TIME Pakistan

Pakistani Militants Kill Former Lawyer of Doctor Who Helped Find bin Laden

Afridi, lawyer for a Pakistani doctor who helped U.S. officials find al-Qaeda chief Osama bin laden, speaks to the media in Peshawar
Khuram Parvez—Reuters Samiullah Afridi, lawyer for Dr. Shakil Afridi who ran a fake vaccination campaign to help U.S. officials find al-Qaeda leader Osama bin laden, speaks to the media after appearing before the court in Peshawar, Pakistan, on Oct. 30, 2013

“We killed him because he was defending Shakil, who is our enemy”

A Pakistani lawyer who represented the doctor charged with helping U.S. intelligence authorities hunt down al-Qaeda leader Osama bin Laden was killed on Tuesday, according to local police in his hometown of Peshawar.

A police official said Samiullah Afridi was shot in the abdomen and neck while returning to his home and died on the spot, Reuters reports.

Afridi had reportedly received death threats for defending Dr. Shakil Afridi (no relation), who was handed a controversial 33-year jail sentence in 2012 for running a fake vaccination campaign that helped CIA agents locate the Saudi-born terrorist leader. Two militant groups, both affiliated with the Pakistani Taliban, have claimed responsibility for Afridi’s murder.

“We killed him because he was defending Shakil, who is our enemy,” said Taliban splinter group Jundullah. Another Taliban faction, the Tehreek-e-Taliban Pakistan Jamaatul Ahrar, said it killed Afridi because they couldn’t get to the doctor who “spied on our respected and supreme leader Sheik Osama.”

The lawyer had only recently returned to Pakistan, having relocated to Dubai after quitting the case last year out of concern for his safety. “Not only is my life in danger, my family is also in danger,” he had said in an interview with Reuters.

The targeting of lawyers by militant groups is not uncommon in Pakistan, says Hasan Askari Rizvi, a Lahore-based Pakistani political scientist and commentator, citing the murder last year of prominent prosecution lawyer Chaudhry Zulfiqar Ali. Ali was involved in the trial of Zaki-ur-Rehman Lakhvi, accused of masterminding the Mumbai terror attacks of 2008, as well as the case of former Pakistani Prime Minister Benazir Bhutto’s 2007 assassination — he was gunned down in his car last May while on his way to court.

Dr. Afridi, meanwhile, had his sentence overturned in 2013 and is currently awaiting a new trial.

“It becomes difficult to find a lawyer because nobody wants to stick their neck out, and therefore cases stay pending and nothing happens,” Rizvi tells TIME. “The government will be able to find a lawyer, maybe in a couple of months’ time, but the new lawyer will also become a target of these groups and that fear will haunt the whole process.”

Pakistani militant groups have also cracked down on polio-vaccination drives following bin Laden’s killing and Dr. Afridi’s prosecution, saying they are un-Islamic and either fronts for espionage or an attempt to sterilize Muslims.

On Tuesday, a gun attack killed two female immunization workers at an Afghan refugee camp near Pakistan’s northwestern city of Mansehra, according to Agence France-Presse. The incident is the latest in a recent spate of attacks against polio workers, 77 of whom have been killed since December 2012.

Pakistan is one of only three countries in the world where the disease still exists, and the number of polio cases recorded in the country last year reached a 14-year high of 306.

TIME health

My Polio, My Mother’s Choice

Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

Today's parents, thanks to vaccines, have never had to learn—need never learn—about pain and grief and loss of control

It had been a good year for Lois Mace.

She and her husband, only three years beyond college, had bought their first house. A solid red-brick and clapboard Cape Cod, it sat on a leafy street named for a character out of a Longfellow poem. In its driveway glistened a new sedan, silver-gray with burgundy roof and whitewalls, a gift from her father, a Ford dealer.

And under its dormers that last day of August 1954 slept her three children: A sunny toddler with platinum blonde hair and a weak stomach sphincter, known around the house, mostly affectionately, as Miss Urp. A three-year-old bruiser with a devilish twinkle in his eye, whom the neighbor nicknamed Meatball. Then there was the eldest, a lithe towhead with quick feet and an even quicker tongue—him they called Motormouth. He was set in a week’s time to walk the two blocks down the hill and start first grade at Nakoma Elementary School.

Everything was the way she liked it, under control.

In the middle of that night, Lois was roused by sounds from the boys’ bedroom. Tucked under the shed roof at the back of the house, the bedroom was stuffy with the heat of late summer. The older boy, who shared a bed with his little brother and a ratty blue bear, lay feverish and whimpering. Her husband carried the boy to the bathroom. He was too weak to stand and use the toilet.

The next day they drove him to the hospital for a spinal tap. The spinal fluid was cloudy. “During the past three or four days almost complete paralysis of both lower extremities and left upper extremity and trunk musculature has developed,” his doctor would write in the medical record on September 4.

Lois Mace Paul, 28, had come very far, very fast from a Depression childhood in a small Iowa town—husband, house, kids so well behaved that strangers would stop by the table in restaurants to compliment her. But now she was also the mother of a boy with polio. He lay in an isolation unit, afraid and confused, unable to sit or roll over. She could only stand in the doorway, swathed in a surgical gown and mask, forbidden to hold or comfort him for fear of spreading the virus.

We can safely assume these events counted as life changing for Lois. After 10 days in isolation, the boy was put on a children’s ward, where he would remain for 130 days, “for institution of hot packs and passive stretching exercises and later institution of active exercises,” according to his medical record. Every afternoon at 2, Lois traveled the three miles to the hospital to sit with the boy. She would read to him as he ate the sandwich—always peanut butter on white bread—that she smuggled past the nurses; her boy wasn’t keen on hospital food. Her husband took the night shift, arriving at 7 to launch Pooh and Christopher Robin on their next “expotition.”

Even judged by the standard of today’s families balancing work and parenthood, the logistical challenges were daunting. Meals to make, clothes to wash and hang, diapers to change. Schedule babysitters for every afternoon. Change clothes and put on makeup—a respectable woman didn’t go downtown in jeans and without a face. Find a way to get back and forth; there was only the one car. Make dinner so her husband could get back to the hospital on time. Bathe and put the little ones to bed on her own. How much time or energy could there have been for coffee or cocktails with friends, or for nights out with her husband?

And it didn’t end there. When the boy was finally sent home, he had to be carried up and down stairs. Over the next decade there would be braces and crutches that he was always expensively outgrowing. And as he grew and his unbalanced muscles twisted his frame, Lois and her husband would sit eight times in a surgical waiting room while Dr. Wixson used chisel, hammer, wire, and staples to straighten his back and legs. Not until the boy himself waited outside an operating room as his own infant child underwent orthopedic surgery could he imagine how fear had shadowed Lois’s life.

Imagination is about all we have to tell us what those events meant to Lois emotionally. She didn’t talk much about feelings.

The boy’s only hint came one afternoon, about the time of his sixth birthday. A high school running back had injured his neck in a game and had been brought into the ward the night before, his limbs numb. As Lois and the boy looked on, a doctor and nurses, after some probing, helped the player sit, swing his legs off the bed, and, to the delight of staff and parents, stand again. Seeing what pleased adults, the boy turned to Lois. “I’m going to do that soon,” he said. She didn’t reply, but tears streamed down her face.

We know she grieved. Lois shared the bad news in a letter to her best college friend, who had joined the Iowa diaspora to Los Angeles. It read like a funeral notice. “Oh, my beautiful little boy,” she wrote in ending. Lois confided to her favorite aunt that she feared the boy would die.

Why didn’t Lois vaccinate me? Because she had not been given that choice. I had fallen ill 224 days before the announcement, on April 12, 1955, that the field trials of the Salk polio vaccine were a success.

As she lay in bed that night, digesting the news that had been shouted out across the country over radio, television, and public address systems in workplaces and schools, Lois had a choice to make. Because kicking inside her was the boy she had conceived in her grief the previous fall.

Today’s parents make those choices knowing much more than she did about the effectiveness and safety of the vaccines offered to their children. They can rely on decades of experience and scientific research.

Lois faced only scientific uncertainty. The Salk vaccine was new. It had been only 60 to 70 percent effective in the trial but had been deemed safe. Some of the world’s top polio researchers weren’t so sure. They had publicly opposed the trial, thought the vaccine the wrong approach, maybe even dangerous. Their fears materialized within weeks. Cutter Laboratories in Berkeley shipped vaccine contaminated with live virus. More than 200 children and family members were paralyzed, and 11 died. The vaccination campaign was briefly suspended.

But from her own experience, Lois Mace knew things that today’s parents, thanks to vaccines, have never had to learn—need never learn—about pain and grief and loss of control. As soon as she could, she took all her children to get the shots, and went back again after the Cutter fiasco.

She could not be certain it was the best choice for them. She knew, to her very bones, that it was the right choice for her.

Mark Paul, formerly deputy editorial page editor of the Sacramento Bee and deputy treasurer of California, is co-author, with Joe Mathews, of California Crackup: How Reform Broke the Golden State and How We Can Fix It. He wrote this for Thinking L.A., a partnership of UCLA and Zocalo Public Square.

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

Nigerian Elections Threaten Campaign to Make Africa Polio-Free

NIGERIA-HEALTH-POLIO
Aminu Abubakar—AFP/Getty Images A polio vaccinator administers oral drops to a child in the Dawanau district of Kano, northern Nigeria in 2013.

Nigeria is is the last country in Africa which is still polio-endemic but it hasn't had a case in six months

For all that ails Nigeria —Boko Haram jihadists rampaging across the country’s northeast, record unemployment and the plummeting price of crude for an oil-dependent government — one thing has been going very right. Nigeria has not seen a case of polio since July 24, 2014. If it can stay that way another six months it will be removed from the World Health Organization’s (WHO) polio-endemic list, leaving just Pakistan and Afghanistan behind. But the general election, on February 14, has global public health officials worried that Nigeria might yet backslide: every election since 2003 has been followed by a surge in polio cases.

A quarter of a century after it was eradicated in the United States, polio is poised to become the second disease since smallpox to be wiped out in the wild. That progress has been achieved through a concerted effort by UNICEF, WHO and Rotary International to establish strict vaccination protocols for governments in affected countries. All it takes is two drops of the vaccine, administered three different times, to render a child immune. In order to achieve that, governments usually hold vaccination drives in affected areas every six weeks. In 1988 there were 350,000 cases of polio in 125 countries; in 2014 that number went down to 339 cases. Which is why this year is such a nail biter for Africa. When Nigeria is declared polio-free, after three years without a case, the rest of the continent can start to breathe a little easier.

Up until now, the greatest concern for public health officials has been Nigeria’s insurgency, which has prevented vaccinators from reaching children in violence prone areas. The upcoming poll has added another layer of worry, says Carol Pandak, Rotary International’s PolioPlus program director. “Elections always pose a threat of hindering polio eradication efforts,” she says via email. “Not only in that government officials are distracted leading up the elections, but possible violence and instability following the elections can have a significantly negative impact on polio eradication efforts.” The post-election surge in cases was most apparent following Nigeria’s 2011 Presidential elections, says Dr. Tunji Funsho, head of Rotary International’s Nigeria program. Election results were met with three days of rioting that killed 800 in the worst outbreak of violence since the 1967-70 civil war. The protests “compromised the security situation and prevented vaccinators from reaching a large cohort of children.”

Elections in India, which was declared polio-free last year, were largely spared the post-polling polio surge because of the country’s relative stability, notes Pandak. Recent Pakistani and Afghan elections saw similar case surges, and Nigeria is not likely to be any different this time around, especially since the two contenders, incumbent Goodluck Jonathan, and former general Muhammadu Buhari, are neck and neck according to a recent poll. These elections “have the potential to be much more disruptive given the political divisions in the country,” says Pandak.

There is also the uncertainty of how the newly elected government will or will not prioritize polio eradication. Funsho notes that in the past, Nigeria’s newly elected officials at the state and government levels were reluctant to fund immunization. As a result, coverage and quality of vaccination services declined. “It takes a strong effort to educate the new political leaders on the value of supporting polio eradication and making it a national priority,” says Pandak.

A surge of cases now would be a serious setback. Nigeria had only six cases last year, down from 53 in 2013. The rapid decline is a serious achievement, considering that in 2003 vaccinations all but stopped in the north of the country when religious leaders declared that the vaccines were part of a plot to sterilize Muslim girls. By the end of the year, 447 children in Africa had been paralyzed by the Nigerian strain of the virus. Within two years it had spread to across 16 countries, reaching as far away as Indonesia.

This year, Funsho is determined to keep Nigeria’s number at zero this year, setting up what he calls a “war room” for polio eradication. He knows that all it takes for those efforts to be undone is an interruption of regular vaccinations and a decline in vigilance. If he succeeds, the world will be one country closer to totally eradicating the disease.

TIME vaccines

Meet the Latest Driver of the Anti-Vaccine Clown Car (Who Thinks You’re a ‘Bad Mother’)

Not your friend: The measles virus—highly magnified—is exceedingly easy to transmit
Dr. Gopal Murti/Visuals Unlimited Not your friend: The measles virus—highly magnified—is exceedingly easy to transmit

Jeffrey Kluger is Editor at Large for TIME.

A doctor who should know better peddles dangerous rubbish

Vanity doesn’t die; misinformation doesn’t die; arrogance and narcissism and opportunism don’t die. But you know what does die? Children. That’s worth keeping in mind as the latest carnival barker from the anti-vaccine community steps up for his ignoble hour of attention.

The new medical reprobate is Dr. Jack Wolfson, an Arizona-based cardiologist and practitioner of holistic medicine. Until recently, he was a largely unknown character—which was a very, very good thing. But in the wake of the California measles outbreak that originated in Disneyland and has so far infected 93 people in eight states and Mexico, he has picked up the megaphone of social and mainstream media to inveigh against vaccines as unsafe, unnecessary, stuffed with toxins and, well, never mind. You know this drill.

The vaccines he condemns would, of course, include the measles vaccine, which was not widely available before 1980 when 2.6 million people died of the disease each year, and which, when it did become available, quickly slashed that death toll by 99.4%. Measles was declared eradicated in the U.S. in 2000—but even now, 1,000 people are being monitored in Wolfson’s own state for possible exposure to the Disneyland strain, which got a toehold in the first place only because of the nation’s falling vaccination rate.

But never mind that. Wolfson has junk science to sell, and he’s going to sell it. “We should be getting measles, mumps, rubella, chicken pox, these are the rights of our children to get it,” he told the Arizona Republic.

“Don’t be mad at me for speaking the truth about vaccines,” he told The Washington Post. “Be mad at yourself, because you’re, frankly, a bad mother. You didn’t ask once about those vaccines. You didn’t ask about the chemicals in them.”

CNN inexplicably afforded Wolfson the familiar split-screen, point-counterpoint platform to argue the vaccine issue with another doctor—as if there were any argument to begin with. The network touted the exchange on CNN.com as “Fiery Vaccine Debate,” which likely earned the site some clicks and gave Wolfson a patina of legitimacy in return.

The thing is though, he’s not legitimate—not as a person whose vaccine advice should be heeded at least—as the agitprop nonsense he offers on the alternative medicine site Health Impact News reveals. Concerned parents and health care providers should not be angry at him for selling his anti-vax bill of goods, he repeats. Instead, “Be angry at food companies. Sugar cereals, donuts, cookies, and cupcakes lead to millions of deaths per year. At its worst, chicken pox killed 100 people per year. If those chicken pox people didn’t eat cereal and donuts, they may still be alive.”

You should be angry at the people who make Bounce and Downy too, because, “You and your children are wearing and breathing known carcinogens” contained in the laundry sheets and fabric softener. “These products kill more people than mumps.”

But most of all, be angry at yourselves, you parents who vaccinate. Why? Because, “Let’s face it, you don’t really give a crap what your children eat. You don’t care about chemicals in their life.”

There is so very much more wrong with Wolfson and the rubbish he’s selling. There is his supposedly unanswerable riposte about the irrelevance of polio. “Where are all those 80 year olds crippled by polio?” he asks. “I can’t seem to find many.” That’s right, you can’t, because the disease has been vaccinated into extinction in all but three countries in the world. If you were looking around before 1955 you’d see plenty of them.

There is his similar dismissal of measles. “What we’re really talking about is just a fever and a rash,” he says. Yes, a fever and a rash that still kills 145,700 unvaccinated people per year. And what does 145,700 people look like? Picture four sold-out Fenway Parks. Now kill all of those people—mostly children. Every year.

Wolfson, like most anti-vaxxers, rails broadly and emptily at the “chemicals” in vaccines and argues that we shouldn’t be putting them into our children’s bodies. But arginine and alinine and octene and hexanal and 2-methyl butyraldehyde are chemicals too and they’re just five of the 73 you put in your body every time you eat a blueberry. Chemicals are not, by definition, bad things. Wolfson similarly rhapsodizes about “nature,” setting it in make-believe opposition to things that are synthetic or invented and therefore, by binary definition, are bad. But as he himself argues, viruses are part of nature, as are bacteria, and as is every other disease that could kill you or your children before your time. In some cases, the whole point of medical science, to paraphrase William Buckley, is to stand athwart nature shouting “Stop!” If you want your nature pure, you’re free to die young.

At least one Arizona pediatrician, according to The Washington Post, is already talking about reporting Wolfson to the Arizona Medical Board, and that’s not an empty threat. Simply taking a contrarian position or advocating for dubious but do-no-harm nostrums is unlikely to get you in trouble with the licensing authorities. But making an argument that is wholly, empirically, medically wrong, and doing so in a way that could actually induce real parents to refuse to vaccinate real children is something that’s demonstrably dangerous.

The state’s medical board standards for disciplining members are exceedingly broad, authorizing action against a doctor who, among other things, “may be guilty of unprofessional conduct.” It would be up to the board itself to define that, but it’s not a leap to think they would do so in a way that would apply in this case.

If there’s anything good about the rise of Wolfson, it’s that it’s a sure sign the anti-vaxxers’ bench is getting thin. He lacks the telegenic sizzle of a Jenny McCarthy. He lacks the one-time credibility of an Andrew Wakefield, whose fraudulent 1998 paper got the phony vaccines-autism link started. The paper has now been retracted and Wakefield has been stripped of his license to practice medicine.

Wolfson, like the others, will have his moment, and then, like the others, he is likely to go away. We will never know for sure how many children will be harmed by his misinformation before he’s finally gone.

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 global health

What the Gates Foundation Has Achieved, 15 Years On

Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived
Scott Olson; Getty Images Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived

Jeffrey Kluger is Editor at Large for TIME.

Much has been done over the foundation's first decade and a half — with more still to do

There are a whole lot of things you may or may not get to do in the next 15 years, but a few of them you can take for granted: eating, for one. Having access to a bank, for another. And then there’s the simple business of not dying of a preventable or treatable disease. Good for you—and good for most of us in the developed world. But the developed world isn’t the whole story.

The bad—and familiar—news is that developing nations lag far behind in income, public health, food production, education and more. The much, much better news is that all of that is changing—and fast. The just-released Annual Letter from the Bill and Melinda Gates Foundation makes a good case for hoping there is still more to come.

The 2015 letter represents something of a threshold moment for the Foundation. It was in 2000 that the Gateses began their work and set themselves a very public 15-year deadline: show meaningful progress in narrowing the health, income and resource gap between the world’s privileged and underprivileged people, or be prepared to explain why not. So far, nobody—neither the Gates Foundation nor the numerous other global health groups like the World Health Organization and UNICEF—have much explaining to do.

The number of children under five who die each year worldwide has been nearly cut in half, from a high of nearly 13 million to 6.5 million today. Polio has been chased to the very brink of extinction, and elephantiasis, river blindness and Guinea worm are close behind. Drought-tolerant seeds are dramatically increasing agricultural yields; economies in the once-desperate countries in sub-Saharan Africa are now matching the developed world in rate of annual growth. Up to 70% of people across the developing world now have access to wireless service, making mobile banking possible—a luxury in the West but a necessity in places there is no other banking infrastructure.

The trick of course is that progress isn’t the same as success. The 13 million babies who were dying a year in the years before the Foundation began, for example, factored out to a horrific 35,000 every single day. Slashing that in half leaves you with 17,500—still an intolerable figure. For that reason and others, the Gateses are turning the 15-year chronometer back to zero, setting targets—and framing ways to achieve them—for 2030.

The most pressing concern involves those 17,500 kids. The overwhelming share of the recent reduction in mortality is due to better delivery of vaccines and treatments for diseases that are vastly less common or even nonexistent in much of the developed world—measles, pneumonia, malaria, cholera and other diarrheal ills. Those are still the cause of 60% of the remaining deaths. But the other 40%—or 2.6 million children—involve neonates, babies who die in the first 30 days of life and often on the very first day. The interventions in these cases can be remarkably simple.

“The baby must be kept warm immediately after birth, which too often doesn’t happen,” Melinda Gates told TIME. “This is basic skin-to-skin contact. Breast-feeding exclusively is the next big thing, as is basic cord care. The umbilical cord must be cut cleanly and kept clean to prevent infections.”

HIV may similarly be brought to heel, if not as easily as neonate mortality. A vaccine or a complete cure—one that would simply eliminate the virus from the body the way an antibiotic can eliminate a bacterium—remain the gold standards. But in much of the world, anti-retrovirals (ARVs) have served as what is known as a functional cure, allowing an infected person to live healthily and indefinitely while always carrying a bit of the pathogen. Gates looks forward to making ARVs more widely available, as well as to the development of other treatment protocols that we may not even be considering now.

“We’re already moving toward an HIV tipping point,” she says, “when the number of HIV-positive people in sub-Saharan Africa who are in treatment will exceed the number of people becoming newly infected.”

Food security is another achievable goal. Even as Africa remains heavily agrarian—70% of people in the sub-Saharan region are farmers compared to 2% in the U.S.—yields remain low. An acre of farmland here in America may produce 150 bushels of corn; in Africa it’s just 30. The problem is largely rooted in our increasingly unstable climate, with severe droughts burning out harvests or heavy rainstorms destroying them.

“Millions of people eat rice in Africa,” says Gates, “and rice has to be kept much wetter than other crops. At the equator it’s staying drier longer, but when the rains do come, they hit harder.”

In the case of rice and corn and all other crops, the answer is seeds engineered for the conditions in which they will have to grow, not for the more forgiving farmlands of the West. In Tanzania, site-specific seed corn has been made available and is already changing lives. “That seed,” one farmer told Gates when she visited in 2012, “made the difference between hunger and prosperity.”

Finally comes banking. Across Africa, only 37% of people are part of the formal banking system, but up to 90%, depending on the area, are part of the M-Pesa network—a mobile banking link accessible via cellphone. The Pesa part of the name is Swahili for money and the M is simply for mobile.

“Today too many people put their money in a cow or in jewelry,” Gates says. “But it’s impossible to take just a little of that money out. If someone gets sick or you have another emergency, you simply sell the cow.” Mobile banking changes all of that, making it much easier to save—and in a part of the world where even $1 set aside a day can mean economic security, that’s a very big deal.

Nothing about the past 15 years guarantees that the next 15 will see as much progress. The doctrine of low-hanging fruit means that in almost all enterprises, the early successes come easier. But 15 years is a smart timeframe. It’s far enough away that it creates room for different strategies to be tried and fail before one succeeds, but it’s close enough that you still can’t afford to waste the time you have. Wasting time, clearly, is not something the folks at the Gates Foundation have been doing so far, and they likely won’t in the 15 years to come either.

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 Pakistan

Militants Gun Down Pakistan Health Workers as Polio Crisis Intensifies

Hospital staff stand near the bodies of anti-polio drive campaign workers who were shot by gunmen, at a hospital morgue in Quetta
Naseer Ahmed—Reuters Hospital staff stand near the bodies of antipolio campaign workers who were shot by gunmen, at a hospital morgue in Quetta, Pakistan, on Nov. 26, 2014

There have been 260 new cases of polio diagnosed in the South Asian nation this year

Public-health workers continue to be gunned down at will by Islamic militants across Pakistan, where ongoing attacks against vaccination teams have hampered the government’s ability to rein in a spiraling polio crisis.

On Wednesday, heavily armed militants in the Baluchistan region capital of Quetta mowed down members of an antipolio campaign, leaving four public-health workers dead and three others injured. Survivors of the ambush chided government officials for failing to provide sufficient security for the team.

“Two men on a motorcycle stopped our car and started shooting. No security arrangements were made,” one of the victims told the Pakistani newspaper Dawn. “We called everyone, but no one came to our rescue.”

The bloody scene in Quetta this week has sadly become all too familiar in conflict-riven Pakistan. On Monday, near the city of Peshawar, gunmen mounted on a motorcycle shot and injured another polio health worker. A Taliban splinter group later claimed responsibility for the attack and issued a statement deriding the polio vaccine as “dangerous to health” and “against Islam,” according to the Los Angeles Times.

The uptick in brazen attacks against health workers has saddled Pakistani Prime Minister Nawaz Sharif’s embattled administration with renewed criticism, after he made boisterous promises during his campaign in 2013 to make peace with Taliban forces.

“Such cowardly attacks against our goal of polio-free Pakistan will further strengthen our resolve to stamp this menace out of the country,” Ayesha Raza Farooq, the Pakistani Prime Minister’s focal person on polio eradication, said in a statement on Monday. “I urge the provincial government to take all measures necessary to protect the polio teams and ensure safe conduct of polio campaigns.”

The militants’ suspicion of vaccination programs has been fueled in large part by the bogus hepatitis B campaign crafted by U.S. clandestine officials searching for Osama bin Laden in Pakistan in 2011, which later lead to the dramatic killing of the al-Qaeda chief by Navy Seals.

In 2012, Taliban forces operating in the country’s tribal belt banned polio vaccinations and began openly attacking public-health officials trying to administer inoculations. More than 60 public-health workers have been killed in the country since the declaration.

Since 2012, transmission of the virus has been most intense in the country’s restive Federally Administered Tribal Areas (FATA). But following an offensive launched by the Pakistani military against insurgents in FATA’s North Waziristan in June, close to 1 million people fled the area. As a result of the exodus, the polio epidemic has spread to other parts of Pakistan that had previously been unexposed to the highly contagious virus.

In the onslaught’s wake, public-health officials claim to have vaccinated more than 1 million people in the past few months, including 850,000 children under the age of 10, who were previously inaccessible, according to the Global Polio Initiative. Still, polio continues to spread across the country.

Public-health officials confirmed this week the existence of 260 new polio cases in Pakistan this year — a fourfold increase since the same duration in 2013, according to the New York Times. Pakistan is one of just three countries where polio remains endemic.

TIME Infectious Disease

Africa Nears Polio Eradication, CDC Says

German Minister Mueller Travels Nigeria
Thomas Imo—Getty Images German Development Minister Gerd Mueller vaccinates a child against polio in a hospital on June 11, 2014 in Abeokuta, Nigeria.

Health officials credit successful vaccination efforts in Nigeria

Correction appended, November 21, 2014

Wild poliovirus has nearly been eradicated in Africa thanks to successful vaccination efforts in Nigeria, the Centers for Disease Control and Prevention revealed in a new report Thursday.

No case of polio has been recorded on the continent since August, the report finds. There have been 22 cases of polio in Africa overall since the beginning of 2014, six of which were in Nigeria, one of the last three endemic nations alongside Pakistan and Afghanistan. The latest tally marked a drastic reduction from 49 cases in Nigeria the previous year.

That drop has been credited to vaccination campaigns in the country’s restive northern states, where a decade of periodic outbreaks had reintroduced the virus to 26 polio-free countries. “Interrupting all poliovirus circulation in Nigeria is achievable,” the report finds, but only with expanded vaccination coverage to some of the region’s most remote and hard-to-reach communities.

Correction: The original version of this article misstated the total number of polio cases across Africa and how many countries were affected. There were 22 cases in Africa since the beginning of 2014 and the virus was reintroduced to 26 polio-free countries since 2003.

TIME Internet

Google Doodle Celebrates Jonas Salk, Scientist Behind Polio Vaccine

Google

Dr. Jonas Salk made polio nearly extinct in just two years

Tuesday’s Google Doodle celebrates the 100th birthday of the American scientist behind the first effective polio vaccine: Dr. Jonas Salk.

“Thank You, Dr. Salk!” reads a sign in the homepage animation, which depicts joyful, fully mobile children dancing and running around with dogs and balloons. Polio largely impacted children.

The Washington Post reports that according to the Salk Institute, “In the two years before [the] vaccine was widely available, the average number of polio cases in the U.S. was more than 45,000. By 1962, that number had dropped to 910.”

Salk was also depicted on the March 29, 1954 cover of Time Magazine:

Time Magazine, Cover Credit: Boris Artzybasheff
TIME Health Care

The Price of Staying Alive For the Next 3 Hours

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

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.
Martin Mcevilly—NY Daily News/Getty Images 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.

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.

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