Exclusive: The Gates Foundation picks a partner to share lessons learned from polio eradication

SAN FRANCISCO — The Johns Hopkins Bloomberg School of Public Health has received a new grant to translate the lessons learned from polio eradication to other global health initiatives, the Bill & Melinda Gates Foundation told Devex.

Polio is one of the top priorities of the largest foundation in the world, and in their 2017 annual letter, Bill and Melinda Gates said they think it is possible that polio could be eliminated this year. At the Reaching the Last Mile summit in Abu Dhabi this week, panelists talked about the near eradication of both polio and Guinea worm disease, and what lessons smallpox — the only infectious disease to be wiped off the face of the planet — might offer. But as the Gates Foundation funds this effort to get to zero case of polio, its program staff wants to make sure to improve upon one of the failures of the smallpox eradication effort by documenting the lessons learned.

Dr. Olakunle Alonge, assistant professor at JHSPH, will lead this new grant, $3.7 million over five years, resulting from a request for proposals called “Applying the Lessons Learned from Polio Eradication to Global Health.” Working with the Global Polio Eradication Initiative, Alonge and a team of partners from seven countries — Nigeria, India, Afghanistan, Ethiopia, the Democratic Republic of Congo, Bangladesh, and Indonesia — will develop courses and clinics that capture the best practices of the polio eradication effort. The goal, said Alonge, is to capture the lessons learned and prevent this knowledge from being lost so that systems and strategies can be repurposed, not recreated.

“We believe in the merits of what Gates is trying to do,” he told Devex. “There should be more funding for this kind of work. It is unique because it is looking back. Most grants look forward, right? But this is looking back and making sure we don’t forget the lessons we have learned that are important for health services delivery.”

The Gates Foundation had 18 applications for this RFP, but Johns Hopkins stood out for a number of reasons, said Lea Hegg, program officer for polio eradication at the Gates Foundation. “The scope of the project is ambitious but realistic,” she said. In their application, Alonge and his team emphasized partnerships with institutions in developing countries and covered a number of different ways of disseminating knowledge about the polio program, not only through curriculum including massive online open courses, or MOOCs, but also through implementation courses for practitioners with follow-on mentoring in the field.

In a meeting at the Gates Foundation ahead of the polio RFP deadline, Jay Wenger, who leads the foundation’s polio efforts, told Devex he wanted to see “blue sky thinking” in the applications.

Whereas other applications tended to focus on a more narrow channel or two-way partnership, the Johns Hopkins proposal was broad in terms of the number of institutions that would have the opportunity for capacity-building through this partnership, and that was one reason it stood out, Hegg said.

“One thing mentioned in the RFP was the desire we had to make sure polio program staff are really very involved in the development of the material,” she said. “They’re identifying people from the polio program to take on that role and spending time with these people they’re calling change agents to gather that knowledge and put it into course materials.”

Prior to joining Johns Hopkins and its Health Systems Program, Alonge attended medical school at the University of Ibadan in Nigeria, one of three countries in the world with polio, and the faculty of public health from his alma mater is a partner in this grant. In every country, the partner institution is a university, aside from Afghanistan, where the partner is Global Innovations Consultancy Services, a group that partners with the government, donors, U.N. agencies, nongovernmental organizations, and others.

Alonge spent four years with the Ministry of Health in Nigeria, and also worked in Liberia and Afghanistan, and now focuses his research on developing a body of work in implementation science, with a particular focus on strategies for health systems strengthening for complex interventions.

“A critical element of that conception of implementation science is being able to distill strategies that you have evidence for the effectiveness of the intervention. That was one of the things we felt this request for proposals was trying to do. This is really core implementation science,” he said. ‘If something works, the question is so how did it work, why did it work, and where did it work, and if something does not work, the question is so how did it not work, why did it not work, and where did it not work?”

The lessons the global health community has learned from polio eradication has relevance to the strengthening of immunization systems, primary health care services delivery, public health emergency response, and of course the eradication of other diseases such as malaria. Understanding what did and did not work in the polio eradication effort can unlock implementation bottlenecks for other health service delivery efforts, he said. The goal, he added, is not only to include frontline workers involved in polio eradication efforts through in-person surveys and other strategies to document those lessons learned, but also to create a way for these workers to transition their skills to address other global health challenges.

The Gates Foundation is not the first to try and document the lessons learned from polio. Earlier this year, the Journal of Infectious Diseases launched the supplement “Polio Endgame and Legacy: Implementation, Best Practices, and Lessons Learned.” But the hope is that these lessons will be more accessible to the people who might not have access to these peer-reviewed journals.

“This is a five-year grant but a lot of these materials will live on forever,” Hegg said. “It’s a global public good that will be out there for people to take advantage of.”

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