The Unintended Consequences of "Polio Eradication" in India?

A reader named Ed Woodcock writes to tell us of …

[A] conversation I had with a WHO (World Health Org.) official I bumped into while touring the Taj Mahal for the first time about 5 or 6 years ago. We introduced ourselves and she told me that she was a “polio advocate,” which obviously led to the question, “What the heck does that mean?” She basically spent her time lobbying organizations for donations to help eradicate polio. Obviously a very worthy cause!

Me: naively asked … “Does India have a lot of polio?”

Her: “It has 90% of the world’s active cases! In fact, the Indian state we’re in (where the Taj Mahal is located) has over 90% of India’s cases. It’s quite tragic. We’ve found that we are funneling so much money to this state to try to eradicate polio that we’ve found it has become a disincentive to fighting it. The state government realizes that as soon as polio is eradicated, the money will try up. Thus they make a half-hearted effort to fight it.”

This might just be the most tragic example of unintended consequences.

There’s no way of knowing if the WHO official was speaking accurately (or if she even was a WHO official), but it’s certainly true that the WHO has been fighting polio in India, and that there seems to be significant progress of late. An earlier article blames the situation on Islamic fundamentalists in India.

We had a section about polio in SuperFreakonomics; in the Illustrated Edition, we showed that, because polio was such a frightening disease which often struck children, it attracted a lot of fund-raising dollars per victim compared to other illnesses:


Many people don't remember polio or think it no longer exists. But it does. It's over 99.5% eradicated but the last part is the hardest. It's currently in four countries: Pakistan, Afghanistan, India, Nigeria. Check out the work Rotary and the Bill & Melinda Gates Foundation are doing to wipe this disease off the face of the earth.


While having cute victims undoubtedly skews these figures, even a rational allocation would not give the same fund per patient, as the cost for a given improvement in quality of life differs between the conditions. In the case of polio in the present day, it makes sense to pay a lot per patient, because we have the opportunity to eradicate polio, at which point we prevent countless future cases for no additional cost.


Wow, I didn't know Nigeria still had Polio. I always put the as one of the more advanced African countries. (although I have no basis for that, I just love their food and the people there)

Kinda crazy though

Eileen Wyatt

Perhaps the WHO representative could point out to the Indian state official that polio is hardly the region's only social problem, so raising vast amounts of money to ameliorate other sources of misery is likely to remain an option for at least a few years.

Miriam Wilburn

I was talking to my sister yesterday about my past weekend, when she commented that it was interesting to her, that both of my children had dropped their old b.f.f.'s and had acquired new ones in the same time period. I asked her if she thought it was a coincidence and she said she had no idea. Well, I will tell you who also has no idea. Stephen Dubner and Steven Levitt, authors of Freakonomics,

How could two smart men get this so wrong? In their book, they are pondering the question of how much influence do parents have over their children. They state rather emphatically that our children our much more influenced by their close friends and peer groups.

Lets go back to my sister saying what a coincidence about my children swapping out their friends. Two years ago when we moved here from Ca., we could not sell our home in Newport Beach. We were "under water" with our mortgage. When we rented our house in Ohio, I had died and gone to Heaven. No more lawn cares, house painting, worrying about leaks, nothing! I lost about 3/4 of what triggers my anxieties. I was able to be more relaxed and could concentrate on having fun with my kids. I lost my edge of irritation that in the past would infect my tone of voice.

When we first landed in Ohio, my children let their friends pick them. After winning the war on gaining self-control over my emotions, I stopped infecting my children with messages of hate. In turn, they were getting rid of their noisy friends. The result was their next choice of friends were a higher quality of people. My kids no longer feel like puppets because they are in control.


Will Bachman

This chart has fascinating data, but the presentation is deeply misleading.

It appears that the radius of the circle is proportional to the dollars / victims.

But since the area goes as the square of the radius, the differences are vastly exaggerated.

The American Heart Association has 10 million victims, about 8 times the 1.2 million victims of the National Tuberculosis Foundation, but the grey circle of the AHA looks abous 100 times bigger than the grey circle of the NTA.

It would be more responsible to do a simple bar chart of dollars / victim: not as sexy of a chart, but a much more relevant comparison.


That chart is pretty misleading. It's natural to read it in terms of the *area* of the circles, but they are actually graphed according to the *diameter*. For example, based only on the graph I would have guessed the top circle (polio) to represent about 8 times the spending of the very next circle (tuberculosis), since you could fit about 8 of the smaller one inside the bigger one. Instead the spending is not even 3 times as high.

The usual purpose of a chart is to make it easier for us readers to understand the relationships between numbers. When it actively misleads us, you'd be better off not even having one!


Got a similar chart for the last decade or so?

Got a chart for the Smile Train (of which I am a HUGE fan).

Along these lines, does it make economical sense that the BMGF is spending so much money to eradicate a disease that affects relatively few, when the money could be better spent on other, more prevalent, diseases?

mfs insd

Greed. I too, would have no incentive to solve the problem when I am being paid that much coin to treat and maintain the problem. They have a quite a gig going. It's great work if you can get it.

ian allen

These comparisons are based on radii not area and thus square the true ratios for a sensationalised visual effect.
area comparisons are appropriate here, as the underlying point is still valid and will still show clearly.