We do not include any current disease eradication campaigns among our priority programs in international aid. We have considered two major eradication campaigns:

• Polio eradication (Global Polio Eradication Initiative)
• Guinea worm eradication (Global Guinea Worm Eradication Program)

Below we list some of the potential concerns around eradication campaigns. Our purpose is not to argue that such campaigns are bad investments in general, but simply to note that the sort of complexity they involve makes them a poor fit for our list of "low burden-of-proof" priority programs. We feel that charities working on these sorts of programs bear a relatively high burden of proof regarding the potential concerns below.

Potential concerns around eradication campaigns

As an eradication program nears its goal, it may require significant additional funds in order to achieve the goal of eradication. Historically, only one eradication program (smallpox) has been successful.

The Disease Control Priorities in Developing Countries report states:

The Disease Control Priorities in Developing Countries report illustrates the problem with a case study of polio eradication:

• Background: "Poliomyelitis became the next principal target when mass vaccination campaigns, proposed by Albert Sabin (1991), proved remarkably successfully in Cuba and Brazil. In 1985, an American Health Organization coordinated campaign was launched to interrupt poliovirus transmission in the Americas by 1991, and this effort succeeded. Some believed that global eradication might be possible, although others were concerned that the far less developed infrastructure of health, transportation, and communications services in many parts of Asia and Africa would make it an unachievable task. In 1988, the WHA adopted a resolution to eradicate polio, but at that time, a longer-term strategy for ending polio vaccination was neither formulated nor agreed on by the public health and scientific community."2
• Cost-effectiveness concerns: "The economics of polio eradication are thus not as favorable as concluded by either Bart, Foulds, and Patriarca (1996) or Khan and Ehreth (2003). Both studies assume that vaccination can cease without IPV being used as a substitute anywhere, both exclude the costs of maintaining a response capacity, and neither accounts for the real threat of reemergence. Sangrujee, Cáceres, and Cochi (2004) take account of two of these considerations, but their analysis calculates only the costs for 15 years, ignoring both the risk of reemergence and the benefits of eradication.... In conclusion, although the economics of polio eradication may have been thought to be favorable by some (Aylward and others 2003), they are far less favorable than were the economics of smallpox eradication, even assuming that polio vaccination could cease."3

  Note: In September 2011, we confirmed a number of errors in the estimates for the cost-effectiveness of deworming published in the Disease Control Priorities report. Based on those findings, we are currently rethinking our use of cost-effectiveness estimates, like the DCP2's, for which the full details of the calculations are not public. For more information, see our blog post on the topic.

Sources

• Jamison, Dean T., et al., eds. 2006. Disease control priorities in developing countries (PDF). 2nd ed. New York: Oxford University Press.

• 1.

  Jamison et al. 2006, Pgs 1173-1174.

• 2.

  Jamison et al. 2006, Pg 1164.

• 3.

  Jamison et al. 2006, Pg 1174.