TIME Health Care

The Price of Staying Alive For the Next 3 Hours

Stayin' alive—and cheap at the price
Stayin' alive—and cheap at the price ZU_09; Getty Images

A new study suggests a little spending now can buy you a lot of time later

How much do you reckon you’d pay not to be dead three hours from now? That probably depends. If you’re 25 and healthy, a whole lot. If you’re 95 and sickly, maybe not so much. But for people in one part of the world—the former East Germany—the cost has been figured out, and it’s surprisingly cheap: three hours of life will set you back (or your government, really) just one euro, or a little below a buck-thirty at current exchange rates.

That’s the conclusion of a new study out of Germany’s Max Planck Institute, and it says a lot about the power of a little bit of money now to save a lot of suffering later—with implications for all manner of public health challenges, including the current Ebola crisis.

The new findings are a result of one of the greatest, real-time longitudinal studies ever conducted, one that began the moment the Berlin Wall fell, on Nov. 9 1989. Before that year, there were two Germanys not just politically, but epidemiologically. Life expectancy in the western half of the country was 76 years; in the poorer, sicker east, it was 73.5. But after unification began, social spending in the East began rising, from the equivalent of €2,100 per person per year to €5,100 by the year 2000. In that same period, the difference in lifespan across the old divide went in the opposite direction, shrinking from 2.5 years to just one year as the east Germans gained more time. Crunch those numbers and you get the three extra hours of extra life per person per euro per year.

“Without the pension payments of citizens in east and west converging to equivalent levels,” said Max Planck demographer Tobias Vogt in a statement, “the gap in life expectancy could not have been closed.” Increased public spending, Vogt adds, is often framed as an unfortunate knock-on effect of longer life. “But in contrast,” he says, “our analysis shows that public spending can also be seen as an investment in longer life.”

The idea that generous, tactical spending now can be both a money-saver and lifesaver is one that health policy experts tirelessly make—and that people in charge of approving the budgets too often ignore. Bill Gates often makes the point that $1 billion spent to eradicate polio over the next few years will save $50 billion over the next 20 years, not just because there will no longer be any cases of the disease to treat, but because the global vaccination programs which are necessary just to contain the virus can be stopped altogether when that virus is no more.

As TIME reported in September, British inventor Marc Koska made a splash at the TEDMed conference in Washington DC when he unveiled his K1 syringe—an auto-destruct needle that locks after it’s used just once and breaks if too much force is used to pull the plunger back out. That prevents needle re-use—and that in turn not only reduces blood-borne pathogens from being spread, it does so at a saving. According to the World Health Organization (WHO), $1 spent on K1 syringes saves $14.57 in health care costs down the line—or $280 for a $20 order of the shots.

All across the health care spectrum, such leveraging is possible. Critics of the Affordable Care Act have slammed the law for the cost of the preventative services it provides, and while it’s way too early to determine exactly how successful the law will be, the encouraging stabilization in the growth of health costs suggests that something, at least, is working.

Global health officials are making a similar, though more urgent, preventative argument concerning the Ebola epidemic in West Africa. Americans are rightly jumpy over the few cases that have landed on our shores, but the 1,000 new infections per week that are occurring in the hot-spot nations of Liberia, Guinea and Sierra Leone make our concerns look small. Frighteningly, according to the WHO’s newest projections, that figure will explode to 10,000 cases per week by December if the resources are not deployed to contain the epidemic fast.

“We either stop Ebola now,” WHO’s Anthony Banbury said in a stark presentation to the U.N. Security Council on Sept. 14, “or we face an entirely unprecedented situation for which we do not have a plan.”

Suiting up and wading into the Ebola infection zone is a decidedly bigger and scarier deal than spending an extra euro on public health or an extra dollar for a new syringe. But the larger idea of intervention today preventing far larger suffering tomorrow remains one of medicine’s enduring truths. We lose sight of it at our peril.

TIME Disease

What It Will Take to End Polio

President Franklin D. Roosevelt leaves his home at 49 East 65th Street for a short visit to his family estate at Hyde Park, north of New York City on Sept. 27, 1933.
President Franklin D. Roosevelt leaves his home at 49 East 65th Street for a short visit to his family estate at Hyde Park, north of New York City on Sept. 27, 1933. Martin Mcevilly—NY Daily News/Getty Images

Jeffrey Kluger is Editor at Large for TIME.

Franklin Roosevelt never knew the Pakistani babies battling polio today, but he knew their pain. The world is fighting to end that suffering forever

You can still see the ramps and rails at Franklin Roosevelt’s house on East 65th Street in Manhattan—even though they’ve been gone for decades. They’re easily visible in the pictures that decorate the home. They’re visible, too, in the popular iconography of Roosevelt, who was photographed standing countless times after being paralyzed by polio in 1921, but always with a hand on a bannister, an arm on an aide, a cane in his grip—and ramps and rails at the ready.

The six-story Roosevelt house, where the family lived from 1908 until their move to the White House in 1933, is now owned—and was restored—by New York’s Hunter College. These days it’s a place of learning and policy conferences. But it is also a place of historical serendipity.

“When the house was built, it was one of the first private residences in New York that had its own elevators,” Hunter president Jennifer Raab told me as we toured the building this morning. Those became indispensable once FDR became paralyzed, and it was in that house that his kitchen cabinet thus gathered in the four months between his election in 1932 and his inauguration 1933. “The New Deal was born here,” Raab says.

For FDR, there were abundant compensations for polio. As Ken Burns’ documentary The Roosevelts makes clear, the disease deepened and grounded him. It made him a champion of children with polio—an effort that led to the March of Dimes and the later Salk and Sabin vaccines—and for that matter a champion of all people who suffered hardship. It was polio that gave Roosevelt a fuller temperament—and in turn gave the nation a fuller Roosevelt.

There are no such compensations for the handful of children around the world who still contract the crippling disease. On the same morning I was making my visit to the Roosevelt house, word came out of Pakistan that the country is on target to top 200 polio cases in 2014, its biggest caseload since 2000. Pakistan is one of only three countries in the world where polio remains endemic—the other two are Afghanistan and Nigeria, with 10 and six cases respectively so far this year—and it’s the only one in which the caseloads are moving in the wrong direction.

As recently as 2005, Pakistan’s case count was down to just 28, helping to push polio to the brink of eradication. That same year, however, religious leaders in northern Nigeria declared a boycott of the vaccine, claiming that it contained HIV and was intended to sterilize Muslim girls. This led to a wildfire spread of the Nigerian strain that stretched as far southeast as Indonesia.

But Nigeria got its house in order, and the hot zone now—a more challenging one—has shifted to Pakistan, particularly in the tribal areas in the north and in the mega-city of Karachi. Some of the problem is simply the crowded, unhygienic conditions in Karachi. But the bigger piece is the fighting in the tribal regions, which have made vaccinations difficult or impossible. That’s been exacerbated by Taliban gunmen, who have shot and killed 59 polio field workers and police officers trying to protect them since 2012.

“It’s a very sad thing,” Aziz Memon, head of Rotary International’s PolioPlus team, told TIME by phone from Pakistan today. “We’re trying to get vaccinators on the ground and into the field despite the ban. And now rains and flooding that have broken 100-year-old records are creating more problems.”

Rotary, which has been the point-organization for the eradication of polio for more than 25 years, is being assisted by the Gates Foundation, Save the Children and multiple other international groups, all working to push back against the Taliban blockade. Vaccinators routinely wait at bus stops around Pakistan, climbing aboard and looking for kids who have no vaccination records and administering the drops on the spot. Refugee camps in the war torn tribal regions provide another way of standing between the virus and the babies.

“When the virus is contained like this it’s a good opportunity to step in and control it,” says Memon. “We can also take advantage of the low-transmission season, which starts soon.”

The effort to snuff out polio altogether is more than merely the moral thing, it’s also the practical thing. Bill Gates repeatedly stresses that $1 billion spent per year over the next few years can save $50 billion of the next 20 years, money that would otherwise be spent treating polio and constantly fighting the brushfire war of vaccinating against outbreaks. Eliminate the disease for good and those costs go with it. What’s more, the delivery networks that are put in place to do the job can be easily repurposed to fight other diseases.

None of this long-range thinking makes a lick of difference to the 187 Pakistani children—or the 10 Afghanis or six Nigerians—who forever lost the use of their legs this year. They are paralyzed, as they will be for life. For them, there is no offsetting wealth, no townhouse with an elevator, no path to global greatness. There is only the disease—a pain FDR recognized and fought to fix. In Pakistan, that same fight is being waged today.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME History

FDR’s Polio: The Steel in His Soul

Jeffrey Kluger is Editor at Large for TIME.

Disease can break a lot of people. As a new film by Ken Burns and an exclusive video clip show, it helped make Franklin Roosevelt

No one will ever know the name of the boy scout who changed the world. Odds are even he never knew he had so great an impact on history. It’s a certainty that he was carrying the poliovirus—but he may not have known that either since only one in every 200 infected people ever comes down with the paralytic disease. And it’s a certainty too that he had it in late July of 1921 when he and a raucous gathering of other scouts had gathered on Bear Mountain in New York for a summer jamboree. So important was the event in the scouting world that it even attracted a visit by the former Assistant Secretary of the Navy and 1920 Democratic Vice Presidential nominee, Franklin Roosevelt.

This much is painfully certain too: somehow, the virus that inhabited the boy found its way to the man, settling first in his mucus membranes, and later in his gut and lymph system, where it multiplied explosively, finally migrating to the anterior horn cells of his spinal cord. On the evening of August 10, a feverish Roosevelt climbed into bed in his summer cottage on Campobello Island in Canada’s Bay of Fundy. It was the last time he would ever stand unassisted again.

Roosevelt’s polio, which struck him down just as his political star was rising, was supposed to be the end of him. The fact that it wasn’t is a self-evident matter of history. Just why it wasn’t has been the subject of unending study by historians and other academics for generations. This year, Roosevelt and his polio are getting a fresh look—for a few reasons.

October 28 will be the 100th birthday of Jonas Salk, whose work developing the first polio vaccine was backed by the March of Dimes, which was then known as the National Foundation for Infantile Paralysis and which itself grew out of the annual President’s Birthday Balls, nationwide events to raise funds for polio research, the first of which was held on FDR’s 52nd birthday, on January 30, 1934, early in his presidency. That initial birthday ball raised a then-unimaginable $1 million in a single evening, a sum so staggering Roosevelt took to the radio that night to thank the nation.

“As the representative of hundreds of thousands of crippled children,” he said, “I accept this tribute. I thank you and bid you goodnight on what to me is the happiest birthday I have ever known.”

This year too marks one more step in what is the hoped-for end game for the poliovirus, as field-workers from the World Health Organization, Rotary International, UNICEF and others work to vaccinate the disease into extinction, focusing their efforts particularly on Pakistan, one of only three countries in the world where polio remains endemic.

Then too there is the much-anticipated, 14-hr. Ken Burns film, The Roosevelts: An Intimate History, which begins airing on Sept. 14. It is by no means the first Roosevelt documentary, but it is the first to gather together all three legendary Roosevelts—Franklin, Theodore and Eleanor—and explore them as historical co-equals. It’s the segments about FDR and his polio that are perhaps the most moving, however—and certainly the most surprising, saying what they do about the genteel way a presidential disability was treated by the media and by other politicians in an era so very different from our own.

“We think we’re better today because we know so much more,” Burns told TIME in a recent conversation. “But FDR couldn’t have gotten out of the Iowa caucuses because of his infirmity. CNN and Fox would have been vying for shots of him sweating and looking uncomfortable in those braces.”

That’s not a hard tableau to imagine—the competing cameras and multiple angles, shown live and streamed wide. And what Americans would have seen would not have been pretty, because never mind how jolly Roosevelt tried to appear, his life involved far, far more pain and struggle than the public ever knew, as a special feature from the film, titled “Able-Bodied,” makes clear. That segment, which is not part of the broadcast and is included only on the film’s DVD and Blu-Ray versions, which are being released almost contemporaneously with the film, was made available exclusively to TIME (top).

Concealing—or at least minimizing—the president’s paralysis was nothing short of subterfuge, the kind of popular manipulation that wouldn’t be countenanced today. But it’s worth considering what would have been lost by exposing the masquerade that allowed FDR to achieve and hold onto power. Roosevelt, as the Burns film makes clear, was a man whose ambition and native brilliance far exceeded his focus and patience. It was a restlessness that afflicted cousin Teddy too, causing him to make sometimes impulsive decisions, like pledging in 1904 that he wouldn’t run again in 1908—an act he regretted for the rest of his life and tried to undo with his failed third-party presidential bid in 1912.

“Who knows what would have happened if Teddy had had the great crises Franklin had—the Depression and World War II?” Burns says. “I do know he was unstable and always had to be in motion. It fell to FDR, who could not move, to figure out a way to outrun his demons.”

George Will, in an artful turn in the “Able-Bodied” clip, observes that when the steel went onto Roosevelt’s legs it also went into his soul. That may have been true in FDR’s case, but it’s true too that suffering is not ennobling for everyone. Some people are broken by it; some are embittered by it. As polio nears the end of its long and terrible run, the things FDR achieved despite—even partly because of—his affliction remain nothing short of remarkable.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

Polio’s Two Vaccines Are More Effective When They’re Combined

For decades, there’s been a tug-of-war between the oral and inactivated polio vaccines over which is more effective at preventing the paralyzing disease. Researchers have now resolved the dispute and say that pairing them are better than either alone

When it comes to fighting a virus, having as many weapons as possible, especially in the form of vaccines that can prevent infection, is certainly welcome. And that’s always been the case with polio, which has not one but two effective immunizations that can stop the virus from causing debilitating paralysis. Which is more effective in preventing illness and which is better at stopping transmission of the virus? Scientists report in the journal Science that neither is ideal, but that together, the vaccines are powerful enough to achieve both results. The results “revolutionize our thinking about how to use polio vaccines optimally,” says Hamid Jafari, director of polio operations and research at the WHO, who led the research.

Recent efforts to erradicate polio has pitched the two vaccines against each other. Developed in the 1950s and 1960s, one was made by Jonas Salk using killed polio virus, and the other, developed by Albert Sabin, uses a weakened but still live virus that could replicate in the human gut to deliver immunity. Jafari and his colleagues, report that children vaccinated with the oral polio vaccine who then received a boost of the Salk vaccine showed the lowest amount of virus in their feces—one of the primary ways that the virus spreads from person to person—and excreted these viruses for a shorter period of time than children who had been immunized with the oral vaccine and received a boost with an additional dose of the same oral vaccine.

MORE: WHO Declares Health Emergency on Polio

The WHO’s global effort to eradicate polio has relied heavily on the oral vaccine, because it’s a liquid that can be eaily given to children orally, and it’s cheaper. Plus, the oral vaccine, because it contains a weakened virus that can reproduce in the human gut, helped to reduce the volume of virus excreted in the feces, and thus lower the chances that others coming in contact with the feces could get infected.

But in places where polio infections were rampant, such as northern India, the oral vaccines didn’t seem to be doing much good at reducing the burden of disease. Even when children were getting the recommended three doses, rates of infections remained high. “The transmission pressure was extremely high in these areas that were densely populated, had a high birth rate, poor sanitation and high rates of diarrhea,” says Jafari. In those regions, it took an additional 10 to 12 vaccination campaigns—about one a month to provide children with additional doses on top of the recommended three doses—to finally control the disease and limit spread of the virus. It turns out that the immunity provided by the oral vaccine wanes over time.

In order to eradicate the disease, public health officials knew they had to do better. So they tested whether adding in the inactivated vaccine would help. And among 954 infants and children aged five years to 10 years who had already received several doses of oral vaccine, adding a shot of the inactivated vaccine did help them to shed less virus compared to those who received another dose of the oral vaccine.

PHOTOS: Endgame for an Enduring Disease? Pakistan’s Fight Against Polio

With polio currently endemic in Pakistan, Cameroon, Equatorial Guinea, and the Syrian Arab Republic, the WHO declared the spread of polio a public health emergency of international concern, and issued temporary recommendations for all residents and long-term visitors to those countries to receive a dose of either the oral or inactivated vaccine before traveling out of the country. In other countries where polio has been found, such as in some sewage samples and fecal samples from residents in Israel, health officials have also advised residents living in those regions to receive a dose of inactivated polio vaccine in order to limit spread of the virus.

“The inactivated polio virus vaccine is becoming an important tool in preventing international spread of polio,” says Jafari. Whenever outbreaks of the disease occur, health officials are now recommending that even vaccinated individuals who could be infected but not get sick, receive an additional shot of the inactivated vaccine in order to limit the amount of virus they shed and spread to others.

TIME polio

The Battle to Eradicate Polio in Pakistan

A Pakistani health worker vaccinates a child in Islamabad
A Pakistani health worker vaccinates a child in Islamabad Anadolu Agency/Getty Images

Political unrest in Pakistan has been a gift to the poliovirus, with 99 cases reported there so far this year. But Rotary International, which has already vaccinated 2 billion children in 122 countries, is hitting back hard

Epidemiology can be all about geography—and that’s especially true when it comes to polio. If you live in the U.S., where polio was eradicated in 1979, the specter of the disease has faded almost entirely, though pockets of infections can occur among the unvaccinated. In Pakistan, however, things are moving in precisely the opposite direction, and have been for a while now.

One of only three countries in the world where polio remains endemic (the other two are Nigeria and Afghanistan), Pakistan had been close to joining the world’s polio-free nations, with only 58 infections in 2012. But thanks to bans on vaccinating—and deadly attacks on polio fieldworkers—by the Pakistani Taliban, the caseload rose to 93 in 2013. In 2014, the total reached 99 by July 18—a figure all the more alarming compared to this point last year, when there had been just 21 cases.

“It’s a scary number,” says Aziz Memon, Pakistani chairman of Rotary International’s polio eradication campaign. “Children in North Waziristan have been trapped for three and a half years without a drop of polio vaccine, and that’s what’s causing this.”

The folks at Rotary know what they’re talking about. Since launching their polio eradication effort in 1985, they have been responsible for the vaccination of 2 billion children in 122 countries. Along with the World Health Organization, UNICEF, The Gates Foundation and others, they have helped slash the global infection rate from 350,000 cases per year in 1988 to 416 in 2013.

That’s indisputably good news, but polio is an exceedingly sneaky virus, with 200 symptom-free carriers for every one case of the disease. That fact, combined with the anti-vaccine forces in Pakistan, not to mention the porous borders cause by war and unrest in the overall region, has caused the disease to leak out from the three endemic countries, with stray cases turning up in Equatorial Guinea, Iraq, Cameroon, Syria, Ethiopia, Somalia and Kenya. In a handful of other countries, the virus has been detected in sewage, but it has not led to any cases of the disease—yet.

It’s Pakistan though that’s considered ground zero, and Rotary has announced that it’s now deploying some very simple weapons in what has always been a village-to-village, door-to-door battle. To improve surveillance and tracking—a maddeningly difficult job in a country in which so many people live off the communications grid—Rotary has distributed hundreds of cell phones to midwives who circulate through communities, canvassing residents to find out who has received the vaccine and who has been overlooked. Information on the unvaccinated kids—the “missing children” in the fieldworkers argot—is entered into the phones and uploaded to a central spreadsheet, allowing later vaccinators to target their efforts more precisely.

“The midwives also track pregnant mothers,” says Memon. “And when their children are born they can continue to maintain complete health records, not just for polio but for other vaccines and basic health care as well.”

Rotary has also worked with The Coca-Cola Company to build what’s known as a reverse osmosis water plant—essentially a sophisticated filtration facility—in the town of Malin, within the city of Karachi. Polio is a disease spread almost entirely by human waste, and once it leeches into the water system it can spread nearly anywhere. The Malir plant, which was constructed near a school to give polio-age kids the first access to the newly filtered water, is a relatively modest one, with just 20,000 gal. (76,000 liters) of clean water on hand at any one moment, and cost only $40,000 to build. But as a pilot project it represents a very good start. “We can’t build a massive plant like the government can,” says Memon. “This is a small plant for a small community.”

One thing, paradoxically, that’s working in the vaccinators’ favor is the increased number of displaced people in Pakistan. A recent push by the Pakistani military to flush the Taliban from its safe havens has broken the vaccination blockade, and already 350,000 children have received at least one dose of the polio vaccine. But 1.5 million refugees are scattered around the country. Rotary has dispatched field workers to refugee camps and transit points to identify the children and few adults who need the polio vaccine and administer it on the spot.

“The government did not have any idea about what the numbers of displaced people would be,” says Memon. In the refugee camps, he adds, there are at least 40,000 pregnant women, whose babies will have to be vaccinated shortly after birth.

The diabolical thing about polio—and indeed any disease science hopes to eradicate—is that even one case is too many. As long as any wild poliovirus is out there, everyone needs to be protected. It is only when the last scrap of virus has been found and snuffed, that the protective push can stop. That has happened once before in medical history—with smallpox. In the case of polio, it’s tantalizingly close to happening again.

TIME Infectious Disease

Polio Virus Discovered in Brazilian Sewage

Poliovirus, Tem
Poliovirus. Transmission Electron Micrograph Of Poliovirus Type 1. BSIP/UIG/Getty Images

Found in Campinas in São Paulo state, host to the Portuguese and Nigerian soccer teams during the FIFA World Cup

The polio virus has been found in sewage samples collected in March from Viracopos International Airport, in Campinas, the World Health Organization reported on Monday. No human case has been discovered.

Campinas, which is part of São Paulo state, is the team base camp for both the Portuguese and Nigerian soccer teams during the FIFA World Cup tournament.

The strain, wild poliovirus type 1, is a close match to one recently isolated in Equatorial Guinea.

The WHO said that the “virus has been detected in the sewage only” and that “no case of paralytic polio has been reported.”

Brazil has been free from polio since 1989. The disease, which can be prevented by vaccination, attacks the nervous system and can result in rapid paralysis. It is most dangerous to young children.

The Brazilian Health Ministry commented: “This detection does not mean any change in the epidemiological situation of Brazil or a threat to the elimination of the disease.”

Health authorities in Brazil are reported to be looking for any un-immunized persons as well as potential cases of paralytic polio. Immunization in São Paulo state is higher than 95% with the last national vaccination in June 2013.

This is not Campinas’ first health scare. In May, AFP reported that the city was battling an outbreak of dengue fever which killed three people.

 

TIME Children

Why Polio is Doomed and Gun Violence Isn’t

It's hard to spot the heroism—but it's there
It's hard to spot the heroism—but it's there Randy Plett; Getty Images

It shouldn't take too much courage to stop a scourge that is killing children. Washington's gun cowards could take a lesson from the heroes battling polio

A century ago, the quickest way to diagnose polio was with the belly button test. A doctor would ask a suddenly feverish, bedridden child to lift her head from her pillow and look at her belly button. If she couldn’t do it—if the muscles in her neck and stomach and pretty much anywhere else could no longer contract and lift the way they should—the odds were that the news was bad. Within the day, the child would be paralyzed.

There has always been a particular ugliness to polio—a virus that robs a child of the simple ability to move at what should be the most restless, kinetic, exploratory stage of life. Mercifully, in most of the world that ugliness is gone—though not everywhere.

Meantime, in the U.S., a new kind of horror has taken polio’s place: the school shooting. This one also strikes at children and defies what should be one of childhood’s givens: that school is a place for learning, a place for play, a place that counts as a so-called safe space, even before we became a nation that required such formally designated asylum zones.

Both polio and school shootings are acts of violence—one viral, one human. But only one, polio, is doomed to lose, as I realized yesterday when I attended a briefing by the Global Polio Eradication Initiative at U.N. Foundation headquarters in New York, just a day after the latest school school shooting, this one at Reynolds High School in Troutdale, Ore.

The big players at the polio conference were familiar names: The Bill & Melinda Gates Foundation, Rotary International, the U.S. Centers for Disease Control (CDC), UNICEF, the World Health Organization (WHO) and the international consulting group Global Health Strategies. The purpose of the meeting was to discuss the progress that is being made to eradicate the last case of polio anywhere on the planet—making the disease only the second one, after smallpox, to have been vaccinated into well-deserved extinction.

The polio hunters are tantalizingly close to their goal: In 1988, polio was endemic to 120 countries and claimed 350,000 people—overwhelmingly children—each year. In 2013, there were only 416 cases worldwide and the disease was endemic to just three countries: Nigeria, Pakistan and Afghanistan. But the year-to-date-numbers are higher in 2014 than they were last year, thanks mostly to attacks on polio workers by extremists in Pakistan and unrest in Syria, Egypt, Iraq and elsewhere, which is allowing the virus to slip across borders.

That’s part of the reason the group assembled yesterday—to review their plan to push back against the resurgence, a plan that is breathtaking in its scope: there are the 105 million doses of oral polio vaccine that have been administered in and around Syria; the 3,176 hard-to-reach communities in Nigeria that are now being reached by health care workers bringing oral vaccine; the 2,000 health camps that have been held to educate and vaccinate in the ground zero state of Kano in northern Nigeria and the 10,000 more that are planned; the millions upon millions of children in 126 countries who will be receiving at least one dose of the injectable form of polio vaccine, which uses a killed virus and thus eliminates even the small risk of the weakened virus used in the oral version escaping into the wild.

And then, of course, there is the sheer, literally death-defying brass of the vaccine workers who regularly trudge into the Pakistani tribal areas, knowing that some of the workers who have come before them have been gunned down in drive-by shootings, and that every day they go out with their vials of drops there is a risk they won’t come home. But they go all the same.

Eradicating a viral disease is nothing less than an act of hunting molecules—protein particles so simple they don’t even qualify as technically alive—and destroying them anywhere they are hiding in the world. That’s an almost surreally difficult thing to accomplish, yet that’s what the Gateses and Rotary and WHO and others have decided must be done. And so they’re doing it.

And then, on the other side of the decency and courage arc, are the gun cowards. They are the American legislators who dare not cast a vote that will anger the National Rifle Association; the governors who walk away from the problem even as the children in their states—whose welfare they have sworn to ensure—are being murdered; the political parties that, if they acknowledge the problem at all, consider it too radioactive to take up this year, this session, this electoral cycle.

“‘No Way to Prevent This,’ Says the Only Nation Where This Regularly Happens,” wrote The Onion, in a brilliant riff on the what-can-we-do faux-helplessness of the political class. But in case they’re really wondering, here’s what they can do: they can think less about locking down their base, expanding their majority, dodging the 30-second attack ad and more about the simple safety of children. Because here is a hard fact: there are babies and young people alive today who will be dead soon because of the choices now being made. If that isn’t enough to turn an election night victory into ash, America’s politicians are beyond help.

TIME Opinion

The New Measles Outbreak: Blame the Anti-Vaxxers

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Thin-section transmission electron micrograph, TEM, of a single measles virus particle or virion Kallista Images—Getty Images

A disturbing report from the Centers for Disease Control shows what happens when anti-vaccine nonsense wins.

You have to be spoiled to play cute with disease—spoiled or, well, stupid. And today’s announcement from the Centers for Disease Control and Prevention that measles cases in the U.S. have hit record highs in the first five months of this year is a maddening example of both. I learned of the report in an especially striking way.

I returned this morning from a conference in Singapore where some of the most stimulating discussions were about global health — specifically, how to extend the preventive measures and treatments so easily available in the developed world to the harder-to-reach parts of the developing one. There were conversations about how wireless technology can be used to communicate between rural villages and urban hospitals, how new medicines can be fast-tracked from development to distribution and how cold chains can be created to keep vaccines viable as they make their way to the people who need them.

On my return to the U.S., I passed through the arrivals terminal at JFK Airport, where Rotary International is running a billboard campaign showing globally recognized figures—Bill Gates, Archbishop Desmond Tutu, Jackie Chan—posing with the legend “We Are This Close to Ending Polio.” To reinforce that point, each celebrity’s thumb and index finger frames the “this close” in a measuring gesture.

By the time I was in the taxi line, the CDC announcement was on my smartphone.

Make no mistake, the measles outbreak in the U.S. is an act of choice, of election, of a decision to get sick—or a decision by parents to put their children at risk. Fully 90% of the new cases are among people who are unvaccinated or whose vaccination status is unknown. And nearly all of those people are unvaccinated for personal, philosophical or religious reasons—as opposed to any medical condition that requires them to avoid vaccines. This is true too of recent outbreaks of mumps and whooping cough, and of the dangerously declining rate of vaccination in the U.S. overall. Nearly all of that folly can be blamed on the rumors and outright lies that continue to be spread about various conditions vaccines are said to cause—autism, ADHD, vaguely defined immune system disorders and on and on depending on which celebrity or health faddist is telling the tale.

Meantime, those polio campaigners? The ones who really, truly are this close to eradicating one of history’s most feared diseases? A lot of them are risking—and in some cases, losing—their lives to do their jobs. In the tribal areas of Pakistan, vaccine field workers are being attacked and killed by Taliban gunmen as they make their way on foot, into villages, with their crates of little vials that, with a few drops, can protect children for life from paralysis and death. And so other field workers take their place, some of whom will surely die too.

In one of the most telling asides in today’s CDC press release, Dr. Anne Schuchat, director of the National Center for Immunizations and Respiratory Diseases, commented on a paradoxical problem in diagnosing new outbreaks of measles. “Many U.S. health care providers have never seen or treated a patient with measles,” she said, “because of the nation’s robust vaccination efforts and our rapid response to outbreaks.”

That, in a phrase, is what spoiled looks like. Of course, you can bet any first year medical student could have spotted the disease a few decades ago—and the same was true with mumps and whooping cough and polio and smallpox and rubella and all of the other diseases that we don’t have to see anymore because we have, in this country at least, vaccinated them all but out of existence. What was true in the U.S. then is still true in the developing world, where those diseases and more still run riot.

The people in those countries would not play cute with disease. The people in those countries would not have the time for rumors and lies and celebrity dilettantes who take up the anti-vax cause because they’ve grown bored with the anti-carb or anti-gluten or pro-cleanse fads. Being this close to eliminating a disease is not the same as truly being done with it. That’s something all those new measles patients learned this year. And that’s something we’ll all have to keep learning until we wise up.

TIME vaccines

The Anti-Vaxxers Simply Won’t Quit

Safe baby: a child in Africa receives an oral vaccine
Safe baby: a child in Africa receives an oral vaccine ranplett; Getty Images/Vetta

Even as cases of whooping cough, polio, measles and mumps soar, vaccine deniers continue to leave children and babies unprotected. Stubbornness may be part of human nature—but the price is just too high

It’s never easy to say oops. You know it if you’ve ever said something nasty during an argument and found it hard to apologize later. You know it if you’ve ever caused a fender bender on the road and been unable to say “my bad.” And you know it if you’ve ever failed to inoculate your baby against a range of disabling and deadly diseases that can be easily and harmlessly prevented with vaccines, in effect failing to perform the most basic job of parenthood, which is to keep your children safe.

What’s that? You think that under those circumstances an oops wouldn’t be hard to get out? Not so, according to a disturbing study presented Monday at the annual meeting of the Pediatric Academic Societies in Vancouver. Researchers looked at vaccination rates both before and during an outbreak of whooping cough in Washington state in 2011 and 2012, and found that even as the disease was spreading and unvaccinated children were suffering, the percentage of parents who brought their 3- to 8-month olds in for their scheduled inoculations didn’t budge.

Nope, the parents effectively said, still not persuaded.

“We have always assumed that when the risk of catching a disease is high, people will accept a vaccine that is effective at preventing the disease,” said lead author Dr. Elizabeth Wolf of the University of Washington, in a statement that accompanied the release of the study. “Our results may challenge that assumption.”

That says something deeply troubling not just about the outlook for childrens’ health, but about human obtuseness, particularly as outbreaks of measles strike New York City, Orange County, Calif. and elsewhere, while mumps cases spread throughout Columbus, Ohio. Despite this real-time, real-world evidence of the damage caused by the anti-vaccine crazies—who have spent the better part of 16 years peddling the fable that vaccines are filled with never-fully-specified “toxins” that cause autism and an ever-changing pu pu platter of other imaginary ills—many parents and even some doctors continue to close their eyes.

That’s a problem not just for the unprotected kids, but for everyone. If we got smoking rates in the U.S. down to just 10% of the population, we’d celebrate that fact as a great public health victory. But as virologists and epidemiologists remind us again and again and again, when 10%—or even 5%—of parents opt out of vaccines for their kids or insist on making up their own vaccination schedule, they destroy the herd immunity effect that should protect the handful of people in any population who can’t get vaccinated for legitimate medical reasons. If a virus can’t find an entry point into a community, it can never make its way to the most vulnerable members. Every parent who opts out opens one more infectious avenue.

The U.S. is not alone in playing craps with vaccine-preventable diseases. The Vancouver report was issued on the same day that the World Health Organization (WHO) declared a public health emergency concerning the spread of polio from Pakistan, Syria and Cameroon, and the presence of the virus in Iraq, Afghanistan, Israel, Equatorial Guinea, Ethiopia, Somalia and Nigeria. The emergency did not arise because of some new, especially tenacious strain of polio. Indeed, the disease has been at the brink of eradication for a few years now, with only 160 endemic cases in three countries—Afghanistan, Pakistan and Nigeria—in 2013, and 257 cases in countries into which the virus was imported by carriers crossing the border. But attacks on medical field workers by militant groups in Pakistan have disrupted inoculation efforts there, and war or unrest in Syria and elsewhere have made the safe passage of vaccinators impossible.

Extremists in the Middle East and Africa are hardly motivated by the same ideas as rumor-mongers and frightened parents in the U.S. But both are committing the same moral crime, jeopardizing the health and welfare of blameless babies. It’s those babies who will pay the price—and the parents and extremists who must bear the blame.

TIME Infectious Disease

WHO Declares Health Emergency on Polio

The World Health Organization declared polio an international health emergency on Monday as the rise in cases threatens eradication efforts and singled out the conflict zones of Syria, Cameroon and Pakistan as worrisome sources of its spread

The recent spread of the polio virus is a public health emergency of international concern, the World Health Organization said Monday.

Ten countries currently report evidence that the virus, which can cause paralysis, is circulating among people. WHO Director-General Margaret Chan recently convened a committee to evaluate international efforts that began 25 years ago to eradicate the disease and the 14-member panel found disturbing evidence that interruptions in vaccination programs have allowed the virus to break through in some parts of the world.

Especially concerning was the fact that three countries—Pakistan, Syria, and Cameroon—showed higher rates of transmission of wild polio virus to other nations even during the disease’s more dormant period. That raises the possibility that when the virus becomes more active, from April into the summer, transmission rates will peak even more. “If the situation as of today and April 2014 is unchecked, it could result in the failure to eradicate globally one of the world’s most serious vaccine preventable diseases,” Dr. Bruce Ayleward, WHO’s assistant director general for polio, emergencies and country collaboration said during a conference call.

The emergency measures require that residents in the three countries actively exporting polio virus receive a dose of either of the two polio vaccines four weeks-to-12 months before traveling, and that they be provided with proof of their immunization. The remaining seven affected countries are encouraged, but not required, to do the same. The WHO recommended these measures remain in place until countries show no new transmission of polio for six months and evidence of eradication efforts, including immunization programs. While not legally binding, the cooperation of affected countries is expected, Ayleward said. The WHO’s action may also help governments to make polio immunization a priority; in 2009, a similar declaration during the H1N1 pandemic allowed nations to prioritize health care services to protect and treat patients affected by the flu.

Health officials have been getting closer to making polio the second disease, after smallpox, to be eradicated by vaccinating children in countries where the wild virus continues to circulate. But social unrest and political conflict have interrupted immunization programs—some health workers have become targets of violence in Pakistan, for example, while growing populations of displaced residents such as refugees who are without access to health care services also provide fertile conditions for the virus to spread. Seven of the 10 countries now reporting wild polio virus have been successful at eliminating the disease in the past, but have been reinfected in recent years.

Chan asked the committee to reconvene in three months to see if the recommendations were effective in controlling the spread of the disease.

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