Disease eradication: An ethical analysis of goal setting and resetting in global public health

Abstract: In 1980, the World Health Organization (WHO) declared that smallpox was “eradicated.” This meant there were zero cases in the world of a disease that had killed and disabled millions. Smallpox was the first human disease to be eradicated. WHO has tried to repeat this success with polio, a disease that paralyzed children and terrified the world. Originally it planned on polio eradication by 2000, but new deadlines are set and missed as new cases emerge every year. As billions have been spent on an underperforming eradication program, questions have accumulated with costs. Disease eradication is costly, and the balance against its goods are not obvious. This panel assembles three experts to discuss the ethics of disease eradication. The first panelist will use the example of the polio eradication campaign to survey the ethics of disease eradication, moving on to discuss ethical issues specific to that campaign, with a focus on those emerging from vaccination with the oral polio vaccine (OPV). The second panelist will argue that, contrary to the egalitarian’s position that noneradication is unjust since it tolerates inequality, abandoning eradication can be justified on sufficientarian or prioritarian grounds and when we duly consider feasibility and the value of allocating resources elsewhere in global health and development. Finally, the third panelist will discuss the health economics of disease eradication, analyzing the future long-term economic benefits of disease eradication against its present costs, and how this informs the ethical decision procedure to eradicate.