Global Polio Eradication Initiative

The Global Polio Eradication Initiative is an initiative created in 1988, just after the World Health Assembly resolved to eradicate the disease poliomyelitis by the year 2000. It was described by the World Health Organization as the largest public health initiative in history.^[1]

Strategy

The strategy for the eradication of polio rests on immunizing every at risk child until there is no one left for the disease to transmit to and the disease eventually dies out. The Initiative is spearheaded by the following Organizations:

• WHO (World Health Organization) who are responsible for planning, technical direction, surveillance and eradication certification.
• Rotary International whose responsibilities include fundraising, advocacy, and volunteer recruitment.
• The CDC who are in charge of deploying scientists and public health experts to WHO and UNICEF.
• UNICEF Who is incharge of the distribution of the vaccine and helping countries develop communication and awareness strategies.
• The Gates Foundation as well provided a large portion of the funding.^[2]

Key tactics used by the GPEI include strengthening childhood immunization through oral vaccines, conducting surveillance through investigation of acute flaccid paralysis cases among children under 15 years old (in order to determine areas where the virus is truly eradicated), and conducting "mop up" campaigns in areas where cases of polio have been identified.^[3]

Funding

By 2012 the GPEI had raised 9 billion dollars in funding^[4] and in alone 2011 the GPEI received a 1.1 billion dollars, for a budget of 0.98 billion dollars. 30% of their funding came from the Gates Foundation 30% from developed governments, 27% from countries at risk of polio, and the rest was made up of donations from non profits, private funders, and other foundations. It is likely that the GPEI will become almost entirely funded by private organizations in the future.^[5]

Evaluation

In 1995 a Global Certification Commission was created to oversee the certification of the eradication of wild-type poliovirus transmissions. Certification for the six WHO regions requires all of the countries in that region to be certified by the commission. By the year 2000 both the regions of the Western Pacific and the Americas met the criteria to be certified free of polio transmissions.^[6] By 2012 the initial number of estimated cases in 1988 of 350,000 across 125 endemic countries has dropped to 650 confirmed cases. In addition the 3 of the six WHO regions are now certified polio eradicated (Europe, the Americas, The West Pacific). And India, which many thought would face the greatest challenge to eradication was removed from the list of endemic countries. According to the most recent study by the GPEI, in 2016, there are only two countries still listed as endemic, Afghanistan and Pakistan.^[7]

It is owing to this dramatic reduction that the funding for the GPEI will likely soon come entirely from private donors and foundations such as the Gates Foundation instead of from individual countries. In fact Bill Gates has listed polio eradication as one of his "Top Personal Priorities".

A 2011 study by Middlebury College (commissioned by the Gates Foundation) indicated a list recommendations for how the GPEI should operate moving forward:

• Include surveillance for other diseases in AFP (polio) surveillance systems
• Use integrated campaigns to reach marginalized populations
• Standardize and compile polio’s maps to of marginalized populations to provide them with additional services
• Fund routine immunization in locations with frequent polio campaigns
• Build staff capacity in a variety of areas beyond polio
• Share pertinent information gathered during polio campaigns with other health programs
• Add questions on key health indicators of interest to post campaign monitoring
• Communicate to workers why repeated campaigns are necessary in high intensity areas
• Raise monetary incentives for campaign workers to a living wage or eliminate them entirely
• Conduct cross planning sessions to determine how programs and services can be integrated to reduce workforce burden without compromising programmatic objectives
• Conduct polio campaigns only where and when they are necessary
• Mitigate the most serious effects of service interruption with strategic planning^[8]

Endgame

The final steps of polio eradication for the GPEI, or what is known as the "endgame" are as follows:

1. Detect and interrupt all poliovirus transmissions
2. Strengthen immunization systems and withdraw oral polio vaccine
3. Contain poliovirus and certify interruption of transmission
4. Ensure the remaining investments made to eradicate polio go to the greater cause of improving global health^[9]

See also

• Eradication of infectious diseases
• List of diseases eliminated from the United States
• The Final Inch, a short documentary about the effort to eradicate polio

References