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Polio Eradicated in Africa
On August 25, 2020, the World Health Organization officially declared the African continent free of wild poliovirus after reports of zero cases since August 2016. This achievement comes after decades of ambitious initiatives that distributed vaccinations to the African population in an effort to stop polio’s spread. In what many are describing as a “momentous milestone,” the news of polio eradication in Africa provides hope that other preventable diseases will one day be eliminated too.

What is Polio?

Polio, the disease that the poliovirus causes, is a highly contagious and potentially deadly illness commonly spread through feces. While one in four people infected merely experience a flu-like illness or are asymptomatic, polio presents serious symptoms to vulnerable populations, especially children.

Severe symptoms that people associate with polio include paresthesia, meningitis and paralysis. Paralysis, the most dangerous and most well-known, occurs in roughly one out of every 200 cases. The muscle and nerve damage that these side effects cause can permanently disable or even kill an infected person if vital organs, like the lungs, become paralyzed. Even after recovering, many younger patients suffer post-polio syndrome (PSP) which may cause muscle pain, weakness or paralysis in adulthood.

In the early ’90s, an estimated 75,000 African children became paralyzed each year due to polio. Due to Africa’s poor healthcare system and sanitation infrastructure, preventing the disease’s spread proved difficult. There is currently no known cure or treatment for polio, making it especially dangerous for children in poor regions suffering other medical issues like malnutrition. However, through multinational and multi-organizational efforts, polio rates began to decline as immunization rates rose.

How Did Africa Eradicate Polio?

The fight toward polio eradication in Africa began with the creation of the Global Polio Eradication Initiative (GPEI) in 1988, followed by Nelson Mandela’s Kick Polio Out of Africa campaign in 1996. These efforts aimed to combine resources from governments, U.N. bodies and organizations like the Bill and Melinda Gates Foundation to sponsor massive surveillance and immunization campaigns throughout the continent.

The combined efforts of these groups brought nearly 9 billion polio vaccines to Africa, according to the World Health Organization. Braving wilderness and war zones including territory held by the terrorist group Boko Haram, 2 million volunteers from organizations like Doctors Without Borders, UNICEF and Gavi immunized even the most isolated African villages.

The report of the most recent wild polio case was in August 2016 in northeastern Nigeria, within Boko Haram territory. However, the Nigerian government and outside supporters were able to quell the outbreak’s spread; since then, zero wild polio cases have occurred in Africa. This years-long feat allowed the World Health Organization to declare polio in Africa eradicated in 2020, a major feat for the continent’s residents and healthcare systems.

What Now?

Estimates determine that international efforts to defeat wild poliovirus in Africa have averted 1.8 million cases and 180,000 deaths. However, these figures only apply to the wild poliovirus—they fail to account for vaccine-derived polio.

There are two main types of polio vaccinations: oral and injected. Because the oral polio vaccination is much cheaper, it is most commonly used for widespread polio immunization campaigns in developing countries. However, this vaccine relies on a weakened version of the poliovirus to immunize rather than the inactive virus utilized by the injected vaccine. This disparity has led to occasional outbreaks of vaccine-derived polio in some African nations.

Currently, GPEI and its associated NGOs in Africa are working to curb any vaccine-derived polio outbreaks while frequently updating vaccinations for vulnerable children. There are only two remaining countries, Afghanistan and Pakistan, that have reported cases of wild polio in the past 12 months. However, by following Africa’s lead and adopting immunization initiatives, there is hope that wild polio can subside permanently in all countries.

– Aidan Sun
Photo: Flickr

polio vaccineIn a coordinated effort of unprecedented size in vaccine withdrawal, 155 countries switched polio vaccines. The switch to the newer form of the polio vaccine occurred between April 17 and May 1 and could help stop the trend of polio-based paralysis in hundreds of thousands of children.

Monitors from the World Health Organization are following up in various countries to confirm that stocks of the old vaccine have been properly disposed of. The switch was the second phase of the WHO’s Polio Eradication and Endgame Strategic Plan 2013–2018.

Eventually, the WHO’s plan anticipates a complete withdrawal from oral polio vaccines in 2019 or 2020.  In addition, it foresees a complete reliance on inactivated vaccines, which contain dead forms of the virus.

Health care providers use oral vaccines because they are cheap and easy to administer. These vaccines work by containing a weakened, but still live, form of poliovirus and exit in the stool shortly after vaccination. In areas with very inadequate sanitation, the viruses have an extremely small chance of spreading between children and redeveloping the ability to cause paralysis.

The switch is from a trivalent form of the polio vaccine that protected against three strains of the virus. The newer, bivalent form no longer contains the type 2 strain, which has been declared eradicated in its “wild” form with no new cases since 1999. Because the Type 2 vaccine viruses can reduce immunity to the other strains and increase the chance of redeveloping paralysis, removal of the type 2 component was the next step in the long-term polio eradication plan.

The global polio eradication has found success in all but two countries, Pakistan and Afghanistan, since it began in 1988. The U.S., which discontinued use of the oral vaccine since 1999, relies on the injectable polio vaccine and was not involved in the recent switch.

The slight possibility of a Type 2 poliovirus outbreak exists because of the switch. Therefore, a stockpile of monovalent oral polio vaccine containing only the type 2 virus will be kept. Synchronizing the switch across the globe was thus crucial in minimizing the risk of the Type 2 poliovirus reemergence.

Polio is at its lowest rates in history. Leaders of the eradication program foresee that if no additional cases occur in the next three years, polio could be declared fully eradicated by 2019. However, countries should continue vaccination for at least five years afterward. If success continues, polio will be only the second disease after smallpox to be eradicated by vaccines.

Esmie Tseng

polio_eradication_in_nigeria

1. Is Nigeria “polio-free?”

Not yet. Global health organizations have not documented a case of polio in Nigeria–one of three nations that have never fully eradicated polio–since July 24, 2014. However, the World Health Organization (WHO) will not declare Nigeria “polio-free” until the West African nation reaches a full year with no new cases.

2. Is it probable that polio will permanently be eradicated in Nigeria?

That depends on whom you ask. On one hand, polio eradication in Nigeria has almost been successful, and recent media coverage seems hopeful that no new cases will appear in the twenty-some days before the WHO’s approval. Eradication of polio on the entire contiguous continent of Africa also seems plausible, as officials declared in June 2015 that the outbreaks in Equatorial Guinea, Ethiopia and Kenya are no longer health threats. This could mean that worldwide efforts to eradicate polio from Africa have improved since the outbreaks began in 2013.

However, some health officials warn that the world should not be too quick to celebrate. Hamid Jafari, the polio chief at the WHO, warned that the virus is very difficult to detect.

“We are not yet certain that the wild poliovirus is gone from the African continent,” said Jafari, “there are areas in the African region in the northeast of Nigeria, Lake Chad, the north of Cameroon where the situation is uncertain security-wise. We may have undetected transmission of poliovirus there.”

3. Why is polio so difficult to detect in Nigeria?

There are a variety of health and political concerns that have made the nation difficult to vaccinate since the early 2000s. From the medical perspective, people often spread the virus without showing any symptoms. Only one in 200 polio cases cause paralysis.

In short, the fact that health officials have not reported any cases does not mean that people in Nigeria are not infected.

Additionally, some areas in Nigeria–like the locations that Jafari referenced above–are near impossible for vaccination teams to reach because of the control of Islamic militant groups. Boko Haram, one of the most “lethal and resilient” jihadist groups in the history of Nigeria, has repeatedly denounced efforts to eradicate polio, claiming that vaccinations are a ploy by the West to sterilize Muslim children.

4. Is religious opposition to vaccinations in Nigeria the source of the problem?

Not really. Boko Haram’s skepticism and violence toward polio vaccination campaigns are based more on its opposition to Western culture than the specific religious beliefs of Islam. Boko Haram is a loose translation of “Western education is forbidden.” Present in Nigeria since 2002 and active in military operations since 2009, Boko Haram is a group of roughly 9,000 men (according to CIA estimates) that seeks to establish the Islamic State in Nigeria by purging the nation of Western influence.

Analysts say that governmental effort to reduce Nigeria’s chronic poverty and construct an education system that is inclusive of local Muslims is the only way to eliminate the threat of Boko Haram. However, the violent actions of jihadist groups against vaccination campaigns are not representative of the entire Islamic community in Nigeria.

Although resistant to vaccination efforts initially, Muslim leaders were actively involved and very influential in vaccination campaigns in the years before 2012, often citing moral principles as justification.

“We don’t care if it’s something that will affect you and your family alone. But [if] you don’t comply with us, you allow your child to go—he’s going to spread it to 200 other innocent children around the vicinity,” said Nigeria’s top-ranking Muslim and the “polio point man” for the region of Kano, Wada Mohamed Aliyu.

5. What outside assistance do foreign organizations provide to Nigeria?

National and local municipalities and organizations in Nigeria play a role in polio detection and prevention as well as immunization, but many global actors have greatly contributed to efforts in order to eradicate the virus. The Global Polio Eradication Initiative (GPEI), spearheaded by the World Health Organization, Rotary International, UNICEF, the United States Center for Disease Control and Prevention, and the Bill & Melinda Gates Foundation, have worked with Nigerian groups to lower the global incidence of polio by 99% since 1988. The GPEI and its associated organizations have not only financially funded eradication efforts but have also actively been strategic partners that have provided technical and political support to Nigeria. Gavi, the vaccine alliance, has also been a major player in facilitating the implementation of inactive polio vaccines, which work in tandem with oral polio vaccines to secure a polio-free world.

Paulina Menichiello

Sources: NPR 1, NPR 2 , BBC, NPR 3, NPR 4, Polio Eradication
Photo: Monitor Healthcare

Polio_immunity
New research has shown that the use of two vaccines in conjunction may dramatically increase polio immunity. Children who receive a vaccine shot after taking an oral vaccine show greater resistance to the disease than those who receive no follow-up shot, and even those who take a double dose of oral medication.

The World Health Organization announced that combining vaccines is starting to be used for mass vaccination campaigns in heavily affected regions, as well as for routine immunizations is developing countries. The double-vaccine method is currently being used in Nigeria and will soon be launched in Pakistan.

The fight against polio has been relatively successful. Within the last 26 years, the number of countries regularly affected by polio has dropped from 125 to three.  The number of cases has fallen by 99 percent. But with increased international travel, the threat of polio is resurfacing in countries previously deemed free of the virus. In May, the WHO declared an international public emergency, reporting polio outbreaks in at least 10 countries.

Until now, researchers were unable to determine a vaccination programs that provided optimal results. But trials in India have established that two vaccines used together yielded the lowest amount of virus in subjects’ feces, one of the major ways the virus is spread.

Oral Poliovirus (OPV), the oral polio vaccine, consists of a two-drop dose of weakened polio virus. It induces immunity within the digestive tract, so it has long been used to disrupt person-to-person transmission of the disease. However, this type of immunity diminishes with time, and in certain cases OPV can actually trigger a vaccine-caused case of polio. This is why inactivated poliovirus (IPV), the vaccine shot, has been added to the procedure. IPV provides immunity stronger and more extensive immunity by traveling through the bloodstream, and also protects against potential infections caused by OPV.

“The results that clearly demonstrate that IPV substantially boosts both [intestinal] and [bloodstream] immunity in children previously vaccinated with OPV are historic and have major operational implications for the global polio eradication effort,” said Dr. Hamid Jafari, WHO’s director of polio operations. He added, “It could play a major role in completing the job of polio eradication once and for all.”

Developing countries still favor oral vaccination because it is less expensive and easier to administer. But OPV’s temporary effectiveness makes it necessary for children to receive repeated doses. The injected vaccine is more expensive, but it is deemed by experts to be worth the investment because only one dose is necessary and it eliminates polio in infected areas more rapidly.

Using the combination strategy is also effective when fighting endemic polio in remote and war-torn areas where oral vaccines may not always be safely or routinely delivered. “We want to take maximum advantage of each contact with a child, said CDC vaccine expert Dr. Steve Cochi. “It’s the start of the last stand for wild polio virus, and we’re trying to hit it with both vaccines.”

– Mari LeGagnoux

Sources: Yahoo, Tech Times, Medscape
Photo: flickr

CIA_vaccinations
The CIA has chosen to end vaccination programs after violent outbursts were directed at federal agents in Pakistan. American-led public health efforts in the Middle East have been met with widespread suspicion after the agency commissioned fake vaccination drives to help discern the whereabouts of bin Laden.

Although this tactic ultimately failed to assist the manhunt in any fashion, Pakistanis have publicly rebuked the CIA’s continued involvement with public health initiatives in the country. The doctor who collected DNA from this ruse operation was indicted and has been sentenced to 33 years in a Pakistan prison.

The controversy surrounding CIA vaccinations in Pakistan is compounded by the persistent prevalence of polio in the country. Sixty-six cases of the debilitating virus have been identified since the beginning of 2014. This marks a disconcerting increase from last year, when only six new cases were reported around this time.

The World Health Organization (WHO) has publicly welcomed the end of CIA vaccinations in Pakistan, insisting that all health initiatives are compromised when the U.S. engages in these types of missions.  WHO hopes greater transparency and legitimacy from Western NGOs will forge a lasting trust between local populations and foreign doctors.

“This reassurance is coming at the right time and we sincerely hope this will contribute toward reaching the children,” Zubair Mufti of WHO told BBC. “Public health programs should only be focused toward providing health to the people and not collateral things.”

Even the White House conceded the fake vaccination drives did more harm than good.

“While political and security agendas may by necessity induce collateral damage, we as a society set boundaries on these damages, and we believe this sham vaccination campaign exceeded those damages.”

Taliban leaders have also applauded this decision. The terrorist organization banned all associated community members, including women and children, from taking part in any vaccination program two years ago. World health leaders like Mufti are hopeful the prohibition will be lifted soon after this announcement, as he believes this would be a vital first step toward eradicating polio in the Middle East.

However, other substantial obstacles complicate the mission to achieve universal vaccination. Despite hundreds of studies disproving any correlation between vaccinations and reduced mental capacity, many citizens of developing and developed nations alike continue to believe these shots lead to mental deficiencies later in life. In addition, it may prove especially difficult to convince Middle Eastern communities of the legitimacy of current vaccination platforms after the CIA admitted to the botched program to track down bin Laden.

Yet, this decision appears to be an important first step toward eradicating the acute, debilitating virus that can result in paralysis.  Although the world is a ways away from achieving universal vaccination and eradicating polio altogether, Pakistan is certainly a great place to start.

– Sam Preston

Sources: BBC, FOX, NY Times
Photo: Humanosphere

Polio Workers
After nearly three months in captivity, six polio workers of the World Health Organization (WHO) have been released by their abductors in Frontier Regional Tank (FR Tank), stated an official on Wednesday.

On the morning of February 17, the six employees departed for Peeng village, located in the northwestern region of Pakistan, to administer polio vaccination drops. Unidentified armed men abducted their convoy and held them in an undisclosed location.

According to the official, the release was largely due to a jirga, a tribal council comprised of eight local tribal elders, who succeeded in negotiating with the captors. Thus far no group has claimed responsibility for the abduction nor is it known whether a ransom was paid.

Those kidnapped included three security personnel, two doctors and their driver. A similar situation took place in February when one polio worker and three Levies personnel were kidnapped from Awaran and released one day later.

Although these hostages were released, the level of violence against polio workers remains a serious threat. It has interrupted polio vaccination operations in the past. Women have often been the target of such violence, with as many as 30 employees of Lady Health Workers, a female health organization, killed in the past two years. In late March one female polio vaccinator was kidnapped from her home and violently murdered.

Beginning in 2006 and escalating in 2011 after the assassination of Osama Bin Laden, Taliban officials residing mainly in the northern, tribal regions of Pakistan, have vilified polio vaccination teams as spies seeking to sterilize Pakistani children.

This constant struggle between militant groups and polio vaccination teams has increasingly had an effect on children, the main beneficiaries of the vaccine.

Reports of polio in Pakistan increased from six cases in 2013 to 54 in 2014, the majority of which originate from the tribal regions of the country, specifically North Waziristan, South Waziristan, the Federally Administered Tribal Areas and the densely populated Peshawar Valley.

Even more significant is the increase in polio sightings outside of the three countries in which it is still endemic—Pakistan, Nigeria and Afghanistan. So far this year, cases have been reported in Equatorial Guinea, Iraq, Cameroon, Syria and Ethiopia.

If trends continue, the WHO warns that untreated polio may result in 200,000 new cases every year.

– Emily Bajet

Sources: The Guardian, Central Asia Online, The News, The News, Tribune, Dawn, Dawn
Photo: Headline Asia

Poliovirus Spreads to Equatorial Guinea
The Polio Global Eradication Initiative announced that “a new wild poliovirus type 1 (WPV1) case was reported in Equatorial Guinea” on April 16 2014.  The country has reported three known cases and due to the genetic sequencing of the virus, health officials believe the virus spread from neighboring country, Cameroon.

This poliovirus outbreak contradicts Equatorial Guinea’s statistics in previous years. The UNICEF Annual Report 2012 for Guinea Bissau declared, “Guinea Bissau has been “polio-free” since 2009…due to vaccination campaigns through child health days and strengthened routine immunization.” According to NPR’s article “Polio Hits Equatorial Guinea, Threatens Central Africa” report, however, the country currently has a vaccination rate of only 39 percent, suggesting that routine immunization programs have decreased since 2009.

Similarly, in Cameroon, the origin of this outbreak, the World Health Organization calculated that 40 percent of children are inadequately vaccinated against the poliovirus. Immunization prevents the spread of the poliovirus, which is an infectious disease with no cure that can cause permanent paralysis. It is communicable via person-to-person contact. Children under the age of 5 are especially susceptible to contracting the virus, making proper immunization campaigns are essential to elimination of an outbreak.

According to the World Health Organization (WHO), from January 2014 to April 2014 ten countries reported a total of 61 polio cases.  When an outbreak of the poliovirus began in Cameroon in October 2013, the country conducted immunization campaigns in response. On March 17 2014, however, Cameroon confirmed new cases of the poliovirus.  In the WHO’s “Poliovirus in Cameroon update”, the WHO elevated “the risk assessment of international spread of polio from Cameroon to very high.” Despite the organization’s attempt to contain the outbreak, the poliovirus spread to Equatorial Guinea.

In an April 24, 2014 UNICEF news note, UNICEF Representative in Equatorial Guinea, Dr. Brandão Có, stated, “Stopping the transmission of polio in Equatorial Guinea is a key priority in order to ensure children, families and communities are protected against this terrible and crippling disease that also has enormous social costs.” UNICEF also reported that a campaign to vaccinate 300,000 children against the virus commenced on April 24, 2014.

— Jaclyn Ambrecht

Sources: NPR, Polio Global Eradication Initiative,, UNICEF(1), UNICEF(2), World Health Organization

Violence Against Polio Workers
In the most recent attack against health workers, one doctor, three guards and two local employees of the World Health Organization (WHO) were kidnapped while administering polio vaccine in Khyber Pakhtunkhwa, a north western region of Pakistan.

Although no group has yet claimed responsibility, militants in the area have a history of inflicting violence against polio vaccinators, whom they accuse of sterilizing their children and being United States spies.

This attack follows a bombing in Peshawar, where a bomb targeting another polio vaccination team killed a policeman.

Polio workers have encountered violence in Pakistan since late 2006, when Taliban officials took control of Swat in the Himalayan region. They prohibited polio vaccination campaigns and vilified Lady Health Workers, many of whom stopped working due to direct threats to their lives.

Matters escalated even further after the assassination of Osama bin Laden in 2011. Under the ruse of a vaccination-campaign, CIA operatives infiltrated Bin Laden’s compound in Abbottabad, which allowed them to test his children’s blood and guarantee his presence at the complex.

Since then, Taliban violence against polio workers has continued unabated, with more than 40 people, including health workers, the police teams guarding them and bystanders having been killed in Pakistan. Torture is also not unheard of, as experienced by three members of a polio vaccination team late last year.

After a particularly violent week against workers in December of 2012, UNICEF and the WHO issued a joint statement condemning polio attacks.

“Those killed or injured, many of whom are women, are among hundreds of thousands of heroes who work selflessly to eradicate polio and provide other health services to children in Pakistan,” said the statement. “Such attacks deprive children in Pakistan of their right to basic life-saving health interventions and place them at risk for a disease that causes lifelong disability.”

Typically affected children under the age of 5, the virus may result in paralysis and death.

Polio remains endemic only three countries in the world, including Pakistan, but if left untreated, officials warn it could trigger as many as 200,000 new cases every year.

– Emily Bajet

Sources: UNICEF, The Express Tribune, The Guardian, Newsweek Pakistan, Open Democracy
Photo: Washington Post

Polio_Vaccine_Global_Initiative
Polio is a disease that not too many people in the first world often worry about. In between bird flu scares and worrying whether vaccinations are good for you, no one really pays attention to Polio. Why would they? Polio is a dead disease, it’s like Latin. It just does not matter because it just does not happen, right?

Wrong. There is a misconception that Polio somehow was eradicated in the 1900s, as if we fought a war on disease and Polio was one of the causalities. Polio is very much real, and many Americans have probably come into contact with Polio in their lifetimes.

Polio is not dead, it is tamed. Vaccinations are what have laid this beast to rest. The Polio vaccine was discovered in the mid-1900s. Since then, the vaccine has been recommended universally (The History of Vaccines).

According to the Polio Eradication Initiative, there are three countries that still have epidemics. One of these countries are in proximity to West Africa and the Horn of Africa where Polio vaccines are not very common (Global Eradication Initiative) If nothing is done about the Polio epidemics in these three nations, it has the potential to spread further and become a global epidemic anywhere that Polio vaccinations are not sufficient.

Currently, the cost to immunize a child against Polio is anywhere from $1-$6 (Simeon Binette). Although that number is much larger when multiplied by the number of children in need of vaccination, it is still a relatively low cost to prevent a worldwide outbreak. Furthermore, it is a luxury most countries have. It is not the norm for a nation to not be able to afford Polio vaccinations, and if they cannot, it is not difficult for organizations such as the WHO or UNICEF to support.

That would be the simple analysis, however there is more to the cost of solving this problem. Many of the children that are not vaccinated in Afghanistan, are not vaccinated because of conflict (Global Eradication Initiative). It is either very difficult or impossible for health officials to get to certain areas of the country and provide these immunizations. The price that needs to be paid here is the end of a war that has been raging for a decade.

Pakistan is having difficulties managing their vaccinations because of a failing government that cannot properly provide a program to vaccinate children nationwide (Global Eradication Initiative). The price that must be paid here is a new government.

Finally, Nigeria. According to the Global Eradication initiative, social problems in the northern half of Nigeria pose a significant block in their efforts to vaccinate children. The price to be paid in Nigeria, is liberal social change.

Basically, even if the funds are there, we have to pay with peace, governmental accountability, and social change; among other things. However the real cost of Polio, is the child in Afghanistan, who will not be able to walk past his fifth birthday, because the adults wanted to fight a war.

– Zachary Patterson

Sources: Global Eradication Initiative: Infected Countries, The History of Vaccines: Polio, Bloomberg, Poliomyelitis

rsz_poliovaccine2
The global community is painstakingly close to eradicating polio. Increases in vaccinations have spared the lives of more than 10 million people worldwide. Polio, a disease which used to claim the lives of up to 500,000 people a year, is almost gone. Its eradication would be a crucial milestone in transforming global health and demonstrating the effectiveness of collective action.

Global collective efforts have brought together UN agencies, governments, foundations, private businesses, and individuals to combat this disease. Worldwide, the number of recorded cases last year fell to an all-time-low of 223. There are only three countries where polio remains endemic: Afghanistan, Pakistan, and Nigeria.

These countries are susceptible to polio because of the fringe communities such as nomads, migrant workers, and displaced populations. People are much more likely to contract polio in areas of conflict and insecurity. In order to eradicate polio, vaccines must be delivered to the most marginalized of our society. This requires belief that every person has equal worth.

If the global community is not careful, and do not maintain its commitment to vaccinations and eradication, the World Health Organization has warned that the disease could break out again, reversing the last few decades of progress. This caveat has motivated UN Secretary General Ban Ki-moon to intensify efforts to eliminate the disease.

This ambition has lead the Global Polio Eradication Initiative to develop a six year strategy requiring countries where polio remains, to step up their efforts to vaccinate all children. Additionally, they are pressuring over 100 other countries to refine their polio immunization programs to ensure all children have access to the vaccines.

Kofi Annan has been urging the international community to provide the necessary funding to make vaccinations for marginalized and hard to reach children possible. The Global Vaccine Summit in Abu Dhabi this week implores partners and philanthropists to dig deep to support increased access to polio vaccinations.

It is vital that people understand that vaccinations improve overall health and drive development. Additionally, there are impressive financial benefits to eradicating polio – in the sum of an estimated $40 billion or more – with most of them accruing in the world’s poorest countries. Success of this nature begs the question: what do we, the global community, have to lose?

– Caitlin Zusy 
Source: Guardian