Global health ethics & infectious disease: Kill it or contain it?

Dueling papers in prominent British medical journals this month address infectious disease spread from two very different perspectives. In The Lancet, two global health experts assert a moral imperative to successfully eradicate polio, based on the ethical principle of a "duty to rescue" those in peril. The Global Polio Eradication Initiative, launched in 1988, has vaccinated over 2 billion children and reduced polio incidence by 99%. More recently, however, critics contend that eradication is too costly a goal, and that effective containment should instead be pursued. The moral argument, naturally, points out that there is more at stake than dollars and cents, and containment would still result in 4 million children contracting polio over the next 20 years. Those children represent, in the words of the authors only part of "the human cost of failing to eradicate" the disease. Polio is all but non-existent in developed nations thanks to thorough vaccination, clean water and sanitation, but remains endemic in India, Pakistan, Afghanistan and Nigeria.

Small pox is the poster child for disease eradication. The story behind this global health effort is fascinating. And though it cost billions to achieve back in the 1970s, it has saved an estimated 2 million lives and 10-15 million infections each year since.

Researchers publishing in The Proceedings of the Royal Society, however see it differently. In a long, technical, and highly analytical piece of research they argue that the most efficient way to reduce global pathogen prevalence is not to eradicate diseases, but rather control them with targeted health care capacity building in countries that need it, based on three key predictive factors: high pathogen prevalence, large population size, and low per capita healthcare spending. $18 billion additional investment each year (1% of total yearly private spending on health care) in largest countries, such as India and Pakistan, would reduce infectious disease burden by several percent for over two billion people. Even small percentages in such large populations would result in huge reductions in infections, death, and disability. Regions that lack a rich diversity of dread disease don't have public health efforts to thank, they assert but cooler climates. Reduction in regional prevalence, they continue, benefits the entire world by reducing likelihood of global spread.

While its hard not to side with the moral arguments, the reality is that someone has to pay, and strengthening health care and public health capacity to meet the challenge of infectious disease would also build capability to prevent other conditions, promote health, and address chronic disease. And as the concept of value increasingly enters the rubrics defining health care quality and outcomes, its hard to know if moral judgments will continue to carry their former weight. What's your perspective, should dread diseases be eradicated when possible, despite huge costs, or is a more economic, if less absolute, solution acceptable?