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Stamping out polio has proved harder than anyone imagined, with the latest blow coming in the form of deadly attacks on health workers delivering vaccine in Pakistan and Nigeria.

But despite the recent setbacks, Microsoft co-founder Bill Gates will join with other leaders this week to argue that the crippling disease can be eradicated by 2018, thanks to a new strategy and unprecedented political support in the handful of countries where polio persists.

It won’t be cheap, though. A new estimate puts the total price tag for the six-year push at $5.5 billion, about half of which still must be raised. That’s one of the main goals of a summit that starts Wednesday in the Persian Gulf state of Abu Dhabi, where the focus will be on increased funding from Muslim nations in addition to traditional, Western donors.

“Islamic leadership … is a critical part of this final stage of polio eradication,” said Dr. Chris Elias, president of global development for the Bill & Melinda Gates Foundation.

Islam is the dominant religion in Afghanistan, Pakistan and parts of Nigeria, the three nations where polio remains endemic.

Once common around the world, including in the United States, the sewage-borne virus was eliminated in wealthy countries after the development of a vaccine. When the first global eradication effort was launched in 1988, about 350,000 children a year were paralyzed by polio. In 2012, there were only 223 cases worldwide.

But the disease has clung stubbornly in a few corners of the globe, occasionally flaring up and spreading to other areas. “Until the polio virus is completely eradicated everywhere, no country is safe from reinfection,” Gates wrote this month in the Cairo Review of Global Affairs.

Three previous target dates for eradication — 2000, 2005 and 2012 — have come and gone without success.

But advocates say things are different this time, pointing to new tools and to India’s surprising success in wiping out the disease in 2011.

“Five years ago, most people thought India would be the last place with polio,” Elias said.

The Indian government mustered more than 2 million workers for the polio fight and pioneered approaches now being applied in other countries.

In Nigeria, health agencies are deploying smaller vaccination teams armed with high-tech maps and GPS-equipped cellphones that allow them to cover more homes in less time — meaning fewer households are missed.

In Afghanistan, permanent polio teams are replacing the large-scale campaigns that are easy targets for opposition and violence. When the teams are allowed to work in dangerous areas, they take advantage of the window by dosing children on an accelerated schedule.

As part of enhanced surveillance systems, sewage in vulnerable areas is regularly checked for polio virus. When the bug turned up in Cairo’s sewage recently, the source was quickly traced to construction workers from Pakistan, who were then targeted for vaccination, said Apoorva Mallya, senior program officer for the Gates Foundation’s polio programs.

Every diagnosed case of polio is genetically analyzed to identify where the virus originated, and to determine its type. One of the three major types of polio virus was eradicated more than a decade ago. A second strain appears poised to disappear soon, with only one known case in the past six months.

“If what we’re seeing now is a reduction in the genetic diversity of the virus, that’s another indicator of progress,” Mallya said.

For the first time, the new eradication plan also includes a road map for phasing out the oral polio vaccine, which contains weakened, live viruses that in rare cases can actually cause the disease. It will be replaced by an injectable vaccine that’s more expensive, but contains killed virus with no risk of infection.

Some health experts remain skeptical that the 2018 target will be reached, or that it’s worth such a huge investment to eradicate a disease that afflicts so few people.

An independent panel that evaluates the polio program cautioned recently that “success is far from assured,” and pointed out that several countries are already scaling back their vaccination programs.

Dr. Howard Frumkin, dean of the University of Washington’s School of Public Health, is concerned that the focus on polio will divert money from other health priorities. But he still joined more than 400 leading scientists from around the world in signing onto a declaration of support for the eradication program.

“I think we’re at the 1-yard line now, and we’ve never been there before,” Frumkin said. “I think we need to stick with it.”

What seems like an enormous investment will pay off manyfold in reduced incidence of disease and the ability to phase out costly vaccination programs once polio is no longer a threat, Frumkin said.

Polio would be only the second disease erased from the earth, after smallpox. “If we succeed in eradicating polio, we will prove that setting big goals leads to big victories,” Gates wrote Tuesday in a Globe and Mail op-ed with Canada’s Minister of International Co-operation.

Gates has declared polio eradication his top priority. Over the past few years, the Gates Foundation has spent about $300 million annually on the effort and expects to continue that general level of support, Mallya said. That would pencil out to another $1.8 billion over the course of the six-year eradication program.

Gates and other program coordinators, including UNICEF and the World Health Organization, recently began reaching out to wealthy Arab nations for help bankrolling the effort.

The Crown Prince of Abu Dhabi committed $50 million in 2011 to help vaccinate 35 million children in Afghanistan and Pakistan against polio, and is expected to announce new funding this week. The Islamic Development Bank made its first donation to polio programs last year, with a $227 million financing package for Pakistan.

Sandi Doughton: 206-464-2491 or