14 April 2016

The Last Push – Challenges in Polio Eradication

The world is closer than ever to eradicating polio, with only 11 cases of wild polio so far in 2016. The Global Polio Eradication Initiative (GPEI) Strategic Plan 2013–18 aims at delivering a polio-free world by 2018. However, due to the continuing wild polio transmission in two endemic countries (Pakistan and Afghanistan) another year and an additional US $1.5 billion are currently projected to be necessary to finish the job in 2019. The gains in polio eradication made to date are precarious and constantly at risk of being reversed. Failure to eradicate polio from the last remaining strongholds could result in as many as 200,000 new cases every year within a decade, all over the world.

Adding to these difficulties, the polio eradication endgame is also being undertaken while the world is still striving to recover from the effects of the 2008 financial crisis and is dealing with the worst refugee crisis since World War II. All of this is challenging traditional donor countries both financially and politically. Furthermore, major donor countries are in the process of rethinking both their quantitative and qualitative approaches to aid, a transition that will have yet-unclear impacts on future support for polio and other disease eradication efforts.

Building on this historic and challenging moment, the Global Health Centre has launched a project to explore the critical dimensions of the global effort to eradicate polio, focusing on overcoming the final barriers and ensuring a lasting legacy for health systems. As European actors’ ongoing support to the implementation of the GPEI is key to the success of the polio eradication “endgame”, the project focuses specifically on the role of European countries in this effort and aims to work with European decisions makers (states and the European Commission) as well as other key stakeholders involved in the process.

Polio eradication has been one of the largest global health programmes ever. The health community has an obligation to ensure that the lessons and knowledge generated are shared and contribute to real and sustainable changes to global health.

The Global Health Centre project aims to address and work with European decision-makers to foster critical action on the global public good of polio eradication and ensure a lasting legacy for sustainable health systems. Much can be learned from how polio eradication has been organised and executed at the country level that will help to inform and strengthen health systems capacities and public health initiatives. At the same time, there are aspects of the polio eradication legacy that relate directly to the future of global health, including relevance to disease-specific initiatives and to the governance of global health institutions and initiatives. The project seeks to analyse what can be learnt from polio eradication for the new phase in global health with the transformative agenda of the Sustainable Development Goals and the new strategic phase of global health with a very strong health systems focus. The project views the legacy of polio also in the broader context of ongoing and potential future programmes for the eradication of infectious diseases and will derive broader lessons relating to global health governance. Therefore, particular emphasis is given on the governance and sustainability aspects of what can be learned from the polio eradication efforts and the lessons for health systems, through which the global public good gained can be extended to provide benefit for years to come. How can the transition best be accomplished? What challenges are there for countries trying to complete the polio eradication agenda and for countries trying to support them?

These are pertinent questions which the project attempts to answer through a mixed methodological approach. In addition to an intensive research effort, insights from a series of policy dialogues and roundtables in Europe’s hubs for health policy are being organised in order to discuss remaining barriers to polio eradication and linkages with a broader global health diplomacy agenda and, especially, the polio eradication legacy. A wide range of actors from international organisations, government, civil society, the private sector and the media, but also the public in general are invited to these events in order to gather evidence and share different perspectives and viewpoints.

These policy dialogues focus on different thematic aspects and the first such event was held in Geneva on 11 March 2016 at the Maison de la Paix focusing on “Polio eradication and the implications for health governance”. On 12 April 2016, a breakfast discussion was held with parliamentarians and experts at the House of Lords in London on the thematic of “Polio eradication: Securing the legacy of the global vaccination initiative”, followed by a public event on 13 April 2016, jointly organized with Chatham House, at the Royal Society tackling “Polio eradication: endgame challenges, lessons and legacy”. 

The discussions at these events were extremely interesting. Among many hot topics, the remaining challenges of eradication and continuing vaccination and the policies needed to sustain the endgame and secure the legacy were discussed. This highlighted the necessity to extract and use the lessons learnt and assets built up during the last three decades of the eradication initiative to help strengthen global health governance and build effective and equitable health systems.

The debate on vertical programing is lively in the polio field. It has been discussed whether the polio vertical approach should be applied to other programmes such as Zika or to new developing threats. At first sight, it may seem difficult to contemplate the transfer of polio to another vertical programme, such as measles for instance. However, the Ebola outbreak changed everything, by showing the need for improved response to infectious disease outbreaks and by Nigeria’s demonstration of the value of its polio assets to mount an effective response. A clear case emerges for the use of polio resources, which constitutes a powerful framework, to raise an effective disaster reduction capacity.

The next high-level meetings and public events are planned in Berlin on 2 and 3 June 2016, with further meetings to follow in Brussels and Oslo. Stay tuned-in by following us on Twitter (@_globalhealth) and on our project website.