Think about that: inoculating 222 million children in 10 days. For comparison,
there are only about 80 million children in the entire United States.
Imagine inoculating every child in America in 10 days. In 10 days, we couldn't
even get every voter in Florida to figure out whom they chose for president.
Not so long ago, polio roamed the globe, and each day would paralyze 1,000
children. Today, there are only some hundreds of cases each year, mostly in
underdeveloped areas of Africa and Asia.
The entire 21-year slog has so far cost $5 billion. By comparison, Wall Street
executive bonuses last year - not salaries, but
bonuses, for a single year that saw the whole mess collapse and the taxpayers
handed the broom - came to $18 billion.
If you look at the polio campaign costs on an annual basis, it's about $240
million a year, or less per year than it has cost to occupy Iraq per day.
The United States has been polio-free since 1994. But if the polio campaign
falters, the virus could return. This, unlike Iraqi military operations, truly
is a case of having to fight them overseas so as not to face them at home.
And why would the polio campaign falter? Because there are huge demands on the
public purse and we must spend judiciously; otherwise, Wall Street CEOs would
have to pay for their own $87,000 area rugs and $68,000 credenzas. (What's a
credenza? I had to look it up. Turns out it's that sideboard thing you only see
in the movies, where Wall Street villains keep their decanters of fine whiskey
for toasting the paralysis of small children.)
Casting out the fiery serpent
Consider another life-saving success-for-pennies program that's evolving right
now, in fact racing against polio to be the next public health triumph. We are
on verge of eradicating Guinea worm, a parasite believed to be the "fiery
serpent" that torments the Hebrews during the Exodus. Go read your Bible, it's
in there.
A female Guinea worm matures in its victim's gut, growing two feet long. Then,
over a year marked by cramping, nausea, and fevers, it burrows out of the
intestines, down through a leg, and to the skin surface. A blister forms
accompanied by a burning sensation - hence the "fiery serpent". The agonized
victim immerses the leg in water for relief; on cue, the worm releases a cloud
of larvae. Others drink downstream, and the cycle repeats itself.
Treatment involves digging into a blister to seize the worm's head, then
extracting it over days to weeks by wrapping it around a stick, a therapeutic
image that some argue may have inspired the Rod of Asclepius, the physician's
symbol of a snake coiled around a staff.
Guinea worm still plagued millions when former president Jimmy Carter organized
a charitable foundation and challenged his advisers to suggest a disease to
stamp out. They nominated Guinea worm: humans are its only host, so if the
cycle is broken in people, the parasite will be gone. Thanks to larvicides,
nylon water filters, and education, we are almost there. Today, there are fewer
than 5,000 recorded Guinea worm cases in six African countries. The total cost
of this 23-year campaign to date has been $225 million. Or less than $10
million a year.
This sort of chump change is so small, you can't even talk outsize salaries;
you have to focus on the tax breaks on those outsize salaries. So, consider
that the following celebrities have saved the following estimated sums each
year on their taxes, courtesy of George W Bush-era tax cuts: movie producer
Jerry Bruckheimer, $5.8 million; LA Laker Kobe Bryant, $1.6 million; rapper 50
Cent, $6 million; real estate mogul Donald Trump, $1.2 million.
Imagine a sort of a Congressional reverse earmark, one that canceled the Bush
tax cuts only for Bruckheimer, out of punishment for Armageddon and Pearl
Harbor, and steered the resulting millions to disease control efforts.
Really, would any of these men notice the slightest changes in their lives if
they returned to paying Bill Clinton-era tax rates?
But wait. Aren't some of these public health campaigns wasteful failures? Sure
they are. Let's look at one public health failure: the drive to eliminate
leprosy.
Caught early enough, leprosy can be cured today with the antibiotics dapsone,
rifampicin, and clofazimine. Over 25 years, courtesy of Novartis
pharmaceuticals and the Japanese Nippon Foundation, these medicines have been
handed out for free, and have cured more than 14 million people of the disease.
They work so well that the WHO now recommends integrating the world's 250,000
known leprosy patients into primary-care settings, just like those with any
other illness.
Treatment is so effective, in fact, that several years ago the WHO launched a
campaign to eliminate leprosy entirely. Ultimately it sank 15 years and about
$200 million into the project. (I cannot find a link for the $200 million
figure, provided to me by WHO officials in e-mail correspondence.)
But there's a logistical nightmare when trying to eliminate leprosy. Other
targets such as smallpox, polio, and Guinea worm exist in one reservoir only:
sick humans.
Not so with Mycobacterium leprae, a bacterium that attacks skin and nerve
cells. Even today, we don't know everywhere this bug lives. It has been found
in the oddest places: in armadillos in Louisiana and Texas, in the noses of
healthy people in some parts of the world, and even in some soil samples.
Such a bug was never an easy target. Even so, in 1991, the World Health
Organization vowed its "elimination" - and then defined "elimination" to mean
less than one case per 10,000 people. At such a low background level, it was
hoped, the disease might dwindle into irrelevance. It hasn't worked. That
1-in-10,000 target was arrived at via politics and hopeful thinking. It was
achieved worldwide in 2000, putting the WHO in the risible position of claiming
"elimination!" and then seeking more money to, like, eliminate it some more.
The organization was bitterly criticized. Earnest, indignant treatises have
been written noting that there is too little money to go around, and accusing
the WHO of risking the credit of the more promising drives against polio and
Guinea worm.
So, the anti-leprosy push was a $200 million failure, because it didn't
eradicate leprosy. It only cured 14 million people of the disease - for half
the price of an Alaskan bridge to nowhere.
Oddly enough, $200 million is reportedly the tax deferral enjoyed by former
Goldman Sachs CEO Henry Paulson - he of bailout infamy - when he joined the
Bush cabinet as Treasury secretary.
So there you have it, finally: for $200 million of public money we can take a
walk in the footsteps of Jesus Christ himself, curing millions of leprosy. A
truly inspiring future is, as always, easily within reach, if we choose it. Or
we can just give Hank Paulson a tax break. Maybe throw in a credenza by way of
thanks.
Matt Bivens is in his intern year at a Harvard-affiliated emergency
medicine residency at Beth Israel Deaconess Medical Center. He is a former
editor of the Moscow Times who lived for years in Russia, and who covered the
war in Chechnya for the Los Angeles Times. His journalism has appeared in
Harper's, Playboy, the Nation and many other publications.
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