World Polio Day: Delivering on the Promise of Polio Eradication
It’s perhaps hard to imagine a time when polio outbreaks led to more than 8000 cases of paralytic polio infections a year in the UK alone. This was the reality before we saw the development of two vaccines against poliovirus in the 1950s - the IPV and OPV. In 1988, polio was endemic (widespread within a particular region or population) in 125 countries, but these life-saving vaccines instilled hope and, with the inception of the Global Polio Eradication Initiative (GPEI), the world made a promise to eradicate polio.
Today, as we approach 9 months without a single new case of wild-polio (the most commonly known form of poliovirus) in the world, it is important to take stock of what we’ve achieved so far. Since that commitment was made in 1988, wild-polio cases have dropped by more than 99.9%. Earlier this year we also celebrated the one-year anniversary of the African region being declared wild-polio free. This is thanks to the tireless efforts of polio workers and over 20 million volunteers around the world. However, the fight is not over. We cannot let complacency hinder this progress. Polio remains a Public Health Emergency of International Concern (PHEIC). Existing cases mean that wild-polio remains endemic in two countries: Afghanistan and Pakistan. Simultaneously, another form of poliovirus known as circulating vaccine-derived poliovirus (cVDPV), which is usually noted amongst populations that have low coverage of the polio vaccine, has been noted in more than 30 countries. We must continue to deliver on the promise made by world leaders and make polio the second infectious disease in humans to be eradicated, after smallpox in 1980.
GPEI plays a vital role in countries’ immunisation systems, and its network of highly experienced health workers has been a precious resource for responding to other emergencies. Polio staff are routinely mobilised to respond to outbreaks of other vaccine-preventable illnesses such as Ebola, yellow fever, dengue, Marburg haemorrhagic fever, measles, anthrax and shigella, as well as other public health emergencies such as an earthquake in Nepal. More recently, polio personnel around the world have used their extensive knowledge of risk communication, disease surveillance and contact tracing to limit the spread of COVID-19. It cannot be overstated that expertise in community engagement or disease prevention can always be applied to other diseases and programmes.
Following the identification of key obstacles for polio eradication in an ever-evolving landscape, GPEI adapted and in 2020 they replaced the existing Polio Endgame Strategy, originally planned until 2023 with an Eradication Strategy (2022-26). The new strategy focuses on overcoming challenges in polio eradication efforts due to COVID-19, reducing response time for outbreaks, and ensuring polio activities are integrated with other essential health services. ‘Integration’ in the context of polio is the process by which essential polio functions such as treatment, diagnostics and disease monitoring are integrated into a country’s primary health care systems and its wider routine immunisation services to ensure sustainability of these functions.
Although integration is a priority that precedes the COVID-19 pandemic, the pandemic emphasised the need to integrate GPEI-supported work into national health systems to ensure stronger and more resilient systems that could also benefit other endemic-prone diseases. Immunisation Agenda 2030, Gavi’s new 5.0 strategy (2021-25), and GPEI, amongst others, all commit to principles of integration that promote ‘collaboration’ of health services such as polio activities, routine immunisation, nutrition and water and sanitation services, and ensure these are integrated into a country’s primary health care services. Programmes at country level are becoming more integrated and streamlined by leaning on each other’s resources and networks.
As we near polio eradication, GPEI will look to wind down its services, and efforts will be shifted towards ensuring we maintain this progress through long-established technical expertise and national ownership – a process known as ‘transition’. Transition means that polio programmes will move to be funded and run domestically, rather than by GPEI. Integrated services can help lay a strong foundation for this transition by building collaborative primary health services. This would allow activities that would otherwise be delivered by GPEI personnel to be embedded into countries’ national health systems, improving the overall coverage of immunisation services and reducing response time in the case of outbreaks. This would also require national health systems that have comprehensive disease surveillance systems and strong community engagement that build trust and strong relationships. They would include strategic coordination and ongoing feedback loops with local, regional and global partners including civil society organisations. Integration has also contributed to increased convenience for service users, improved staff morale owing to a more diverse workload, more learning opportunities and improved efficiency in their work.
Efforts to integrate these activities require planning, a strong infrastructure and financial commitments. Integration of these activities is happening now. They require time, effort and financial commitments allowing GPEI to help build strong health systems that sustain progress long after GPEI winds down its services. If we are to build sustainable, country-led health systems that maintain this hard-won progress in the absence of GPEI, we cannot let complacency undermine the promise of eradication made since 1988. As a crucial partner of the GPEI, it is essential that the UK government reaffirms its commitment to eradicating polio at the earliest possible opportunity. In 2019, the UK pledged £400 million between 2020 to 2023 to GPEI to ensure the world can deliver on the promise of polio eradication. This commitment has been shaken in the wake of the decision to cut its commitment by 95% in 2021 as part of the wider cuts to the UK’s Official Development Assistance (ODA) budget. In a world where political will and strong health systems have been shown to be essential in the fight against infectious diseases, it is paramount that on the road back to spending 0.7% of Gross National Income (GNI) on ODA, the UK government recommits to providing GPEI the essential support it needs to finish the job and eradicate polio for good.