Nancy Leys Stepan

One of the strange things about eradication is how it repeatedly arises, phoenix-like, from its setbacks.

Fred Lowe Soper paradoxically embraced the cause of disease eradication in the 1930s, just as the Rockefeller Foundation abandoned the project. Smallpox eradication was re-born in 1967, just before malaria eradication was given up by WHO. Polio eradication was launched in 1988, just when many public health experts rejected eradication altogether, in favor of concentrating on primary health care.

What explains the continued appeal of eradication, despite the rarity of success?

In this regard, it is instructive to look at the difference between Soper and Donald A. Henderson.

Soper died in 1977, before the last case of smallpox was identified and smallpox eradication was secure; yet despite everything, he remained a convinced eradicationist to the last.

Henderson, who led the Intensified Smallpox Eradication program to success between 1967 and 1977, by contrast, has been generally skeptical that other eradication campaigns are warranted. This year, however, he changed his mind and endorsed the polio eradication effort, ongoing since 1988, and which, though it has reduced the worldwide total of polio cases per year to tantalizingly small numbers, has not yet reached the magic number of zero.

Personally, I think eradication campaigns should be exceptional and rare features of modern international health.

The paths to good health are multiple, and eradication campaigns can be faulted for targeting diseases that are not always of the highest priority in the countries where current eradication campaigns are operating, burdened as they are with so many diseases.

Eradication campaigns are also often too reliant on external donors or “philanthro-capitalists,” absorb too many resources of a country’s health budget (both technical and financial), and do not always generate the kinds of sustained health care capacities poor countries really need.

On the other hand, I use the example of the current campaign to eradicate Guinea Worm Disease (GWD) to argue that, today, under the right circumstances, eradication and primary health care need not be in conflict, as they were in the past.

GWD was an obscure disease to most people in the west when it was first proposed for eradication by The Carter Center in 1981, though its worldwide incidence was believed to be in the millions.

Since there was no drug or vaccine for GWD, preventing people from drinking water contaminated with minute arthropods that carry the Guinea worm larvae was the only way to interrupt transmission. In principle, complete interruption, and therefore eradication, is possible through these methods.

As a locally-organized, bottom-up, preventive program, GWD eradication takes on the features of a basic health program. It has already reduced incidence to very small numbers.

If successful, GWD would suggest that eradication and primary care can form mutually reinforcing policies to improve health, especially the health of the poorest and most disease-burdened populations of the world.