Xkcd and Bill Gates on Polio Eradication | Hacker News Reader

Xkcd and Bill Gates on Polio Eradication

gatesnotes.com

205 pointsAmorymeltzer61 comments

My oldest brother got polio at 5 years old and I was exposed to him when I was 2. But I got the vaccine shortly after (in 1955). I am so grateful for the vaccine. For the record my brother is still alive and has had numerous surgeries. Most recently both hips were replaced and they used that as an opportunity to add some length to his shorter leg. This has made a tremendous positive difference in his life.

Stay focused.... "We don't need no stinking app".

My father contracted polio as a child. His doctor told his parents that it was too advanced and that he would certainly die. That he survived was pure luck. I recently learned (from my mother) that the latent stress of the experience caused him to be unable to say the name of the disease during the first years that my parents knew each other. He would refer to it as "when he was sick," and couldn't say "when I had polio," until much later.

I'm grateful that we've made such progress in this area.

Thank you both for sharing those stories. I'm happy that you and your parents endured.

I sometimes see a person with a... specific way of walking on the streets of my city. Only recently a friend pointed out to me what disease caused that problem. I am grateful that my generation didn't have to experience it, to the point most people don't even know what the disease is and that it was a problem only so recently. People who helped this happen are true heroes of our times.

I was relieved to learn recently that we're 2/3 done with polio, only the last strain of the virus remaining. Here's to hoping it will be over soon, and then the next disease, and the next one after that!

Thanks

Many younger people have no idea what modern medicine does for us that was not available when I was young. I had Rubella (german measles) that almost killed me, mumps which I remember being very sick, and ChickenPox. We still have to fight the flu but I had the Asian flu when I was very young as well. Many people died that year, 1957. Estimates are about 70,000 in the USA. http://www.britannica.com/event/Asian-flu-of-1957

An interesting story about the German Measles. Our family physician at the time told my mother to expose me to my next door neighbor that had the measles because I would get it anyway. So I remember sitting with him for an afternoon. I don't remember anything else from the next 2 weeks. My mother apologized till the day she died for doing that to me.

"What doesn't kill you makes you stronger." Or at least that is the lie that I remind myself once in awhile.

It's not a case of just carrying on as we were.

Here are the pockets of Polio: http://voices.nationalgeographic.com/files/2014/04/gitn_1204...

Why?

1) Vaccinators can't access some regions of Afghanistan and Pakistan because of violent resistance to Western aid.

2) Western vaccines are resisted by Muslim Nigerians who fear Polio vaccines are a Western plot to sterilise Muslims.

3) Hajj is a great opportunity for the disease to spread between members of these regions.

http://www.irinnews.org/report/48667/nigeria-muslim-suspicio...

http://news.nationalgeographic.com/2015/03/150303-polio-paki...

Hearts and minds need to be won or brute force needs to be used, if decades of effort are going to pay off. Until it's eradicated in these regions, we're stuck vaccinating our children to avoid re-establishment of the disease.

As if brute force solves anything ... it is obviose that you did not learn anything from the past. Because brute force is the reason for no. 1) and 2). And it looks like you have a problem with islam religions, that you should solve before mkaking stupid remarks.

bobjob, you've totally misunderstood me.

Addressing your issue with brute force: Firstly, you should understand that I'm a logical person, capable of moral and philosophical thought.

Looking at the problem in it's raw form, Polio needs to be eradicated before we can halt expenditure on the eradication program, which comes at a huge global cost. To eradicate the disease, we have to destroy it.

To destroy it, we use vaccines to reduce the number of carriers and available hosts to zero. This requires hosts to forcefully, or willingly be vaccinated.

Humanity finds itself staring at a few pockets of the disease which are proving difficult to wilfully, or forcefully vaccinate.

Humanity has two choices: Give up, or carry on

Carrying on produces further choices:

Humanity can, through the process of negotiation, wait for these pockets wilfully vaccinate, reducing the number of carriers to zero. No more Polio. Problem solved.

Humanity can wait for these pockets to develop their own wilful way of eradicating the disease from their population, reducing the number of carriers to zero. No more Polio. Problem solved.

Humanity can find a way to forcefully vaccinate these pockets, reducing the number of carriers to zero. No more Polio. Problem solved.

Humanity can find an alternative way to forcefully reduce the number of carriers to zero, such as selective murder or the less-selective, genocide. No more Polio. Problem solved.

Humanity can wait for nature to reduce the number of carriers in these pockets to zero through natural disaster. No more Polio. Problem solved.

These, whilst some of them horrifying, are solutions to the problem humanity faces, for the "greater good" and all that jazz. The cost and viability of these solutions are under constant consideration whether you like it or not.

Why haven't they occurred? Well,

People continue to resist the vaccine.

Developing new methods of eradicating disease doesn't happen spontaneously in small populations.

The moral price of forcefully vaccinating this population is probably on the cusp of acceptability. The practicalities are more challenging at this time, however I wouldn't be surprised if a solution of this type isn't being actively worked on.

Nature works in it's own time.

The global value of the lost life is too high for decision to be made to enact mass murder for the sake of eradicating Polio at this time.

Upon finishing, answer not needed, let me ask: If we ran out of the ability to produce Polio vaccine for the world, would you rather: murder several million people, or, condemn humanity to a future with Polio, at the cost of hundreds of thousands of lives per year, on top of hundreds of thousands of new cases of disability?

Good analysis, for those who have a knee-jerk reaction to this line of thinking, consider how you'd feel if we were talking about terrorist groups that we knew were planning massive strikes against civilization.

If you view deaths due to diseases that would be prevented by vaccination in that light the money that we're spending on fighting terrorism versus spending similar amounts (literally trillions of dollars) on eradicating diseases by any means necessary (yes, even boots on the ground & forceful vaccination) the situation starts looking very different.

Why can a few ignorant pockets of humanity hold the entirety of the rest of the species hostage in perpetuity? And unlike some needing to take out some insurgent group because they might attack the west it's pretty much guaranteed that these diseases will flare up again, with guaranteed deaths for untold amount of innocents. Just look at how close we came with the recent Ebola crisis.

> bobjob, you've totally misunderstood me. > Addressing your issue with brute force: Firstly, you should understand that I'm a logical person, capable of moral and philosophical thought. You said that brute force should be used and I'm of the opinion that this is wrong. Not only will it not solve the problem(you can never catch all people), but it will create violence that will kill people. As a side effect will it foster the well grounded hatred of the affected(and a lot of unaffected) people toward "westerners".

> Looking at the problem in it's raw form, Polio needs to be eradicated before we can halt expenditure on the eradication program, which comes at a huge global cost. To eradicate the disease, we have to destroy it. True

> To destroy it, we use vaccines to reduce the number of carriers and available hosts to zero. This requires hosts to forcefully, or willingly be vaccinated. It does not require force, but patience. Mankind survived so far and we can carry the cost for some more time. The cost of doing forceful vaccination is simply to high.

> Humanity finds itself staring at a few pockets of the disease which are proving difficult to wilfully, or forcefully vaccinate. > Humanity has two choices: Give up, or carry on Carry on as we do now and wait til they see reason(for that we have to stop using them as test subjects[1][2]).

> Carrying on produces further choices: > Humanity can, through the process of negotiation, wait for these pockets wilfully vaccinate, reducing the number of carriers to zero. No more Polio. Problem solved. I'm for this

> Humanity can wait for these pockets to develop their own wilful way of eradicating the disease from their population, reducing the number of carriers to zero. No more Polio. Problem solved. or for this

> Humanity can find a way to forcefully vaccinate these pockets, reducing the number of carriers to zero. No more Polio. Problem solved. And creating new problems, you know like war and terrorism

> Humanity can find an alternative way to forcefully reduce the number of carriers to zero, such as selective murder or the less-selective, genocide. No more Polio. Problem solved. Same as the last one, you create new problems.

> Humanity can wait for nature to reduce the number of carriers in these pockets to zero through natural disaster. No more Polio. Problem solved. Will not happen, there are to many carriers involved and you can not contain the areas they live in.

> These, whilst some of them horrifying, are solutions to the problem humanity faces, for the "greater good" and all that jazz. The cost and viability of these solutions are under constant consideration whether you like it or not. And as long as people in power do not get stupid, they will not choose brute force.

> Why haven't they occurred? Well, > People continue to resist the vaccine. For understandable reasons(see [1] or [2])

> Developing new methods of eradicating disease doesn't happen spontaneously in small populations. It does not, it needs time so that trust can be build.

> The moral price of forcefully vaccinating this population is probably on the cusp of acceptability. The practicalities are more challenging at this time, however I wouldn't be surprised if a solution of this type isn't being actively worked on. The moral price is not acceptable and never will be. Especial if the reason for there resistance are actions from the outside(from there point of view).

> Nature works in it's own time. > The global value of the lost life is too high for decision to be made to enact mass murder for the sake of eradicating Polio at this time. Mass murder is never a valid way to reach a goal, esp. if the murdered are people(e.g. in this case we are talking about feeling, intelligent, reasoning human beiings).

> Upon finishing, answer not needed, let me ask: If we ran out of the ability to produce Polio vaccine for the world, would you rather: murder several million people, or, condemn humanity to a future with Polio, at the cost of hundreds of thousands of lives per year, on top of hundreds of thousands of new cases of disability? If we run out of the ability it is our own fault. We just need to stop bulling people and making war(martial, ecological, economical, moral) for profits sake. Not answering could be construed as me accepting your "final solution", sorry won't happen until you start repeating your arguments.

[1] http://www.theguardian.com/world/2012/mar/02/aid-groups-cia-... [2] http://edition.cnn.com/2012/06/06/world/asia/pakistan-polio-...

Maybe if this http://www.theguardian.com/world/2011/jul/11/cia-fake-vaccin... didn't happened there would be less resistance.

If Saudi Arabia were on board, maybe the Hajj could be a good opportunity to get vaccinations to some of those groups of immigrants?

Imagine if they made it a visa requirement and they were the ones doing the vaccination rather than the US.

> 1) Vaccinators can't access some regions of Afghanistan and Pakistan because of violent resistance to Western aid.

It might be relevant to actually mention the reason that this resistance exists[0][1]. There was resistance even before the CIA's tactics to assassinate Bin Laden were discovered, but it certainly doesn't help that we (the US) have legitimized these fears in their minds.

Forcibly vaccinating people (as you suggest below) would be even more disastrous, for the same reason. If the problem is that people are concerned about Western hegemony in their local countries, the solution is not to forcibly subject them to medical treatment by Western powers.

[0] http://news.nationalgeographic.com/2015/02/150225-polio-paki...

[1] http://www.theguardian.com/world/2011/jul/11/cia-fake-vaccin...

Yes, of course, the implications are costly, but the costs of not doing so are also vast and must (and will) be considered very closely.

Polio could be eradicated by subterfuge, humanity can claim it's victory and the world doesn't necessarily need to know how Polio was magically eradicated in these vaccine-resistant populations.

Or perhaps the world could unite, West, East, Middle East, Christians, Muslims, Buddhists etc and force this vaccination upon these pockets in unprecedented unity.

"It's not 'they' who want this of you, WE all want this of you".

This is new ground. Humanity collectively has something standing in the way of progress. Humanity has the opportunity to approach it jointly.

I find this to be shortsighted. It might work, and polio might be eradicated because of it, but what happens with the next disease? You'll simply confirm their fears and cause even more resistance to medical science.

It strikes me as being the same sort of thinking that caused the CIA to abuse the vaccination program in their hunt for bin Laden. In both cases, a focus on a single short-term goal harms more people overall because of the larger consequences.

I agree wholly.

I want to add:

Couldn't you also say, that humanity's short-term goal of not violating the lives of people who don't want Western vaccines, could cause more harm to people overall because of the consequence of failing to eradicate Polio?

>Hajj is a great opportunity for the disease to spread between members of these regions.

Is this not also a great place to perform vaccinations though? I mean pretty much every Muslim is going to rock up there sooner or later & it is a mostly stable environment open to somewhat western influences (if the Saudis agree).

Children are the ones who need to be vaccinated.

1) Vaccinators can't access some regions of California because of violent resistance to vaccination.

2) Western vaccines are resisted by hippie Californians who fear Measles vaccines are a Western pharmaceutical plot to spread autism.

3) Disneyland is a great opportunity for the disease to spread between members of these regions.

Let's see if Jenny McCarthy is forcefully vaccinated. Until then, it will be hard for me to take your "They aren't the same people as us, so let's use brute force, for humanity" attitude seriously.

There are major differences. First is that your point (1) is simply untrue. There is resistance, yes, but not violent resistance.

More importantly, measles is still pretty widespread and there's no realistic prospect for near-term eradication. Getting all the California hippies to vaccinate wouldn't make a difference in terms of measles eradication, because they make up an insignificant proportion of global measles cases. Polio, however, is endemic in precisely two regions of the world, and getting those two regions to vaccinate would eliminate the disease entirely.

I'm perfectly comfortable with the idea of CPS taking children away from anti-vax parents, and unvaccinated adults who refuse vaccination being forcibly quarantined.

One could argue that mandatory vaccination laws, which are being passed in some states, are a form of force. I think that these laws are good and useful, but they do point out that even Westerners need coercion at times. They also point out a potential way to apply 'force' to the remaining pockets, which is to introduce vaccination requirements into international treaties, either as requirements for trade deals or something else. The UN would probably be the proper vessel for this, rather than any individual Western country, although certainly those countries could spearhead the effort to make this happen.

Yes, luckily for these people, they live in a region where Polio is uncommon.

Most of the world could stop vaccinating their children if they chose to. It'd be fine. Until the disease spreads to their population and people start to get infected.

One case of Polio could quite quickly cause California to become a Polio infected region, like Nigeria, Afghanistan and Pakistan. Then we'd have to deal with that area too.

Though without the conviction of other populations, I imagine a once-defiant Western population would quickly revert to willingly accepting the vaccine once they've seen the horrors of the disease with their own eyes.

Yeah - in some ways the effectiveness of vaccines is the only reason that people in western countries can argue against vaccinations at all.

The continued eradication of Poliovirus is a testament to the almost inhuman tenacity of the medical and perimedical community that's dedicated so much of their time and professional lives to the issue.

There's been a number of other public nuisance / threat viruses that haven't fared so well in recent years. HIV among them; treatment has improved so significantly that the previous risk communication ethos, "avoid risky behaviors or you might die," just doesn't cut the mustard anymore.

Transmission reductions have stalled in adolescent to middle-aged groups is still high and over the total population looks to have been stalled for some time.[1] CDC [2] and other reporting numbers show it stalled for most of the last 15 years.

> The continued eradication of Poliovirus is a testament to the almost inhuman tenacity of the medical and perimedical community that's dedicated so much of their time and professional lives to the issue.

We see a lot of things like crowdsourcing, crowd funding, and the constant stream of stories like "sick kid gets a million get well cards after plea goes viral". Those are all interesting lessons in the power of the attention of a lot of people for a short amount of time.

But I think we forget what is ultimately a greater contributor to human progress: the attention of a few for a long time.

You don't need a crowd to change the world. You just need persistence.

Hope he gets the Nobel Peace Prize some day for aggressive billionaire philanthropy. There are plenty of other generous donors out there, but he sets an example of what do with tech wealth.

So confused by the lack of hover text… :-)

Yeah, I spent more than a few seconds making sure that my browser window was selected, that my JS blocker wasn't interfering with the page, etc. before I gave up trying to get a hover text.

Samesies. I thought it was a good strip, but I always love the XKCD hover text. :(

In a strange way, this reinforces his point. We don't need new clever alt="ernatives", we need to keep doing the good old-fashioned effective work.

I saw World Polio Day XKCD Comic, which wasn't the usual extra joke but is certainly accurate and appropriate an ALT tag.

Possibly because I have a FireFox extension just for those, actually: http://piro.sakura.ne.jp/xul/_popupalt.html.en

Anyway, thanks Randall and Mr Bill!

Anyway, thanks Randall and Mr Bill!

Mr Bill has an entirely different meaning to those of us who watched Saturday Night Live back in the 1970s. https://en.wikipedia.org/wiki/Mr._Bill

I think Feynman is worth quoting here:

All the major problems of the relations between society and science lie in this same area. When the scientist is told that he must be more responsible for his effects on society, it is the applications of science that are referred to. If you work to develop nuclear energy you must realize also that it can be used harmfully. Therefore, you would expect that, in a discussion of this kind by a scientist, this would be the most important topic. But I will not talk about it further. I think that to say these are scientific problems is an exaggeration. They are far more humanitarian problems. The fact that how to work the power is clear, but how to control it is not, is something not so scientific and is not something that the scientist knows so much about.

Let me illustrate why I do not want to talk about this. Some time ago, in about 1949 or 1950, I went to Brazil to teach physics. There was a Point Four program in those days, which was very exciting--everyone was going to help the underdeveloped countries. What they needed, of course, was technical know-how.

In Brazil I lived in the city of Rio. In Rio there are hills on which are homes made with broken pieces of wood from old signs and so forth. The people are extremely poor. They have no sewers and no water. In order to get water they carry old gasoline cans on their heads down the hills. They go to a place where a new building is being built, because there they have water for mixing cement. The people fill their cans with water and carry them up the hills. And later you see the water dripping down the hill in dirty sewage. It is a pitiful thing.

Right next to these hills are the exciting buildings of the Copacabana beach, beautiful apartments, and so on.

And I said to my friends in the Point Four program, "Is this a problem of technical know-how? They don't know how to put a pipe up the hill? They don't know how to put a pipe to the top of the hill so that the people can at least walk uphill with the empty cans and downhill with the full cans?"

So it is not a problem of technical know-how. Certainly not, because in the neighboring apartment buildings there are pipes, and there are pumps. We realize that now. Now we think it is a problem of economic assistance, and we do not know whether that really works or not. And the question of how much it costs to put a pipe and a pump to the top of each of the hills is not one that seems worth discussing, to me.

(from https://www.nytimes.com/books/first/f/feynman-meaning.html)

I thought there was a problem with the Taliban fighting against polio-eradication efforts due to the Bin Laden thing? I would guess that they might need some new tactics to deal with that?

Maybe the CIA is secretly doing some work to make itself look less bad and kill an enemy that used to murder American children? Sounds like a decision they might plausibly make.

Or maybe they're just staying out of the way and we happen to have a bunch of nurses accepting the risk of violent death.

The comic really needs a panel that goes something like, "Hey, since vaccination programs are so common, let's take advantage of that by using undercover nurses as scouts so we can kill terrorists!" And then that gets shot down as the completely idiotic idea it is.

I would really like to see an estimate of how many deaths will result from the CIA's subversion of Pakistani vaccination programs, and how it compares to the deaths caused by bin Laden. I'd wager the former will outweigh the latter by a substantial margin.

Funny. We had a chat in the office this morning about Gates. Original comment was about how his philanthropic work made him so worthy of enjoying the fruits of his labors. My take on it was that the permanent damage he inflicted on computing was justified by how he is spending the proceeds. It was not a well received comment then, no different from whenever I get to make it (and I fully expect this thread to be no different).

You rock Bill. Rock on.

People change with time. Not always for the better, but in this case, whatever was Bill's reasoning in the times of early Microsoft, he has his heart in the right place now. He also has the means and the smarts to bring a lot of good impact from that now.

When I look at the field when commercial microcomputing started, it's hard to complain too much about any "permanent damage" Gates' might or might not have made. He was the one who survived, and he was smart, but remember software companies at the time were completely taken over by some of the biggest assholes in modern history. On that topic, "In Search of Stupidity" is a book which is very revealing of the times, and of much worse characters. I completely recommend it for anyone who likes to think Microsoft is especially evil.

Agreed. It's also easy to forget that Gates was able to do it all because he was so drastically undercutting the very expensive status-quo.

Had he not insisted on keeping so much control, it might have been even longer before computing was available to the general masses.

He is responsible for delaying the web for years. Unforgivable, IMHO. And never mind destroying great companies by monopolistic tactics.

Meh, he also put a computer on every desktop.

Miracles can be accomplished when people work together. That may sound trite but today many doubt it, insisting government can do nothing right, reducing funding for research and health programs, etc.

Holy crap. That is so dead on in how people are approaching international development lately.

Can you give some examples? (To be clear, I'm not at all skeptical but would just love to hear specifics!)

Thought of one on my lunch break:

Drones! Lately Drones have been seen as something that is going to revolutionize international development. You can map things quickly! Get tons of info! Etc.

However the problem is something like a drone tends to make host governments pretty nervous. Nepal from what I understand was a great example of that. There was a ton of drone usage there by NGOs, journalists and other groups. This increased the tensions that the government has with foreign aid workers which in turn slowed down the rate of recovery.

As a counterpoint there are great things like the 'contact tracking' apps used in the Ebola response. Various ICT4D companies made a mobile app that allowed field workers and local health workers to track who people had contact with and do followup appointments to make sure that they remained disease free. It's a simple concept but one that proved to be from what I understand very helpful.

Mobile apps can actually play an important role in polio eradication

http://www.polioeradication.org/Research/PolioPipeline/No7Wi...

I'll give Gates credit: it only took him about a decade of futile ultra-technological attempts to understand that curing disease is often best done more simply.

Source? Would like to read more about this if there's a write up somewhere. My perception was that they were doing was was effective very early on (vaccination drives etc.)

What he says is literally impossible.. it hasn't even been a decade since the Gates foundation started funding polio eradication. The first the Gates foundation did anything was in 2007, when they gave $100m.

http://www.boston.com/news/nation/washington/articles/2007/1...

http://www.gatesfoundation.org/Media-Center/Press-Releases/2...

And that money (along with $100m from Rotary International) went to the Global Polio Eradication Initiative, which is the World Health Org's immunization program (started in 1988).

8 years, not 10, but: https://en.wikipedia.org/wiki/Mosquito_laser

In 2007, the Bill & Melinda Gates Foundation requested Intellectual Ventures LLC to find a way to fight and eventually end malaria. Intellectual Ventures resurrected the idea of using lasers to kill mosquitoes and now has a working prototype.[2] The idea has been criticized because most areas where malaria is prevalent do not have reliable electrical power.[3]

There's no vaccine for malaria. You have to either invent one (I'm sure there are people trying) or try some other strategy.

Good point. In fairness though, that began with a $100k challenge to Intellectual Ventures, and they came up with the idea. Gates then gave them $1m to continue developing it with the idea it could be used to protect large areas.

http://www.theregister.co.uk/2011/11/03/laser_mpsquito_repel...

The funding is peanuts compared to what Gates has been spent on Malaria.. here's a couple of the press releases I could find for 2003 ($160m), 2005 (250m) and 2008 ($200m).

http://www.gatesfoundation.org/Media-Center/Press-Releases/2...

So you are discounting the $100 million pragmatic investment made in 2007 because there was a much smaller contemporaneous pie in the sky investment?

This page discusses their similarly large pragmatic investments in malaria prevention, through things like insecticide spraying and bed nets:

http://www.gatesfoundation.org/What-We-Do/Global-Health/Mala...

https://en.wikipedia.org/wiki/Mosquito_laser

I want to make sure I get this clearly

Your criticism is that Bill Gates once spent an insignificant (relative to his resources) amount of money to take a flyer on a weird solution to a problem that vexes the world.

Did I characterize it correctly?

That's part of it. If you look at the early gates investments in disease, they tended to be high-technology solutions like direct attempt to make vaccines and deliver complex infrastructure. Most of these attempts failed pretty badly, which Gates finally thought deeply about, and he reorganized around impact based on outcomes, rather than what his preconcieved notions about what would work would be. He switched to bed nets and other more practical solutions. I believe he wrote about this change in thought at some point but I can't find the article.

You could go through their press releases one by one and list all the worst millions that they donated to this or that:

http://www.gatesfoundation.org/Media-Center/Press-Releases?p...

As I understand it the only real "Technological" component to Gates' work was actually measuring outcomes correctly and spending money based on those outcomes. Not sure what you are referring to though.

is that true? i thought the gates foundation also invested in new and better ways to transport and deliver the vaccines. i, of course, have no citation for this.

This feels like you just wanted an excuse to snipe at Bill Gates while pretending to praise him.

I'm sniping at past Bill Gates. I give him credit for learning. most billionaires fall into the same trap of high tech solutions, and never get out of it. I give him credit for figuring out the right directions to make impact.

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