Why do we invest so much time and money on health issues in distant lands when our health needs at home are so great?

There are many reasons; let me explain just one.

Depending on your age, your knowledge of polio is probably limited to recognizing that it is a serious infectious neurologic disease that no longer exists in the United States.

You won't have first-hand experience with the devastation polio can wreak. That's because of the remarkable success over the past two decades at nearly eradicating the disease from the face of the earth – nearly.

The World Health Organization set a goal to eliminate the disease in 2000, and then when it failed, it shot for 2006, and now the goal is 2012.

But we won't achieve this goal.

Success seemed so very close but eradication has become mired in politics and economics. Successful vaccination efforts require local government commitment and community acceptance.

At the moment polio is confined to pockets in South Asia and parts of Africa, but this could change quickly. What these infected areas have in commons is that they lack public health systems, governments there are short-lasting, and there is often more importance placed on wars and security than on human health.

The problem is that with an infectious disease such as polio, holding the current course is hugely expensive – any slight decrease in funding or public health vigilance risks huge failure, leading to the possibility of paralysis of hundreds of thousands of children.

Polio can be temporarily decreased through aggressive public health outreach campaigns such as village immunization days. But for a region to stay polio-free requires ongoing efforts for years.

The world is a different place today than it was at the start of the eradication campaign in 1988. Today people travel around the globe, bringing with them their bacterial passports. In 2001 the African country of Chad was congratulated for eliminating polio. But just across its border in Nigeria, public health systems were weak and immunizations were given low priority. Cases began coming across the border and infecting local people.

Today Chad has the greatest number of polio cases in the world. Angola, also polio-free for much of the early part of this century, is now home to several serious outbreaks. The same story is true for the Democratic republic of Congo, Pakistan and Afghanistan.

There is another problem with polio eradication. The oral Sabin polio vaccine has been amazing in its public health benefits, but on rare occasion the vaccine itself can cause polio. That is because the vaccine is composed of live virus that has been altered.

Last year there were 58 cases of polio that have been attributed to the vaccination itself in the millions of people vaccinated. That compares to hundreds of cases of polio caused by community-spread infections often referred to as the "wild type" infections.

In our globally connected community, local problems quickly become global problems as someone with the infection steps on a plane and ends up in one of our international airports. This is why it is important that, as global citizens, we stand united and use our collective resources to wipe out these horrible diseases.

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• Read more articles by Michael Wilkes, M.D.

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