My generation was the first to be spared from polio. But I had relatives that were not as lucky. I knew kids just a few years older than me who lived in iron lungs. This is a massive accomplishment that should be celebrated.
I think the celebration is slightly premature. Several areas in the African interior are inaccessible due to conflict, so testing is not possible. ... so we are not really certain it's been eradicated in those areas.
Also important is the possibility of environmental reservoirs for the disease in nature. Hopefully not, but it is still possible.
Only continued vigilance can guarantee victory. Many areas were declared polio free once before, only to have it resurface.
My Mom nearly died from it when she was a kid. The lifelong complications can be really debilitating even if you survive. I'll be very happy when it's declared fully eradicated everywhere.
I was born decades after the vaccine, but the reality of polio was prominent in my mind because a friend’s mom was left with a limp wrist after having polio as a child. So I was cheering for Dikembe Mutombo, one of my favorite NBA players, when I heard he was putting some of his fame and fortune towards fighting polio. On April 13, 2011, the Johns Hopkins Bloomberg School of Public Health gave Mutombo the Goodermote Humanitarian Award for his work against polio both globally and in Congo, his home country.
A hundred years ago, Malaria in the United States was bad enough to warrant a dedicated government office (It was folded into the CDC after WW2). This turned into a major eradication program through the use of DDT in the 1940's and by the 1950's Malaria was effectively eliminated from the states through the decimation of the mosquito population. Mosquitoes have of course rebounded over time, but malaria has not.
Mosquito release programs like this are now several decades old and have shown high efficacy with few environmental side effects where they have been tried. It is certainly more environmentally friendly than DDT. Meanwhile, the benefits are enormous and if done successfully in Africa could be directly measured in terms of human suffering.
Indeed, I just recently learned, this is why the CDC is in Atlanta:
> On July 1, 1946 the Communicable Disease Center (CDC) opened its doors and occupied one floor of a small building in Atlanta. Its primary mission was simple yet highly challenging: prevent malaria from spreading across the nation. Armed with a budget of only $10 million and fewer than 400 employees, the agency’s early challenges included obtaining enough trucks, sprayers, and shovels necessary to wage war on mosquitoes.
Their mandate changed. They are not the centre for disease control and prevention and they act in accordance with their mandate as a public health agency
Yes, I know. I have friends there who are fantastic, smart, committed civil servants working within their mandate and structure. I have a Master's in Public Policy from the Kennedy School, I'm not anti-government. But mission creep has hurt the CDC more than helped the nation. Public health is far too big a remit for any one agency.
Collecting gun-related injury and fatality data allows us to make evidence-based informed decisions about what types of legislation are likely to be effective to reduce harm. For example:
And that has nothing to do with Disease Control and is a clear demonstration of mission creep. The CDC has recently displayed its incompetence regarding its core function. Maybe it should master that before addressing other issues of society which are, at best, only tenuously in its purview.
You have many questions. At first it seemed as if you were curious about what other aspects the CDC had delved into. Now it looks like you are pursuing some agenda. The basic questions can be answered with a bit of research. Here are some more to ponder. Or maybe these are what you are getting at.
What was the CDC's original mission?
Did it execute it competently?
Why is it now involved in areas other than communicable diseases?
Do people in organizations seek to increase their power and influence?
Do they do this by enlarging the scope of their organizations' missions?
How is this notionally science-based entity being influenced by other factors?
I actually suspect this role was thrust on the CDC because they are generally supported by everyone (everyone sane anyway). I'm not a fan of this having happened because they should be too important to get mixed into politically poisonous debates.
Well, don't they do other things that involve health? Like drinking guidelines and dietary guidelines and cancer research/information and things of that sort?
Still well within the realm of health and certainly affects communicable diseases (an unhealthy population is more prone to worse effects of disease).
Public health is precariously close to politics in a lot of cases and it casts shade on their mundane and universally appreciated work on topics more directly related to disease.
That said, it'd kind of inevitable that they run a course like that because constantly doing good non-controversial work banks political capital and the politicians are gonna try to harness organizations like that for their own ends.
Question, why was DDT never tried in Africa if it was so successful in Florida and also in Italy after WW2? Why don’t we use DDT today? I’m curious to know the answers and have better understanding of the complexity of what makes eradicating malaria in Africa in the 21st century more complex than it was in the 1940’s and 50’s in other parts of the world.
We do. DDT has never been banned for disease control, it was banned for indiscriminate agricultural use and by that time resistance was already developing anyway.
Successful eradication in Florida and Italy was based on aggressive source control (stagnant water), control of re-importation, and use of insecticides (including DDT) for outbreak control.
Airborne spraying of more targeted larvicides continues to be used in Florida and other places.
Malaria rates in rural areas of Africa are much higher than urban areas so urbanisation also plays a role.
You mean for agriculture? Because using DDT for disease vector control was never internationally banned (only banned at the national level).
It's banned in agriculture because it kills stuff other than the mosquitoes. In particular, its use is restricted by the "Stockholm Convention on Persistent Organic Pollutants". Persistent Organic Pollutants are pretty much as bad as they sound, and DDT is one.
> Carson has been targeted by some organizations opposed to the environmental movement, including Roger Bate of the pro-DDT advocacy group Africa Fighting Malaria and the libertarian think tank Competitive Enterprise Institute; these sources oppose restrictions on DDT, attribute large numbers of deaths to such restrictions, and argue that Carson was responsible for them. These arguments have been dismissed as "outrageous" by former WHO scientist Socrates Litsios. May Berenbaum, University of Illinois entomologist, says, "to blame environmentalists who oppose DDT for more deaths than Hitler is worse than irresponsible." Investigative journalist Adam Sarvana and others characterize this notion as a "myth" promoted principally by Roger Bate of the pro-DDT advocacy group Africa Fighting Malaria (AFM).
> As late as 2004 leading newspapers editorialized that eradicating malaria in Africa outweighed the environmental damage
This doesn't make sense. Eradicating malaria in Africa is beneficial to the human species. Environmental damage applies to all other species. I don't understand how one could "outweigh" the other. They are just two different objectives.
Environment also includes the crops, the insects that pollinate the crops, the pests which eat the crops, the predators that keep the crop-eating pests under control, the fish…
We’re not (yet) beings of pure thought who can exist independent of our environment, so the damage to the environment does have to be counted before we decide if something is net-positive.
of course they are related. Take a preposterous example: draining the mediterranean sea would be an environmental disaster which we wouldn't do. But if it would forever end world hunger, poverty and disease we would do it. The trade-off changes.
It is devastating chemical, killing not only insects, but all kinds of other creatures. It is one of the reasons for the writing of "Silent Spring".
https://en.wikipedia.org/wiki/DDT
> DDT was less effective in tropical regions due to the continuous life cycle of mosquitoes and poor infrastructure. It was not applied at all in sub-Saharan Africa due to these perceived difficulties.
We’ve been committing mass murder of mosquitos for decades and, as far as I know, nobody has ever found evidence that it’s problematic. Mosquitos seem to be one of the few truly unnecessary (and universally unwanted) bits of the natural order.
I've read that some bird populations might suffer, but even ecologists will admit that mosquitos aren't particularly vital to any one species, and the elimination of mosquitos as a primary disease vector may even be a net-positive for the animal world.
On top of that, only a small number of mosquito species carry malaria or dengue. Granted, I'm not sure how well we've studied cross-species fertility in mosquitoes (and thus risk of genetic solutions jumping the species barrier), but if we're able to very selectively exterminate this small number of species, my understanding is that the remaining mosquito species would expand to fill any ecological gaps.
I genuinely don't know the answer to this, but are they not a significant source of food for any predator such that their elimination wouldn't be noticed?
I'm reluctant to be playing god on this front, especially in light of the fact that it seems like the insect population is not doing well, globally, and forms the base for a complex food chain.
For decades we have been performing a semi-eradication effort for mosquitoes for decades, and we have not noticed a substantial change that can be considered a result of that.
I understand hesitation to muck with nature, but I think it's sort of a privileged position to have when you live in an area where malaria and West Nile are not a serious risk. Malaria kills a lot of Africans every year (400,000+ [0]), and I'm not sure how much hesitation I'd have towards eradication if anyone in my family died from it.
That’s more something bat enthusiasts say to get people to like the critters. In reality insectivorous bats primarily eat larger, easier to catch prey like moths.
Given the small size of mosquitoes, restrictions imposed on prey detectability by low frequency echolocation, and variable field metabolic rates, mosquitoes may not be available to or profitable for all bats. [1]
Humans have been “futzing with nature’s systems” and transforming or destroying ecosystems since the agricultural revolution, or before. This particular futzing is targeted, subject to careful scientific study, and if scaled out globally, has a fair shot at ending one of the greatest causes of human misery in the history of the world. What exactly are you concerned about?
I fall on the GMO is good side of the fence. I agree that careful science is far safer than the billion year "let's try random shit and see what sticks" experiment that nature runs. However, if I were to articulate my fears about experiments like these it would be to say that mankind's skill is a double edged sword. We've built a tool that quickly and effectively spreads and wipes out a species. That's the good side of the sword. In the off chance we messed up, missed something important... well now it's a quick and effective tragedy. That's the other side of the sword.
For me the equation is tilted pro-GMO because I see the alternative of letting nature run its course as a 100% certainty that a current tragedy continues to unfold.
So I'll continue to support GMO experiments like this. I just might have my fingers crossed, in case our D20 roll is bad and the kill gene jumps into the Zika virus and then into humans...
Horizontal gene transfer (HGT) or lateral gene transfer (LGT) is the movement of genetic material between unicellular and/or multicellular organisms other than by the ("vertical") transmission of DNA from parent to offspring (reproduction). HGT is an important factor in the evolution of many organisms
A similar story that I found absolutely amazing is the story of the screwworm and its eradication from the US. Not the whole world, mind you (which feels foolish long term).
I am not trying to make a point. This discussion made me think of it and I wanted to share.
By that logic, no modern technology should be adopted. However i am sure ecologists have studied in depth the impact this might have on the food chain or other dependencies and have mostly found mosquitoes to be completely useless and hopefully the test cases prove the same.
There are multiple kinds of mosquitos only a few carry human-infectious disease. It is my understanding that displacing Aedis Egypti (probably spelled wrong sorry) would not materially wipe out the ecological niche
Well good thing you started with that since you are clearly not familiar with him at all. He is very very well read and highly involved with the charity.
I dunno: He played a crucial role in a long-term, industry-wide collaboration that resulted in practically every household having at least one computer. And for years he's been devoting his fortune and his intellect to solving global-scale problems. That has gotta be worth some redemptive value for past sins, yes?
His fight against disease certainly does a lot to redeem him in my eyes. I was never a fan of him in his Microsoft days, and I'm still not a fan of Microsoft or their products, though they stand out less today because the other Big Tech companies are just as bad in various ways. Remember when we all loved Google and Apple? Windows is still terrible, though, and not fulfilling the promise of what should be possible with computers.
I also remember how we laughed when his Encarta encyclopedia tried to sell Bill Gates as widely known as a philanthropist. It wasn't true then, but it is true now. He certainly deserves that credit.
It's as if the entirety of computing would be better off today if Microsoft had been broken up back in 2001, and the world wasn't forced to suffer through decades of windows stagnation.
This is a nit, and should not be taken as engaging with the substance of your comment, positively or negatively:
"Antitrust" are the laws designed to break up monopolistic "trusts". So far as I am aware, Bill Gates only ever had costs from any antitrust operation, legal or illegal.
All these anti vaxxer people are also pushing HCQ ... but it actually does prevent Malaria. If not for the side effects that compound over time, if the body was able to flush it out somehow, it could be very useful, no?
That or finding ways to sterilize all anopheles mosquitoes, or do other mosquitoes carry it also
It’s called the advancement of science and it’s one of the reasons it is not generally a frontline treatment (because we have more effective treatments now, as well as resistance).
You might as well say that a person is too phlegmatic and needs bleeding when they have gallstones.
It's because he is looking long term. Once you eradicate polio then it's gone forever. If he stops now to save more children from malaria instead then polio will return and the work so far wasted.
The evolution of exactly the same illness is difficult[1].
Polio is an Enterovirus[2]. There are many virus in that family, and most of them cause only a mild stomachache and fever. A week later you forget that you where ill. Moreover, in the 95% of the case the Polio virus only cause the same symptoms instead of the paralysis.
One of the other virus can evolve and start to cause an illness that is very similar to Polio and we can decide to call it Polio, or PolioII, or some acronym like SPGWSPLI or something like that[3].
Nobody is sure about the cause of Acute flaccid myelitis [4], but it is somewhat similar to Polio and it is probably caused by an Enterovirus too. If something like that cause a big outbreak, we will hopefully make a vaccine and eradicate it too.
[1] Where "difficult" means "almost impossible, but there is a chance".
Bill Gates got involved with polio via $100 million matching fund to Rotary International about a decade ago. It was one of the foundation’s early healthcare initiatives and leveraged several decades of work by Rotarians around the world...polio eradication was the major project of Rotary at the time.
Malaria is different in that there was not the same level of eradication infrastructure to leverage and different because it touches on drinking water and food chains in the non-human environment. Malaria is not mostly a vaccine distribution problem.
It's the same reason that if Oprah took her billions to try and solve some global problem with her husband Stedman, many mentions of the work they were doing would not mention Stedman.
One is a famous individual who built up an obscene fortune, and the other person is married to them. And despite how involved their partner is deploying that wealth for the good of the world, people are just not going to mention the less famous one who didn't build up the fortune as often.
The question was "Why isn't she mentioned?" He did not ask "Would it be apt to mention her?" "Should you also mention Melinda when referring to the Bill and Melinda Gates foundation?" The answers is yes to both of these questions. She is an impressive person who has accomplished much in her life.
He did this (I assume) to imply the reason she was not mentioned was because she was a woman and not because of the large and obvious disparity in fame.
Just to clarify I didn't mention it because she was a woman but because she seemed to be an equal and important partner in the foundation but the accomplishments always seemed to land in Bills corner.
There are many reasons, but one specific to Hacker News is that Bill Gates writes articles that are posted on Hacker News.
Bill Gates also regularly gives speeches. I checked and Melinda doesn’t have any on youtube since 2013.
So Bill is very much the public face of the foundation, even though Melinda is equally active and her name is in its name.
Not the only reason, but worth pointing out a prominent benign one.
For instance, a parallel example is how ycombinator is often mentioned as being founded by Paul Graham, and Jessica Livingstone is left out. Why? Partly sexism of course. But Paul also was the public face of YC with his essays.
And we have evidence it’s not just sexism, because YC had four founders
> by Paul Graham, Jessica Livingston, Trevor Blackwell, and Robert Tappan Morris.
I think the second two are even less well known than Jessica Livingstone, and this correlates with how much public writing and speaking she’s done as the face of YC and about startups.
(There’s a whole other discussion to be had about whether women are chased out of the public sphere, but this comment is long enough)
This is a reasonable question, and my understanding is that Melinda was the prime mover behind starting the foundation and pushing Bill to look outward. But that notwithstanding Bill has almost always been the public face, and one has to suppose that is an intentional choice
I didn't downvote this (and don't generally do so), but here's a line of reasoning that might explain it: something has to go seriously wrong in the world for the lives of millions of people to be contingent upon the charitable sentiments of one obscenely wealthy man. Put another way: regardless of whether he's doing good, it shouldn't be the case that polio eradication depends on his material wealth.
Celebrating the beneficial outcomes of Bill Gates' charity without reflecting on why he's able to give away billions of dollars without breaking a sweat invites us to ignore the fact that the system that enriched Bill Gates doesn't actually encourage him to do any good (and actually involved him doing quite a lot of harm).
I have the opposite sentiment. Things have been going extremely right for a single person to be able to go out and destroy issues that literately thousands upon thousands of people are affected by. Since governments of the developed world are mostly democratic no action to fix those issues in other countries is taken. This would have not otherwise been possible.
To be clear: it is good, morally speaking, for Bill Gates to contribute to the effort to eliminate polio. The observation is that Gates' ability to do so (i.e., his profound wealth) is completely unfixed to any good he produces: he could just as easily use his wealth for morally bad ends.
In others words, we're extraordinarily lucky that this particular ultra-wealthy person has decided to do good things with (some) of their money. But grounding moral and humanitarian progress on a steady stream of luck seems shortsighted.
I don't think it's luck. A significant part of the very rich are donating huge amounts to charity. With the giving pledge being the most clear example.
It's most certainly not a fluke that the mega rich are solving problem governments can't or won't.
> It's most certainly not a fluke that the mega rich are solving problem governments can't or won't.
There is no "can't or won't" on a global scale: some countries have, others haven't as a function of their means. The fact that ultra wealthy individuals have better means than entire countries is an indictment of the state of affairs, not praise.
Edit: To elaborate on the above: eradicating polio isn't something that democratic, liberal countries are uniquely good at. Autocratic and despotic governments have also historically been good at it and have aggressively pursued it, because paralyzed citizens just aren't very useful. Countries that don't pursue eradication are historically ones that just lack the means (whether that's money, or infrastructure, or whatever), not ones with specific political structures.
> There is no "can't or won't" on a global scale: some countries have, others haven't as a function of their means.
That is exactly "can't or won't". The USA or China certainly "can" fix these issues in Africa if they want to but they "won't". But the African countries themselves obviously don't have this capability thus they "can't" fix it.
> The fact that ultra wealthy individuals have better means than entire countries is an indictment of the state of affairs, not praise.
Why is this an indictment. This is not self evident at all to me. The opposite is true from my perspective. This story and initiatives like the giving pledge very clearly show me that that the mega rich are doing things no country is doing. And thus these problem would remain unsolved if they would not be here.
Charities like the Bill and Melinda Gates Foundation tend to be one of the charities that critics of rich philanthrophy actually exclude. The common argument is that such philanthropic endeavors should not be at the whims of the rich, but should rather be run by the government and the rich should be more greatly taxed by the government to secure those funds.
However, The Gates Foundation tends to fund programs in developing countries where those countries's governments are not capable of funding it themselves.
It helps that the Bill and Melinda Gates Foundation has a hyper focus on outcomes and a track record of delivering. It's an example of what is possible to accomplish when philanthropy is done well.
While I can understand and in some sense agree that it's unfortunate our current best solution to tackling some of these problems is for someone with a lot of resources and no bureaucratic entanglements to focus on solving the problem once and for all. I can also recognize that few governments are capable of solving it regardless of political philosophy.
I'm more than happy to celebrate a solution that works today over a hypothetical solution that hasn't been successfully deployed yet. Maybe I'm too pragmatic.
I hear what you're saying, but, who or what organization would else would do it? Individual countries struggle with it because, amongst other reasons, they're not as wealthy or stable as the US and Europe was when they beat (in this case) polio; they struggle to stay afloat, and they have bigger concerns for their people, base necessities like water, food and housing.
The UN? They (to me / personal viewpoint / citation needed) don't seem to have any power, influence, means or goodwill to handle a problem like this. I mean they have never been as silent as they are now, while China and the US have literal concentration camps, Russia is assassinating political opponents and is encroaching on other countries - directly (Ukraine) or indirectly (influencing governments, heavily influencing destabilizing decisions like Trump's election or Brexit), the US is in a civil war and on a crash course towards a fascist dictatorship, currently working towards a sham election, actively undermining postal services so mail voting will not work so that Trump can go "Well shit is fucked, I'll just stay on a bit longer to fix this for you" and declare national martial law so that the army can beat down whoever objects.
Bill gates did indeed do "quite a lot of harm" to many businesses and I have cursed his name many times while wrestling with some Microsoft chicanery.
But that harm was done to competitors, on the business field. The people who became collateral damage could always go and get jobs at some other company. The companies suffered and sometimes died but such is the way of capitalism.
If the upside was that his money gets redistributed to the genuinely poor and needy, who don't have any opportunity to earn for themselves in some cushy IT job, then I'm personally OK with it.
(I forget the specifics, but a piece of ancient code we wrote included a dummy assignment to a variable called BILLGATESBOLLOCKS, to get around some MS devilment).
It’s good that he’s a billionaire that uses his wealth for truly great humanitarian causes. However, he is an exception and most billionaires don’t do this. And they probably shouldn’t have to, if we created a system that doesn’t allow for this kind of obscene enrichment of individuals.
Personally I trust Bill Gates to do more good with his money than the US Government. Eradicating polio in other countries seems very much preferable to bombing them into democracy.
That’s a false dichotomy. The WHO and other International aid organizations were founded and funded at the direction of the USG. The US continues to fund humanitarian causes around the globe. Gates himself has said that Government funding is essential to the causes he’s interested in.
Given the incentives, isn't this a Robin Hood story ? Bill Gates, Robbing the rich to give to the poor ?
But the problem is that we are those rich people. We as tech people have suffered under the microsoft monopoly. Heck, we still suffer, from the horrors of windows 10, to browser incompatibilities, etc.
How could these Africans ever comprehend the pure dread of being forced to develop for IE6? /s
So what if he did "terrible" stuff 25+ years ago? I am sure no-one in this thread would give 90%+ of their personal wealth to humanitarian work such as these. People just like to complain.
Please, 90% of a 100 billion (that is currently growing faster than he can spend it) is not a fair comparison. Money is worthless once you've bought everything you want.
I understand where you are coming from, but he could have some stupid mega-doomsday-underwater-mansion project for the ultra-rich, instead he's doing this, why not appreciate it?
It has everything to do with people's perspective of the world: rich people cannot be good people. If you gain something, somebody else needs to lose something. So for a rich person to get rich, he must have taken a lot from other, "nicer" people.
Bill gates must really love swimming "uncle scrooge"-style in his billions. That's all he cares about. Everything he does must be to gain more billions, so he can swim in a bigger pool.
Bill was also super competitive, so let's focus on that and forget that he made his money providing value to users and businesses. It's better to act like he stole the money in an unfair way.
I personally feel very sad for a person that can't imagine that someone else could feel happy and satisfied by helping others, by having a huge impact on peoples lives in a positive way. I'm sure Bill and Melinda get more satisfaction of helping other people than looking at numbers on their bank account. But hey, that's not possible because he's rich, and therefore evil.
That makes sense. It's specially telling that the top voted reply to my message says Bill Gates donated Billions "without breaking a sweet". Clearly that person never read about his personal involvement and time commitment to numerous researches and social programs. It's 100% prejudice.
Thanks for sharing this viewpoint. This is the cancel culture run amok. While these people might very well be well-meaning, their ideological purity tests often end up being just sanctimonious holier-than-thou rants and tantrums.
It is at its core, the issue of the perfect being the enemy of the good. Bill might be an imperfect angel, but he is an angel nonetheless in spending his fortune to help millions/billions out of abject poverty and suffering. That dwarfs almost any effort by other people.
You could psychoanalyze this as acts of redemption, guilty conscience, seeking further world domination or whatnot, However it's undeniable he's helped many, many people and far, far,far more than his keyboard detractors ever would or could. And that's a very good thing IMHO.
People dislike him for a number of reasons. I despised his actions through most of his tenure at M$. He destroyed some things I cared about and tried hard to destroy others, and I was nowhere near them and didn't use their products.
I'm not really big on the idea of 'redemption' - my actions today do not erase what I've done in the past. But he has lived a pretty decent life since then, and tried to do good things. So good on him.
He bribed people for sure. Microsoft products had completely overtaken the public sector IT of several countries back in the 90s/00s. To get into the public sector of several third-world and not so third-world countries, bribing is more or less mandatory, business as usual. We've seen scandals like these dozens of times with all kinds of big companies. Bribing to get big public infrastructure projects from companies like Siemens, bribing to get pharma machinery into public hospitals. No such scandal was ever published for Microsoft that I know of, but this is how things work.
Without disclosing my opinions/take on Bill Gates, I think some see his charity as a means to gain power in specific regions to [insert conspiracy theory].
A tangentially related matter I see cited more often than not in these circles, are about an uptick in vaccine-caused paralysis occurring in India, causing the foundation to be kicked out.
The argument being that an uptick in “non-polio acute flaccid paralysis” (NPAFP) was recorded in areas where the oral vaccine was distributed, and this subsequently got the foundation “kicked out of India” (quoted because, as source below states, this is false) [0]
There's no need to refer to "conspiracy theories" (although Bill Gates's close ties to Jeffrey Epstein after his 2007 trafficking conviction did not do him any favors there). The ulterior purposes of the Gates Foundation are pursued mostly in the open:
That The Nation article seems to be implying that Gates is dodging his civic duties to pay taxes and support nice things like public infrastructure, but at the same time he's also avoiding paying for terrible things like funding the military which bombs things like weddings and Médecins Sans Frontières hospitals.
Gates has done some shady things in his day, but I can't fault him for that one. His fortune is a drop in the bucket of the federal budget, but being able to control and target his charity makes a hell of a lot of difference in the world. It's not like the federal government was going to cure polio in Africa, but for a few billion more dollars in tax revenue.
I would assume there to be a multitude of bad reasons, but as for a good one.. If you forced me to pick one driving one, the perception that he is laundering his reputation through philanthrophy would hopefully be it.
A good act does not wash out the bad, nor a bad the good.
His reputation didn't really need "laundering". He ran a software company, sometimes aggressively, but people act like he ran a private military corporation and trafficked in blood diamonds.
Summary: Whilst initial immunity is developing after vaccination, attenuated polio viruses can be excreted and cause a rare circulating vaccine-derived poliovirus (cVDPV) outbreak. 21 outbreaks have occurred in the last 20 years, with 760 cases, out of 3 billion vaccinated and 10 million polio cases averted. cVDPV is averted by getting as many people in the community vaccinated within a 12-month window as possible. It naturally stops being a risk as the vaccinated population approaches 100%.
In my experience from living in Tanzania, malaria is way down in Africa. Almost everyone said that true malaria isn't very common. I started a school there and none of the 200 kids there got malaria over the 4 year span of the school's existence.
I think the statistics about it might be overestimating since people constantly say they have malaria, but rarely if ever have it. It means just sick colloquially in Swahili.
In 2019, WHO started administering a malaria vaccine in 3 countries, Ghana, Malawi and Kenya. The vaccine has already passed Phase 3 trials, and 360k children will be immunized annually between now and 2023 [1].
I grew up in an area that forms part of the general malaria area of South Africa, but I have never had malaria. I know many people who have had malaria and the general observations that I have is:
1. Using malaria medication is advisable if you don't have access to good doctors and good hospitals. If you permanently live in a malaria area, it's not practical.
2. If you have quick access to a good doctors and good hospitals, it's often better to treat yourself once you are sick. ---> NO this is not travel advice <---. The malaria medications have a lot of side effects to use permanently; the expensive ones have less side effects and I believe pilots generally use such ones since risking getting sick has the potential side effect of a plane crashing.
3. The key is detection and treatment. You can easily die in an top EU or US or Singapore hospital if the doctor doesn't ever see malaria and you happen to have it. You have to test until you get a positive---even if it is a false positive, and then you test again. I personally know people who's parent died of malaria in a good hospital in South Africa, but in an area that is far from the malaria areas, and hence has doctors who don't test for it. I am not a doctor so I am not sure how one is treated once tested positive, but I do know many people who recovered very quickly due to the doctors being acutely aware of how to treat malaria.
4. Taking into account said things above, malaria is not a major threat. If you read stories about game rangers in the KNP of South Africa, many of them died from malaria in their later life because they were somewhere deep in the bush/lowveld and far from hospitals and couldn't be bothered with having malaria, yet again, and stopping their fun bush activities to go to the hospital 200km away.
5. My grandmother had malaria 6 or 7 times and died rather healthy in her mid 90s. My family actually actively avoided the malaria areas in the summer back in the late 1800s and early to mid 1900s by living on the higher escarpment. You could also read about Dr. Annecke and the efforts back then to combat malaria.
6. The countries to the north of South Africa don't have the facilities to treat malaria, generally, and with proper treatment and selective DTT application, you should be able to limit the ranges of the parasite. Yes, DTT is a bad chemical.
7. On that topic, malaria is caused by a parasite, so in terms of vaccines it's not clear what the mechanism behind it should be.
8. If you think about the Panama worm exclusion line that featured a while ago on HN, something like that would have made sense if Africa were a more developed continent. But in any case, the point is that the poor state of many things in Africa is part of the malaria problem.
9. Many other things about Africa is way cooler than the other continents. We still have lion and rhino, for one. There were many large predators on the other continents. So, "development" is something of a complicated word.
10. South Africa generally manages malaria well, so it is possible to contain it through holistic management. And no, holism is a word that belongs to Jan Smuts and you cannot steal it for your magic peanut oil business.
The rule with malaria medication is that either you take it consistently or you don't take it at all.
If you take it consistently, you don't get malaria.
If you don't take it, you get sick, you go to hospital, they put on a drop, you're largely fine.
If you take it inconsistently, you run the horrible risk of getting malaria, but not having proper symptoms, which means you don't go to hospital early enough, which means you end up with late-stage malaria, which is really bad.
I think there are plants like Cryptoleptis and Sida Acuta that can be used as tonics or to treat Malaria. They are effective against it's lesser known and less virulent cousin Babesia (common in the US via biting insects or blood donations). Test reliability could be improved significantly, including T-cell responses (sound familiar?;-). I think due to the unsustainable cost model of western patented pharmaceuticals and their lack of adaptability and/or side effects, many are also looking into herbal approaches and studies on efficacy & safety.
Sorry, but I don't think this is good advice. Malaria medication does generally work well, I only pointed out that unlike something like Aids and antiretrovirals, it's just not something you can use safely and at scale, for the rest of your life.
If those plants are effective against malaria, it is inevitable that it should be applied in a practical way, which often turns out to be in the form of pills.
This is the best news I've heard in weeks. What a great milestone and a wonderful world we live in. Congrats to all the NGOs, African and international, that worked so hard.
For more uplifting news, I spent a few hours today diving into figures about human development for a small project about greatest differences between neighbouring countries. They're basically all going up. Aside from countries at war (e.g. Syria) and minor setbacks like 2008, we're doing better all the time. I actually made a wallpaper from one of them:
Answer in rot13: Rnpu yvar vf n pbhagel, fubjvat yvsr rkcrpgnapl ng ovegu. Gurer ner fbzr boivbhf bhgyvref ohg 'orgjrra gur yvarf' vf nyfb n pbhagel gung qrpyvarq funecyl: Flevn. Yrg'f whfg abg qb jne ntnva, 'xnl?
You can find this graph interactively on the United Nations Development Programme website: http://hdr.undp.org/en/data (this graph can be found in (rot13) urnygu -> yvsr rkcrpgnapl ng ovegu).
Here's hoping we double down on Polio efforts and ensure it is entirely eliminated. Finishing is super important, and this milestone shows this is something humanity can finish.
That's because that list isn't complete. Doesn't have prion diseases, pseudomonas aeruginosa, balamuthia, macacine alphaherpesvirus 1, raccoon worm, orthohantavirus, and a million unknown bacteria and thousands of rare parasites and viruses.
As fun as it sounds, I think aging is what drives humans to progress and evolve. So just in my opinion, I don't think classifying aging as disease is a good idea.
The BBC article doesn't explain what "wild" means in detail. This NPR article does:
> And there's another type of polio that's problematic. Sixteen African nations are currently battling outbreaks of what's called "vaccine-derived polio." This is a form of polio that stems from the oral polio vaccine used in lower income countries because it is cheap and easy to administer.
> The oral vaccine contains a live but weakened version of the polio virus. The virus replicates inside the child's intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person.
The stories about this introduced me to the concept of a vaccine-derived polio.
Basically, the weakened form of polio that is in the vaccine, which usually survives in your GI tract for a couple weeks before being eliminated, can be passed onto others if there is a lack of basic sanitation (polio is primarily transmitted through infected fecal matter). If this is in a community with low immunization rates, the vaccine-derived virus can survive much longer than intended. This can actually provide a benefit to others, because they will achieve some level of immunity from the weakened virus. However, if the weakened virus is allowed to circulate for a long time (>1 year), it has the (unlikely) chance to mutate and become less weak.
Of course, the number of severe polio cases that have been avoided by the vaccine vastly outweighs the number of vaccine-derived cases. But I thought this was an interesting concept!
> ...more than 13 million cases of polio have been prevented, and the disease has been reduced by more than 99%. During that time, 24 cVDPV (circulating vaccine-derived polio virus) outbreaks occurred in 21 countries, resulting in fewer than 760 VDPV cases.
Modern medicine has created a sort of utopia that humanity couldn't have imagined a few hundred years ago. But there is a dark side that includes conspiratorial thinkers like anti-vaxxers.
Massive congratulations! Let's see about malaria next.
I have heard that it might not be crazy to apply DDT sparingly and appropriately to this problem. To my knowledge, it was a big part of how mosquito-borne disease was virtually eradicated in North America.
Wetland habitat destruction is a real concern, but so is the untimely deaths of hundreds of millions of people.
Good, but I am unaware of any good solution to the endemic AfPak area. This is IMHO a mirror of world trends: Africa seems to be getting better (if slowly), but parts of Asia are slipping behind. It's possible that the program is in an undeclared race: Can we eliminate polio before these areas get even worse?
This has been a very long fight, and there are a few pockets to defeat to declare that we’ve eradicated polio. I see many comments talking about malaria. One of the most effective ways to tackle that is through the work done by organizations, like Against Malaria Foundation (AMF), that are also supported by Effective Altruism based organizations (like GiveWell, Effective Altriusm Funds), etc.). The cost of saving a life from malaria is quite low with this. I would strongly encourage people who donate to charities to donate at least a small amount regularly to AMF or the others mentioned above.
This is an amazing achievement and I salute everyone who worked so hard to get this far.
My grandfather had polio and was lucky to survive. He spent quite a bit of time in an iron lung. Apparently it changed his personality significantly for the worse.
I know some people in tech don't like his Microsoft past but considering the role of Melinda and Bill Gates foundation in this and his continued funding for other such initiatives including Covid-19 vaccines, I think if someone deserves a symbolic award like Nobel Peace Prize(or whatever the equivalent would be in this case) it would be both of them.
If you're into "service over self" I encourage you to join your local Rotary club. Here are our "four way test" of the things we think, say and do:
* Is it the truth?
* Is it fair to all concerned?
* Will it build goodwill and better friendships?
* Will it be beneficial to all concerned?
Finding Nash equilibria for #4 isn't easy but it's a good set of guiding principles and if you believe them, you should think about surrounding yourself with others who do too.
Yes, the polio induced by the vaccine is actually the the more prevalent one today. They call it by fancy name: 'paralysis-something-something' so that the vaccine is not blamed for the polio.
For those who are interested and able, Rotary International and the Gates Foundation have been doing a 2 for 1 match for years, tripling your gift towards ending polio.
Unfortunately this will not change the situation if Africa that much. As the Malthusian Trap is still live there and the cause of the great divergence between the first worl and the third world.
Just read a biography of Jonas Salk and a major portion of it is devoted to the issue of the oral vaccine (OPV) versus the injected vaccine (IPV).
Salk spent a large portion of his later life pressing for the OPV to be delicensed because he considered any risk of live vaccine infecting immuno-suppressed persons or of the weakened virus becoming reactivated unacceptable.
As I understand it the OPV was still in use in the US until 1999. It was an interesting case study in the different forces that kept a vaccine proven to cause some cases of Polio every year in use.
This is not the big, massive victory that the article makes it sound like. The caveat "wild" is doing a lot of work that isn't properly explained. What this means is that for the last several years, all the cases of polio in Africa have been from circulating vaccine-derived poliovirus - basically, a version of the weakened virus used in the vaccine which has circulated for long enough to reverse the mutations that weaken it. It spreads like wild virus and paralyzes like wild virus, but technically it's not wild-type virus. (As I understand it, the only practical difference is that we can tell from genetic sequencing that it came from the vaccine rather than being wild-type.) And this can't be fixed by stopping the vaccination program - in fact, that actually makes things worse, since it gives the deadly vaccine-derived poliovirus more people who don't have immunity to infect.
It's not even clear that it's poasible to actually eliminate polio in developing countries with this vaccine or any existing vaccines. The developed countries managed it but they had far better infrastructure to roll out first the oral vaccine and then the inactivated vaccine to everyone, and also far better sanitation, and it's likely both of these things mattered - under-vaccination makes this problem a lot worse, and whilst the inactivsted vaccine protects people from polio there's some doubt as to whether it can stop them spreading it via the oral-fecal route due to poor immunity in the gut. The current hope seems to be developing and deploying a new, better live vaccine which cannot easily regain its original virulence.
CVDPV still is weaker than "wild" polio - only about 1000 cases ever (out of billions of vaccinations), and outbreaks are controlled quickly (if slower than the original expectation). Apparently both due to remaining mutations and since it's nearly all polio type 2 - which was otherwise eradicated a long time ago, apparently that type is a bit less "fit".
It's a problem, but one that can be managed by the existing tools which brought polio down to this level - many countries switched from trivalent OPV or removed OPV2 precisely to avoid this scenario, and a new OPV2 vaccine will hopefully eliminate the problem in the affected areas:
Right. There was some previous discussion on Hacker News about this under the headline "Polio eradication program faces hard choices as endgame strategy falters" [https://news.ycombinator.com/item?id=21920406].
Finally, some really good news in 2020. This has brightened up my exceedingly crappy week :).
I've read about polio a few times, and every time I do I feel grateful to be born after they started vaccinating every child in the United States. It's a terrible disease and it would be amazing if it went the way of smallpox and (hopefully soon) Dracunculiasis.
I was surprised too, but the WHO backs up the existence of "vaccine-associated paralytic polio", though I'm finding some conflicting numbers it's on the order of 1 in a million paralysis cases per vaccine. That presumably outpaces wild polio paralysis cases due to the non-existence of wild polio, in certain regions. WHO evens says it's possible for others to catch the paralysis from close contact with a recently-vaccinated individual, though it's never spread beyond that.
There are two similar but crucially different problems with the current live polio vaccine that both end in cases of paralytic polio. Vaccine-associated paralytic polio is a very rare complication where someone gets full-on paralytic polio as a result of being vaccinated; it can also happen to people who catch the vaccine virus from someone else rather than from vaccination, but it's just as rare there. Circulating vaccine-derived poliovirus is the one that's really nasty for elimination efforts - once the vaccine poliovirus circulates unchecked within a community for a while, it mutates and basically turns back into full-on real, unweakened polio in all its contagious paralytic awfulness, at which point anyone who's exposed to it is at much higher risk. As I understand it, cVDPV makes up the large majority of both polio cases and paralytic polio cases across the globe these days, and 100% of cases in Africa now the wild-type virus has been eliminated from there.
If VAPP was the only problem it could easily be fixed just by eliminating polio and then ending the live vaccination program. Unfortunately, that would make the cVDPV problem worse because it's an actual, circulating virus that primarily infects people who haven't been vaccinated, and ending vaccination would increase the number of people at risk from it. As the document from 2015 you've found suggests, the folks trying to eliminate polio hoped that if they phased out the live oral polio vaccine carefully and in well-coordinated ways they could avoid major cVDPV outbreaks afterwards. This doesn't seem to have worked out as well as they hoped back then. In particular, this article and HN discussion from a few months ago which someone helpfully dug up is mostly about the failure of this endgame plan in Africa: https://news.ycombinator.com/item?id=21920406
In 2020 there were 102 wild cases, and 295 vaccine derived cases. You have to go back to 2016 for wild cases to outnumber vaccine cases.
He's getting downvoted for the tone: People are assuming he is discrediting the vaccine by saying that. I personally don't see that implication, I just see a bare, and correct, fact.
Many poorer countries have relied on cheaper forms of the polio vaccine with a weakened virus, which can sometimes cause small outbreaks.
Ironically this fact is often used the anti-vaxxers as an argument against vaccines.. when it's only been true because polio vaccination has been so successful at eradicating the real virus which was causing considerably more problems.
The oral vaccine is not only cheaper it also works better. This means if you have endemic Polio it can make good sense to deploy OPV even knowing that there is risk of it reverting. The rich industrialised countries that switched to the boring inactivated vaccine don't have endemic Polio so the risk structure is different (as well as being able to afford the more expensive product).
It's not entirely clear why OPV is more effective, but perhaps it matters that you eat it (when I was a child it was administered as a sugar lump) and so the attenuated virus is entering the body via the gut, exactly where a real working polio virus infects people. The more expensive killed vaccine is injected into a muscle instead.
Possibly, but the vaccines have prevented many orders of magnitude more cases: "Since 2000, more than 10 billion doses of OPV have been administered to nearly 3 billion children worldwide. As a result, more than 13 million cases of polio have been prevented, and the disease has been reduced by more than 99%. During that time, 24 circulating vaccine-derived poliovirus (cVDPV) outbreaks occurred in 21 countries, resulting in fewer than 760 VDPV cases."[1]
There were only 350,000 cases in 1988, when the vaccine was first deployed, and 5 billion people on Earth then versus 7 billion now. How do 350,000 cases turn into 13 million, according to the WHO?
In the US it's been the case since the 70s, with the last wild type polio case in 1984 and vaccine derived polio cases up until 1999. [0] [1].
Then in 2000, OPV was banned in the US. [2]
But the statement, while true, is misleading because of its intention to discredit the use of vaccines at all. Just check the graphs linked before the introduction of the vaccine. Night and day, as horrible as the vaccine caused cases are.
Well, yes, that's what it means to get close to eradicating a wild disease. There's a sort of hysteresis effect so it's hard to instantly swap to not vaccinating and you want to ensure that there are no local populations with wild transmission.
Oversimplifying, after some years without cases, you change from the oral (attenuated virus) vaccine to the injectable (totally inactivated) vaccine, to solve the risk of the vaccine derived cases.
I don't know about 'for a long time' but for a certain time frame this is true[0].
However we are talking about there being 21 cases of this occurring compared to pre-eradication infection levels in the 100's of thousands per year. So whilst your statement is sort of true, it is willfully misleading.
