Global health centre
01 April 2017

Political Barriers to Polio Eradication: Perspectives from Washington D.C.

On the verge of success, this year will hopefully mark the global interruption of wild poliovirus transmission once and for all. Gearing up for the final stretch of eradication efforts, Rotary International and the Bill and Melinda Gates foundation will be join forces this June to host a major polio pledging event at the International Rotary Convention in Atlanta. The Global Polio Eradication Initiative (GPEI) currently faces a number of challenges, not only in sustaining sufficient commitment to complete eradication, but also in ensuring that learning and assets from this unprecedented public health initiative are responsibly absorbed into other health functions. Many of the perceived obstacles to achieving these tasks are political rather than technical and this constitutes one of the reasons the GHC is undertaking research on the political barriers to polio eradication in the European context.

Similarly to the research done by the GHC, the Center for Strategic and International Studies (CSIS) in Washington D.C. has conducted research on polio-related activities and policy, with a primary focus on the U.S. policy context. Nellie Bristol, Senior Fellow at CSIS’ Global Health Policy Center, joined Stephen Matlin on 30 March 2017 at the Graduate Institute for a conversation about her research and the key challenges remaining for polio eradication, particularly in relation to the changing political context in the U.S. A central concern to all polio stakeholders is the question of whether political and financial support to the Initiative will be sufficiently maintained to protect the world’s US$ 9 billion dollar investment in eliminating polio and finally achieve eradication. Over its nearly three decades of operation, the GPEI has benefitted from significant U.S. leadership, with the U.S. constituting the single largest contributor to the Initiative. The U.S. Centers for Disease Control (US-CDC) and U.S. Agency for International Development (USAID) have been significant actors in polio eradication efforts. Nellie Bristol highlighted that the most pressing challenges in the U.S. context include general political uncertainty following the 2016 Presidential election and the lack of capacities to effectively make the case for polio in connection to other health issues. Rotary International has played an important role in lobbying for support tied to this specific health issue – an approach Bristol said will need to be continued to make sure key global health concerns remain on the domestic agenda.

Once polio is eradicated, special efforts will be necessary to ensure that the investments made in polio-related infrastructures, as well as the knowledge gained by the many stakeholders involved are effectively captured in local, national and global health systems. In this regard, fears of waning political and financial support are even more pronounced. In the U.S., there is currently no consensus on the transition of polio assets: while in Europe there is support for health systems strengthening and universal health coverage, this agenda is not prominently supported in the U.S. context. The U.S. prioritise a vertical approach to health which facilitates monitoring and the tracking of funding. Therefore, in the U.S, the recently started conversations on transition have to be carefully nurtured and have to yet gain momentum. Not all of the stakeholders currently engaged in polio eradication will continue their commitment beyond certification, hence, it is yet to be determined which agendas and actors will rise to the task of ensuring the polio legacy. In this context, the importance of drawing lessons learnt and analysing the role of eradication in public health was highlighted in the discussion.

As the global health community awaits the approaching WHO Director-General election, the fate of polio eradication efforts weigh heavily on the mind, both in terms of what successful eradication could mean for the most vulnerable communities, and primary recipients of live-saving polio-related interventions; and for the global community in terms of what lessons learnt and assets from polio efforts will be successfully applied to future ventures in global health. The sustainable transition of polio assets is a key issue for the upcoming World Health Assembly in May.