Should Bill Gates call the shots with polio?

Bill Gates is waging war with polio. The world has been on the verge of eradicating it for years, but stubborn pockets of disease remain in countries like India and Nigeria. Gates is now putting the might of his foundation behind eradication and is calling on governments and scientists to join him.

This latest move that has drawn fierce criticism from leading global health experts, including Donald A Henderson, the lynchpin in the smallpox eradication campaigns. The editor of The Lancet, Richard Horton, recently tweeted that global health does not depend on polio eradication.

The Gates Foundation has stirred controversy over disease eradication before. In 2007, it took the global health community by surprise when it announced a drive to eradicate malaria. Then too, malaria experts were concerned that it would divert from urgent research to control the disease through drugs and vaccines, and the jury still seems to be out on whether pushing for eradication is sensible.

Those who support Gates' polio plan argue that while eradication is more complex than it was for smallpox, aiming high can't hurt. The problem is that any move Gates makes is significant. Where Bill Gates go, the rest of global health follows. Arguably this then means that his foundation cannot ignore the judgement of the scientific community.

It is worrying then that in an article in the New York Times, Ezekiel J. Emanuel, chief bioethicist for the US National Institutes of Health says that since he had not seen enough data to form an opinion, he deferred "to people who’ve really studied the issue, like Bill Gates.”

Surely the balance has tipped the wrong way if a key figure in one of the world's most important health institutions, and who is said to be highly influential in the Obama administration, is looking to a philanthropist for advice on public health?