What lessons does polio eradication offer for global health?

A child gets a mark after polio vaccination. Photo by: UNICEF Ethiopia / CC BY-NC-ND

SEATTLE — Interviews in the English language can only offer so much insight into polio eradication efforts in the trilingual nation of Sri Lanka.

“The administrators in Colombo are happy to discuss plans and progress in English, but workers in the districts discuss priorities, problems and achievements in Sinhalese and Tamil,” said Sanjoy Bhattacharya, professor of the history of medicine and director of the Center for Global Health Histories at the University of York.

Two decades of research and collaboration in public health campaigns across South Asia have taught him the importance of languages. Now, Bhattacharya is among those working to ensure that the documentation of the Global Polio Eradication Initiative, or GPEI, is multilingual. He is applying for funding from the Bill & Melinda Gates Foundation to build an international coalition that will advocate across multiple languages for future vaccination-based disease elimination and eradication programs.

The latest request for proposals from the Gates Foundation — Applying the Lessons Learned from Polio Eradication to Global Health — is seeking submissions that will help train future generations of leaders to apply best practices gleaned from polio eradication to other public health challenges. While polio is one of the foundation’s top priorities, staff told Devex they are not yet sure of the best ways to share what has and has not worked.

“There are things we’ve learned in the polio eradication program — both do’s and don’ts — that we don’t want to go away,” said Jay Wenger, who heads the foundation’s polio efforts within the Global Development Program. This is in part “a reflection of smallpox, because people didn’t make a conscious effort to codify what we learned. You can find lessons on smallpox, but you have to go read somebody’s book.”

Last month, the Journal of Infectious Diseases launched the supplement Polio Endgame and Legacy: Implementation, Best Practices, and Lessons Learned. The 51 articles are intended to serve as a resource on what GPEI can teach us about how to implement public health activities. But these assessments of planning and implementation, vaccine supply and routine immunization strengthening tend to follow a trend of information that is valuable but inaccessible beyond the peer-reviewed journal readership.

"There is a certain audience that has access to those peer-reviewed journals and has time to read them, and there is a limit to how much you can put that knowledge into practice,” said Lea Hegg, program officer for polio eradication at the Gates Foundation.

The foundation’s request for proposals came out of conversations between Michael Galway, head of its polio operations in Nigeria, and Walter Orenstein, associate director of the Emory Vaccine Center, who previously worked with the foundation and with Centers for Disease Control and Prevention.

“They suggested this idea, and it went a couple of years without anyone pursuing it, because we were focused on eradication,” Hegg told Devex. “But as the transition discussion started gaining momentum, so did the idea that we do need to capture the lessons on polio before the program finishes, because they're happening now.”

The polio eradication effort is often criticized for being a vertical program, but Wenger said the benefits of the eradication will outlast the final cases — mentioning, for example, how the polio emergency operations center in Lagos, Nigeria, was turned into an Ebola response center within 24 hours of the disease surfacing.

The Gates Foundation and its partners are also working with traditional leaders in Nigeria to use the same microplans that guided the planning and implementation of polio vaccination campaigns for other routine immunizations, Hegg said.

In a country where the immunization rates come up as more than 100 percent, because the denominators are outdated and inaccurate, the effort to leverage a range of capabilities including GIS technology to count every child under five will benefit other public health efforts.

“In some of these last places we go, the only thing that kids get is the polio vaccine,” Wenger said. “These are areas that are distant and so far away or so war ravaged that government health care and private health care does not get there.”

“The polio program has been shaped by Nigerians and Indians and Pakistanis and Congolese and all these people who may not have connections with top-tier global institutions but have the expertise a Harvard [Master of Public Health] should know.”

— Lea Hegg, program officer for polio eradication at the Bill & Gates Foundation

Hegg explained that the request for proposals aims not only to make the lessons learned from polio eradication more actionable for public health practitioners, but also to make sure that future generations learn from the diverse leaders who have been critical to the success of the program.

"The global health leaders that came out of the smallpox effort are known worldwide as these amazing figures in public health … but they're all white men from the developed world,” she said. “The polio program has been shaped by Nigerians and Indians and Pakistanis and Congolese and all these people who may not have connections with top-tier global institutions but have the expertise a Harvard [Master of Public Health] should know.”

The Gates Foundation hopes to see proposals from universities based in developing countries, and in a phone call about the request for proposals where institutions from the United States made up most of the participants, she encouraged applicants to consider forming partnerships with developing country institutions.

Hegg explained that the reason to pursue a request for proposals rather than reaching out to partners the Gates Foundation has worked with in the past for direct grants is to generate good ideas from the community.

And this is an area that Wenger said needs “blue sky thinking.”

“I get a very strong sense that national governments want the specificities of programs within their countries understood, recorded, and then combined with similar experiences from other countries, and regional, international and global alliances,” Bhattacharya told Devex.

His application is for a project partnering with the governments of Sri Lanka, Brazil and India, which he said were initially concerned that efforts to document the lessons learned from GPEI would provide a narrow perspective from the highest levels of global health. They have since been reassured by the foundation’s interest in engaging perspectives at the national and local levels.

Applications for the request are due August 21. The Gates Foundation hopes that by the time the world is rid of polio, the grant recipients will have rolled out accessible and actionable material about the lessons learned.

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About the author

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    Catherine Cheney

    Catherine Cheney is a Senior Reporter for Devex. She covers the West Coast of the U.S., focusing on the role of technology and innovation in achieving the Sustainable Development Goals. And she frequently represents Devex as a speaker and moderator. Prior to joining Devex, Catherine earned her bachelor’s and master’s degrees from Yale University, worked as a web producer for POLITICO and reporter for World Politics Review, and helped to launch NationSwell. Catherine has reported from all over the world, and freelanced for outlets including the Atlantic and the Washington Post. She is also the West Coast ambassador for the Solutions Journalism Network, a nonprofit that trains and connects journalists to cover responses to problems.