In 1796, in Gloucestershire, England, Edward Jenner developed the smallpox vaccine, and inoculated an 8-year-old boy, James Phipps, using matter from a cowpox patient. Two centuries later, in 1980, smallpox was successfully eradicated. It had once been a major killer, claiming more than 500 million victims all over the world in the 20th century alone. It was the first human disease to be successfully eradicated — a major achievement for global health.
Despite this triumph, the World Health Organization is well aware of the failure, in the aftermath of this success, to retain the infrastructure built up to eradicate smallpox, and is determined that the same will not occur once polio is finally vanquished.
The core partners of GPEI are Rotary, the World Health Organization, the U.S. Centers for Disease Control and Prevention, and the United Nations Children’s Fund, joined more recently by the Bill & Melinda Gates Foundation. GPEI has built up an extensive infrastructure for polio, including a surveillance and laboratory network, trained health workers, and state-of-the-art emergency operations centers.
The Global Polio Eradication Initiative hopes to make polio the second disease ever eradicated, and, at the time of writing, only 11 cases have been recorded so far this year — the lowest ever — and just three polio-endemic countries remain: Pakistan, Afghanistan, and Nigeria. GPEI is taking lessons from the aftermath of the smallpox eradication program to ensure that we get over the finish line, and the assets and knowledge accrued by the effort are not squandered once polio is finally defeated.
1. Maintain infrastructure assets
We now have a global network of 145 laboratories established by GPEI, which also tracks measles, rubella, yellow fever, meningitis, and other deadly infectious diseases. It is imperative that this infrastructure is maintained and repurposed to counter emerging health threats. To do this, GPEI has developed the Post Certification Strategy, which will mobilize the transition plan once polio is officially certified as eradicated by WHO.
The transition plans will be specific to each country, depending on its given infrastructure. For example, in some countries, the polio infrastructure will be fully integrated into their public health systems. This is the case for India, which was certified polio-free in 2014.
For other countries, the responsibility may be shared between national governments and the international development community, while in the least developed countries, international actors may need to fully support national governments — both technically and financially — to maintain the polio eradication infrastructure.
2. Repurpose the assets
One of the best ways to maintain the infrastructure built up by GPEI is to immediately put it to good use in fighting other diseases or health threats. In fact, this is already happening.
Since its inception in 1988, GPEI has supported a wider range of health initiatives, such as the delivery of measles vaccines, surveillance for vaccine-preventable diseases, responses to infectious disease outbreaks including Ebola and the plague, and the delivery of anti-malarial bed-nets, vitamin A supplements, and humanitarian aid.
“If the infrastructure, assets, and health workers acquired by the polio eradication effort are maintained, they will provide an unmatched platform for taking on the health and development goals of the 21st century.”— John Hewko, general secretary of Rotary International
Nigeria managed to thwart the deadliest Ebola virus outbreak in history in 2014 by repurposing its polio eradication infrastructure and technology to track all cases, and implementing a rapid and effective outbreak response. The polio infrastructure is also currently being used to support the Ebola outbreak response in the Democratic Republic of the Congo.
3. Recognize the value of trained health workers
Hundreds of thousands of health workers have carried and delivered the polio vaccine to more than 2.5 billion children. In countries such as Pakistan, this is predominantly a female workforce, and since 2013, thousands more women have joined the effort.
According to data from WHO, in India, more than 98 percent of frontline vaccinators and social mobilizers are women, and they are instrumental to the success of continued immunization campaigns, which reached up to 97 percent of children in the country in 2017.
A recent study attests to the high demand for female vaccinators from local communities who can gain the trust of their neighbors and access households in order to provide vaccinations.
These workers have been trained to provide health services beyond polio vaccination in their communities as part of their work, including the delivery of other vaccines, birth registration, counseling on breastfeeding, and other critical initiatives. The knowledge and skills gained by this workforce will be transferred to support broader health services after polio is gone.
As the table above shows, more than 50 percent of the time spent by GPEI health workers is already dedicated to diseases and threats beyond polio.
Health workers have valuable skills that are imperative to strengthening routine immunization. Countries and multilateral partners are planning carefully to ensure that their talents will continue to be utilized to support other health services after polio is gone.
GPEI’s transition plan already anticipates which countries will be the main focus of activity after the last case of polio. As WHO requires at least three years with no new polio cases before eradication is official, this time is in effect a deadline for preparing health and routine immunization systems after polio in certain regions.
A total of 16 priority countries in sub-Saharan Africa, the Middle East, and Southeast Asia have been identified — where the bulk of the polio eradication infrastructure is located. If the infrastructure, assets, and health workers acquired by the polio eradication effort are maintained, they will provide an unmatched platform for taking on the health and development goals of the 21st century.
Once polio is wiped off the face of the earth, we will mark a major step forward in pursuit of the third Sustainable Development Goal, to “ensure healthy lives and promote well-being for all at all ages.”
Rotary International was a changemaker partner at June’s Devex World. To hear more from them and to catch up on the day’s events, click here.