To this extent, the ethics of eradication is straightforward. However, it is important to counterbalance this ethical commonplace with the recognition that there were a number of failed and expensive eradication campaigns in the twentieth century, including yellow fever, yaws and malaria [4]. In some cases – like yellow fever – the disease should probably not have been a candidate for eradication attempts selleck chemicals llc in the first place, as it has an animal reservoir. In other cases, the failure may more accurately reflect the intrinsic

difficulty of globally eradicating a disease, even where it is correctly judged to be technically feasible to do so. Factors responsible for this high level of difficulty include selleck chemicals the degree of international coordination and

cooperation over a prolonged period that are required for successful global eradication campaigns, the challenges of ensuring that enough individuals continue to be vaccinated to maintain herd protection everywhere in the often long period between the disease being eradicated locally and being eradicated globally, and the continual risk that cases will be exported back into territories that were previously free of the disease as a result of war or political instability [5]. The long endgame of the polio eradication campaign provides a vivid example. The World Health Assembly committed to the eradication of polio in 1988, with eradication originally scheduled to be completed by the year 2000. Recent instability has seen an increase in the number of countries exporting wild poliovirus, a WHO declaration of a Public Health Emergency of International Concern,

about and doubts about the achievability of the most recent target date of 2018. Eradication campaigns differ markedly from standard medical treatments, and even from standard vaccination campaigns, in the way that their burdens and benefits are distributed. In standard contexts of medical treatment, the expectation is that the recipient of the treatment will be its main beneficiary; to give just one example, the International Code of Medical Ethics states that “a physician shall act in the patient’s best interest when providing medical care” [6]. In standard vaccination campaigns, the expectation that the individual person vaccinated is the main beneficiary remains, but such campaigns also aim to create spillover benefits to others from herd protection. As a global eradication campaign moves closer to success, less and less of the expected benefits of a vaccination will accrue to the person vaccinated, and more and more to the world at large through the elimination of the health threat from the environment. As the number of cases of the disease approaches zero, the expected benefit to individuals who are vaccinated may become less than the expected costs, if the vaccine itself poses at least a minimal risk [7].