A no-brainer: How to transition from polio eradication to measles eradication

By Steve Cochi 13 October 2015

Polio immunization carried out by members of Rotary International in India. How can the polio infrastructure be harnessed for measles eradication? Photo by: Jean-Marc Giboux / Rotary International / CC BY

Why stop with eradicating polio when the eradication of measles is within our grasp? During more than 25 years of operations, the Global Polio Eradication Initiative has mobilized and trained millions of volunteers, social mobilizers, and health workers; accessed households untouched by other health initiatives; mapped and brought health interventions to chronically neglected communities; and established a standardized, real-time global surveillance and response capacity.

Many of these polio assets have been applied in tandem to measles elimination, which has similar strategies and program implementation infrastructure needs. Since the beginning of GPEI in 1988, more than 13 million paralytic polio cases have been prevented through the use of polio vaccine; since 2001, 15.6 million measles deaths among children have been prevented with measles vaccination.

Does it make any sense to dismantle the polio assets and infrastructure in the next few years because of poor planning and lack of forward vision, only to have to reconstruct it later at greater expense and after lost momentum and human resource capacity? It is inexcusable not to seize this opportunity to prevent the 145,000 annual measles deaths still occurring worldwide and create a world free of both polio and measles.  

As the initiative nears completion, the primary goals of transition planning for the GPEI are both to protect a polio-free world and to ensure that these investments — made to eradicate polio — contribute to future health goals such as measles eradication after the completion of polio eradication. As a practitioner who has spent decades on polio eradication — and as an advocate for measles eradication — my view is that transitioning from eradicating polio to measles is a no-brainer. It is both an opportunity and an obligation that should be taken for compelling reasons, including the close relationship between these two initiatives.

Here are a few reasons why this makes sense and how the polio infrastructure can be — and already is — readily harnessed for measles:

First, the strategies used to eradicate polio are very similar to those for measles eradication: disease detection and use of a laboratory network for diagnostic confirmation; the importance of achieving and maintaining high immunization coverage; the need for periodic high quality supplementary immunization campaigns to reach children who lack access to the routine immunization system; and strong outbreak preparedness and response.

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Second, the polio infrastructure required to successfully eradicate measles is concentrated in the lowest-performing countries, which are the most challenging to achieving measles (and polio) eradication. Now is the time to determine how this massive infrastructure can be sustained and repurposed for measles eradication.

Third, transitioning the polio assets for measles eradication and other priority global health activities will sustain and extend the side benefits these resources have already provided, while at the same time maintaining and mainstreaming essential polio functions — such as polio disease detection, immunization, communications and community engagement, outbreak preparedness and response — which will continue to be needed in immunization programs after polio eradication is certified worldwide.

GPEI has documented many important lessons learned that must be harnessed and applied to measles eradication, in conjunction with strengthening national immunization systems (see “Global Polio Eradication Initiative: Lessons Learned and Legacy”). Here are some of the essentials we cannot afford to lose:

1. Knowledge and best practices accumulated on communications and community engagement, mobilizing social and community support for vaccination, and using a targeted disease elimination initiative like measles or polio eradication as a springboard for broader health communication. These lessons and experience have been generated in the most challenging countries in the world including India, Nigeria, Pakistan, and Afghanistan.

2. The value of an advanced, state-of-the-art global, regional and national laboratory network and real-time disease detection and response. I have seen in many countries the knowledge and resources of this network applied to measles and other vaccine preventable diseases.

3. The knowledge and experience garnered on how to reach every child, including the most underserved, migrants, nomads, people living in conflict zones and others marginalized by health systems.

4. Outstanding program monitoring and the use of accountability frameworks to assess performance.

5. Partnership coordination, advocacy and resource mobilization. GPEI has assembled an unprecedented and committed global partnership led by Rotary International, World Health Organization, UNICEF, Centers for Disease Control and Prevention, and the Bill & Melinda Gates Foundation, which has collectively and relentlessly worked together to overcome the many challenges GPEI has faced, and whose vanguard is the 20 million frontline vaccinators. This largest ever global health partnership is in an ideal strategic position to wipe the measles virus off the face of the earth.

Transitioning from polio to measles eradication will not be easy. We are already experiencing many of the growing pains and challenges associated with the task, such as complacency of countries and partner organizations in addressing off-track targets in the Global Vaccine Action Plan, and the compartmentalization of polio-measles-routine immunization staff and programs into separate silos of work and at times, competing interest groups.

Even though it is hard work to transition, disease elimination programs are not a zero-sum game  — successfully repurposing resources and knowledge from polio eradication to measles eradication is a win-win, especially for the world’s children. In short, the end of polio will not be only an incredible achievement in itself, but will open the door to protect the vulnerable from numerous diseases such as measles that kill and injure children.

So what are we waiting for?

If we do not thoroughly plan and implement actions now to ensure that the legacy of polio eradication is optimized, the only losers will be the world’s children. For me, measles eradication as the next step is a no-brainer.

What does it take to end a global disease? Find out in the new Devex series with Rotary International launching Oct. 20 — and join the conversation on social media using #endpolio.

Ending a Global Disease is a conversation hosted by Devex, in partnership with Rotary International, to explore successes in the fight against polio and identify lessons that can be applied to overcoming other global diseases. Visit the campaign site and  join the conversation using #endpolio.

About the author

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Steve Cochi

Dr. Stephen L. Cochi is the senior adviser to the director of the Centers for Disease Control and Prevention’s Global Immunization Division. He has spent 33 years at CDC working in the field of immunization and from 1985 to present, he served in various roles at CDC where he led and managed the U.S. immunization program and its international activities.


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