Why eradicate disease? (Guest Editorial).

The concept of totally eradicating a disease has long been a siren song. For some, it has transcended reason and become a crusade.

Only smallpox has been successfully eradicated. Four other eradication efforts have failed, and two in progress are faltering. Recent events have changed the calculus for looking at eradication programs.

The possibility of a deliberate release of biological warfare agents poses a serious threat and will continue to do so for the foreseeable future, so we must remain eternally vigilant. Today, that means stocking smallpox vaccine and bifurcated needles and sustaining a manufacturing base should more vaccine be needed.

For the current polio campaign, this problem has yet to be seriously addressed. As I see it, between the threat of deliberate release and the problems inherent in eradicating polio itself, the arguments in favor of trying to wipe polio off the earth rapidly dissolve.

Arguments in favor of eradication have included potential cost savings via elimination of vaccination programs, stockpiling, and other expenditures.

If we acknowledge the possibility of the threat of a deliberate release, we must remove those savings from any calculus regarding the value of eradication.

What should our policy on eradication be? We are now attempting to eradicate poliomyelitis, which was widely viewed as the easiest to tackle after smallpox. Heroic efforts have been made, but significant differences between polio and smallpox make the task of polio eradication far more difficult.