Thirty years ago, polio infected about 350,000 people per year. But last year, just 21 contracted the disease. That reduction stems from a worldwide increase in vaccination efforts, which has a compounding effect: The lower the number of known carriers, the less chance the disease will spread.
Bill Gates, whose Gates Foundation has heavily funded this work, did some math on the avoided fallout, which he posted to his personal blog in January. Over the last several decades, about 2.5 million kids have been vaccinated, resulting in at least 16 million people without paralysis. One of the biggest innovations in the anti-polio movement, though, is how Gates helped pay for it.
In 2014, the Gates Foundation announced a partnership with the Japanese government, which agreed to add to its already-strong track record of working to end polio by providing a loan of $76 million to Nigeria to further its progress. With the help of international aid investment, Nigeria has steadily reduced the prevalence of polio since 2012, when the country accounted for half of all cases globally. Rather than keep the developing country on the hook for the multimillion-dollar tab for that progress, the Gates Foundation offered to repay it, if Nigeria achieved certain benchmarks: Over 80% of the country’s highest-risk areas needed to have more than 80% of their residents covered by vaccines, according to a Gates Foundation spokesperson. As of this year, those conditions have been met.
While the foundation declined to share its exact logic for outsourcing the loan, the reason is pretty obvious. Short term, the nonprofit could focus money elsewhere–it spends an estimated $3 billion annually in international aid–and incentivize on-the-ground partners to hit the aforementioned health benchmarks with the promise of repaying the cost. “The aim of this innovative mechanism is to support the recipient government’s commitment to its polio eradication efforts without imposing a financial burden,” noted the Japan International Cooperation Agency at the time of the announcement. The Gates Foundation knows this tactic works: It did the same thing with $51 million in aid for Pakistan in 2011. (Only Pakistan, Nigeria, and Afghanistan are currently struggling with the disease.)
Overall, the foundation’s hope is to totally wipe out the disease. That goal necessitates a more strategic attack plan, and a more consistent way of measuring success, than if, for instance, the foundation was just aiming to lower rates of infection. “Gates’s commitment to end polio is certainly a bold, ambitious goal, and this move is one towards a ‘winnable milestone,'” adds William Foster, a partner at Bridgespan, a nonprofit consultancy, in an email to Fast Company. That’s one of the key factors that Bridgespan has identified as crucial for audacious philanthropic change.
It’s important to note that countries aren’t considered disease-free once their number of reported cases hits zero. For two years beginning in 2014, Nigeria believed itself to be polio-free, only to see two cases pop up in 2016. Health officials expect it will take several years to ensure there are no further outbreaks.
“The Gates Foundation is pleased to repay the loan [from] the government of Japan thanks to the strong leadership of the Nigerian government in polio eradication,” says Paulin Basinga, the foundation’s director in Nigeria, in an email to Fast Company. But major progress is worth even more than that. Ultimately, the full eradication of polio is an investment in both health and morale building. Gates recently told Fast Company, “The whole let’s-do-more thing doesn’t make any sense if you don’t think there’s some great progress taking place.”