LONDON/PESHAWAR: When Bill Gates hears about children like Fahad Usman, a two-year-old Pakistani boy crippled by polio before he learned to walk, the billionaire philanthropist sounds frustrated and fired up.

Fear and suspicion have prevented thousands of children like Fahad from being protected against the infectious and incurable disease. Now more than ever, it's time that stopped, Gates says.

Rumours that polio immunisation campaigns are “Western plots to sterilise Muslims” or that the vaccine is “George Bush's urine” underline the need to take politics out of the fight to eradicate polio, he says.

If Gates, the most influential of global health advocates, gets his wish, and in an interview he's pretty sure he will - the world won't stop at the 99 percent reduction in cases so far, but will rid itself of polio completely by 2018.

Yet evidence from Pakistan and Afghanistan, two of only three countries where polio is still endemic, suggests a battle lies ahead to overcome Taliban opposition, vaccine refusals, security and funding gaps to beat out that last one per cent.

“We are working hard to depoliticise the whole thing,” said Gates, whose $35 billion Gates Foundation is spearheading international efforts to eradicate the disease.

He noted what he called “episodes of lack of communication” between those who want to rid the world of polio and some Taliban leaders, but was optimistic that working with new donors and using local knowledge would secure eventual success. He is eager to involve more donors from Muslim countries.

“In no way should this campaign be associated with just the West,” he said. “This is the whole world working together to eradicate a disease.”

PARALYSED FOR LIFE

Polio attacks the central nervous system and can cause permanent paralysis within hours of infection. Two-year-old Fahad is one of 35 children struck down with it in Pakistan so far this year.

“Fahad's left leg went completely limp, and slowly, in a day or so, his right leg was gone too,” his father says.

There is no cure for polio, but it can be prevented. A polio vaccine given in several doses can protect a child for life.

The most recent case in Pakistan was recorded on August 30, and because polio spreads from person to person, the World Health Organisation says as long as any child remains infected, children everywhere are at risk.

Afghanistan and Nigeria have recorded 17 and 88 cases so far this year respectively, while Chad, a non-endemic country which borders Nigeria, has had five.

Immunising the last children on earth is an expensive, business - not because the vaccine is costly (most are made by generic manufacturers and cost between 12 and 14 U.S. cents a dose), but because reaching people displaced by war and poverty requires vast operational logistics, time and human resources.

Gates and experts at the Global Polio Eradication Initiative insist the $2 billion a year needed now will be well worth it.

They say if the campaign succeeds, the world would not only declare its second eradicated disease - smallpox was wiped out in 1979 - it would also be billions of dollars richer.

A 2010 study found that if polio transmission were to be stopped by 2015 the net benefit from reduced treatment costs and productivity gains would be $40 billion to $50 billion by 2035.

Yet getting the pink drops of protective vaccine into every child - over 90 per cent coverage is needed to succeed in wiping out this highly infectious disease - is complex.

Immunisation campaigns have been disrupted by fighting along the Afghan-Pakistan border where villages are home to many of the children missed so far.

And fear is being spread by local Taliban leaders such as Maulana Fazlullah, nicknamed Mullah Radio for his broadcasts from the Swat Valley northwest of Islamabad, who denounces polio vaccinations as Western plots and threatens those who argue.

Senior Taliban commanders, Maulvi Raza Shah and Sirajuddin Ahmad, say they oppose polio vaccines because they don't know what is in them and believe they are part of a plot by the West to sterilise Muslims.

“Every drug has a known formula but polio vaccine has no formula. And then the United States and its allies are giving us this vaccine free of cost when they don't even give free water to their own people,” said Raza Shah.

Accusations that immunisation campaigns are cover for spies were given credence when it emerged that the United States had used a Pakistani vaccination team to gather intelligence about Osama bin Laden.

RISKS AND CONSEQUENCES

At his temporary home in Jalozai, a sea of refugee tents where the family now lives with others displaced by violence, Fahad's father Mohammed Usman talks of the tragic consequences of such cultural and religious clashes.

He says it breaks his heart every time he sees his son struggle to stand. “It's very painful for me to hold him, to know that he will not be able to walk. Every time his mother looks at him she has pain in her eyes,” he says.

Experts say if the eradication effort fails and polio rebounds, the virus could cause up to 10 million cases in the next 40 years. The human and economic costs of that would go way beyond the $9 billion invested so far in trying to wipe it out.

At this point, though, there is an almost $1 billion shortfall in funding for the fight against polio, according to the independent monitoring board's report.

At the United Nations General Assembly in New York this week, Gates held talks with the presidents of Pakistan, Nigeria and Afghanistan, as well as senior government officials from Australia, the United States, Britain, Japan and Canada.

At the same meeting, the president of the Islamic Development Bank announced a loan agreement for $227 million to cover Pakistan's polio eradication costs. The bank also gave a $3 million dollar grant to Afghanistan.

Gates describes this meeting of so many key players in the bid to end polio as a “great evolution”.

“We've got the Islamic Development Bank coming in, we've got ongoing commitment from Abu Dhabi, and we'll have people from both those donors going out to Pakistan to talk about how committed they are and how important this is,” he said.

This high level support, he says, will be combined with detailed house by house or tent by tent plans which document which families are refusing the vaccine, why they are, and whether follow-up with a religious, social or medical official is likely to be most successful in changing their minds.

“Getting people to be comfortable with giving medicines to young children has always required really good social marketing, good outreach and good followup,” said Gates.

“Every piece you tighten up moves you closer towards getting the 90 per cent of the kids to have the drops. And once you achieve that, you can succeed.”