ETHICAL DILEMMAS IN CURRENT PLANNING FOR POLIO ERADICATION

Intensification of polio eradication efforts worldwide raises concerns about costs and benefits for poor countries. A major argument for glo bal funding is the high benefit-cost ratio of eradication; however, fi nancial benefits are greatest for rich countries. By contrast, the gre atest costs are borne by poor countries; the Pan American Health Organ ization has estimated that host countries bore 80% of costs for polio eradication in the Americas. The 1988 World Health Assembly resolution setting up the polio Eradication Initiative carried the proviso that programs should strengthen health infrastructures. Drastic cuts in don or funding for health make this commitment even more important. Two in ternational evaluations have reported both positive and negative effec ts of polio and Expanded Programme on Immunization programs on the fun ctioning and sustainability of primary health care. Negative effects w ere greatest in poor countries with many other diseases of public heal th importance. If poor countries are expected to divert funds from the ir own urgent priorities, donors should make solid commitments to long -term support for sustainable health development.