7. Conclusion
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173 Chapter 7 Conclusion A world free of measles by 2015 is not a dream. —Ciro de Quadros We have a real chance to build the partnerships, generate the political will, and develop the scientific breakthroughs we need to end this disease. We will not stop working until malaria is eradicated. —Bill Gates Any goal short of eradicating malaria is accepting malaria. It’s making peace with malaria. It’s rich countries saying, we don’t need to eradicate malaria around the world as long as we’ve eliminated it in our own countries. That is just unacceptable. —Melinda Gates The field of global public health is currently in an era of unprecedented funding and ambitious goal making.1 The global financial crisis of 2008– 2009 is likely to have some effect on aid (McNeil 2009), but it takes place in the context of historically high levels of funding for global health initiatives : $21.8 billion in 2007, compared to $5.6 billion in 1990 (Ravi­ shankar et al. 2009). It is not surprising that, in this climate, the ideal of eradication would find supporters. The World Health Organization and other major global health funders and organizations are poised to attempt massive eradication efforts targeting measles and—shockingly, to many observers including myself—malaria. Like the Polio Eradication Initiative on which it is modeled, the­ Measles Initiative started with a disease elimination campaign in the Americas. In 1994, riding the crest of the successful elimination of polio in the Americas, and inspired by the successful elimination of measles from several countries in the Caribbean, the Pan American Sanitary Conference 174 Chasing Polio in Pakistan moved to eliminate measles from the Americas by 2000 (Pan American Health Organization 1994). Their strategy of mass measles campaigns was modeled in important ways on polio campaigns and made use of the infrastructure created by polio elimination efforts (Acharya et al. 2002; Hersh et al. 2000). These efforts were quite successful, reducing the number of cases from hundreds of thousands per year to just a handful (de Quadros et al. 2004).2 In 2001, the Measles Initiative began efforts to replicate this success globally (Hoekstra et al. 2006). It made great progress, reducing yearly measles deaths by a reported 74 percent worldwide by 2007 (Measles Initiative 2009). The Measles Initiative has not declared itself an eradication program and probably will not do so if polio eradication is not achieved. However , people involved in the project—many of whom were instrumental in launching the Polio Eradication Initiative—have indicated that if polio is eradicated, they want measles to be next. A number of recent articles have argued that measles eradication is “technically feasible” (de Quadros et al. 2008; Fenner 1999; Meissner, Strebel, and Orenstein 2004; Orenstein et al. 2000). The Measles Initiative’s leaders seem to regard polio eradication as a test case. “Launching a global initiative on measles eradication will require demonstrating that polio has been eradicated,” writes Ciro de Quadros, an influential leader in both the polio and measles elimination efforts in the Americas (de Quadros 2004, 137). The eradication of polio would provide excellent impetus to push the Measles Initiative, which has made substantial headway in reducing measles mortality worldwide, into high gear (Orenstein et al. 2000). In contrast, the malaria eradiation project, proposed by Bill and Melinda Gates in 2007, is a new effort, at this point a concept rather than a reality. But would-be eradicators of malaria are hoping that the eradication of polio will give their project a boost. Bill Gates said: “We’re very committed to polio because we think success there will breed positive excitement . A failure there would definitely be a setback for malaria and all diseases. Just the whole idea of success would seem so remote that that would hurt a lot.” However, he immediately added: “Our commitment [to malaria eradication] won’t wane no matter what happens in this area. It’s a lifetime commitment on our part. And, I do think people will join in” (Gates and Gates 2007). Malaria eradication, then, will probably remain a goal no matter what happens in the course of polio eradication. The lessons of polio eradication could prove critical for these two very big, very ambitious, very difficult projects. I have argued in this book that the need to frame projects in a way that impresses donors and faith in the power of technological solutions to health problems contribute to a cul- Conclusion 175 ture of optimism...