directly involved, and full recovery is entirely possible. If the brain or the spinal cord is involved, permanent paralysis and death are possible.
 
There is a vaccine to prevent polio. Just to provide a refresher, UNICEF has a really good basic description of how vaccines work: "During vaccination, a harmless version of a germ is introduced to the body and the immune system responds by producing antibodies to attack the intruder. Thereafter, a memory of this 'invasion' remains so that the immune system can quickly recognize and neutralize disease-causing agents when they appear." There are two different forms of the polio vaccine available now: the inactivated polio vaccine given via injection, and the oral polio vaccine, which is given by drops orally. According to the American Academy of Family Physicians, there is a slight risk of contracting polio from the oral drops because that version of the vaccine has weakened but still live poliovirus, whereas the injectable version does not contain live polio.
 

There is your basic background. Why is this all important? In early 2011, Bill Gates officially made an appeal for an effort to completely wipe out polio worldwide. According to the New York Times article on the story, Bill Gates has been donating to the cause since 2005, and has given over $1.3 billion since then. In the last few years, he has become an outspoken voice for the eradication effort. He has donated his money towards both research and to help pay for the stipends allotted to the vaccinators. He has visited polio-stricken countries and has used his own status to push political leaders as well. For example, in January 2011 he and Crown Prince Sheik Mohammed bin Zayed al-Nahyan each donated $50 million toward the effort of vaccinating children in Pakistan and Afghanistan. 

 
This all seems good and dandy - the article makes it sound like leaders all over are uniting to rid the world of polio. Until you get to the sentence: "Is it right to keep trying?" Apparently the effort has cost $9 billion so far and is costing about $1 billion each successive year. The small pox eradication, to which the polio eradication effort is sometime compared to fuel the flames of hop, cost about $500 million. Total. That's a little different. And Dr. Henderson, was the World Health Organization officer that started the small pox eradication effort, has very loquaciously argued that polio cannot ever be completely eradicated.
 
I was conflicted when I read that part of the article. While $9 billion is a lot of money, later in the article it is cited that people in the US spend $18 billion on pet food each year. Comparatively the polio effort may cost more than the small pox effort, yes, but in the grand scheme of the economy, how much is $9 billion?
 
What made me stop and think harder, after reading the cynical section about how polio might never be eradicated and how maybe control is a better goal, a new question arose: should the money Bill Gates is pouring into this effort (whose efficacy is questionable) be going to other efforts for other diseases that are much more prevalent and much more dangerous? Beyond the question or issue of controlling how an individual spends his money, I focused on the more broad question of how limited resources should be used for the betterment of worldwide health as a whole. How should that money be spent? Is eradicating diseases that may (or may not) be beaten one at a time the way to go? How much international aid can the US provide along with these private donors to help the efforts? Would it make more sense to instead put efforts into setting up more efficient and functional health care systems in these countries with these diseases? Whose job is it to help these people? Should the governments of these countries be held responsible? How could we even do that? At what cost will Bill Gates pursue his effort to eradicate polio?  And how are we able to decide if it is worth it?