Disease eradication as a public health strategy: a case study of poliomyelitis eradication

Disease eradication as a public health strategy was discussed at internatio nal meetings in 1997 and 1998. In this article, the ongoing poliomyelitis e radication initiative is examined using the criteria for evaluating candida te diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibil ity) and societal and political considerations (operational feasibility). T he benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause o f disability, and far-reaching intangible effects, such as establishment of a "culture of prevention". The costs are found to be financial and finite, despite some disturbances to the delivery of other health services. The "t echnical" feasibility of poliomyelitis eradication is seen in the absence o f a non-human reservoir and the presence of both an effective intervention and delivery strategy (oral poliovirus vaccine and national immunization da ys) and a sensitive and specific diagnostic tool (viral culture of specimen s from acute flaccid paralysis cases). The certification of poliomyelitis e radication in the Americas in 1994 and interruption of endemic transmission in the Western Pacific since March 1997 confirm the operational feasibilit y of this goal. When the humanitarian, economic and consequent benefits of this initiative are measured against the costs, a strong argument is made f or eradication as a valuable disease control strategy.