Polio, once one of the world’s most feared infectious diseases, still stubbornly persists, notably in countries with high poverty rates, structural issues that create poor sanitation, and unrest. For decades, global health leaders have waged a campaign to eliminate the virus, and have largely contained it, but the final push has stalled. It is considered endemic in Afghanistan, Pakistan, and Nigeria — having previously been considered endemic in India — but it continues to jump borders, such as to Chad this year. As a result of the resurgence of Polio in 2011, the World Health Assembly as of mid-May was considering adopting a resolution declaring polio eradication a programmatic emergency for global public health.

Last week, the United Nations Secretary-General Ban Ki-moon said the time was now to wipe out polio, asking for another $2 billion in commitments, to save up to $40 billion by 2035. Remember, this is money that if not going to polio, could be going to other pressing global health issues, like malnutrition, which the United Nations, as of 2010, claimed accounted for more than one-third of the nearly 9 million deaths worldwide of kids five and under. The tragic part is, low-cost prevention and treatment measures, according to the UN, could have saved most of these lost lives.

The global campaign to eliminate polio was first launched in 1988. It has been the single-most expensive medical campaign focussed on a single human illness in the history of humanity.

A major funder of polio eradication efforts, the Bill and Melinda Gates Foundation, as of 2009 had pumped nearly $1 billion of their foundation’s money into what is known as a “vertical” intervention strategy, targeting a single disease, not a “horizontal” strategy, which goes after root causes of health issues like social inequality, poverty, and poor primary care infrastructure.

This debate is particularly sensitive with polio, given Bill Gates’ personal trips to Nigeria to convince the country’s leaders to spend their meager health resources on polio eradication, when they face many daunting challenges with a very poor basic health care system. About 800,000 Nigerian children under five die annually, the second highest rate of any nation in the world, according to UNICEFʼs 2009 count.

The campaign that eradicated smallpox in 1979 also offers telling lessons for the polio eradication effort. International aid was $100 million. Recipient nations spent $200 million of their own funds—a scenario many say will repeat with the current polio strategy. The World Health Organization (WHO) reports that in many African nations like Nigeria, government spending on health is less than 5 percent of all outlays. It is unlikely countries like Nigeria can pay for polio eradication and other efforts like reducing child mortality from malnutrition.

Having travelled widely in India in 1989, I vividly recall seeing the victims of polio in many communities. No one wants to see polio’s return. But are the resources this effort demands, particularly for meeting Millennium Development Goals, worth the concerted effort?