What the UK aid cut means for polio eradication efforts

The 95% U.K. aid funding cut to the Global Polio Eradication Initiative will have a “devastating impact” on the polio eradication program, but the impact won’t be limited to polio.

U.K. aid to GPEI is unrestricted, and the public-private partnership has primarily used it for global response and surveillance. In 2020, U.K. contributions allowed GPEI to continue supporting outbreak response in 25 countries — several of which are in sub-Saharan Africa — and surveillance work in nearly 50 countries.

But in a statement released Tuesday and shared with Devex, GPEI said it will no longer be possible to continue that kind of support, “unless replacement funds are identified.”

This will have implications for other diseases such as measles, yellow fever, and COVID-19, which have been benefiting from the polio infrastructure and assets available in countries. For example, disease surveillance officers working on polio also do surveillance work for these other diseases, said Oliver Rosenbauer, spokesperson for GPEI.

The United Kingdom’s decision could also have an impact on GPEI’s upcoming strategy, which aims to do more integrated polio campaigns and boost routine immunization for polio. But it requires both funding and commitment from countries to fully implement it.

“There’s a lot of uncertainty and anxiety,” said Rosenbauer.

Under pressure

In Pakistan, one of the two remaining polio-endemic countries, only one case of poliovirus type 1 has been reported in 2021, and six cases of circulating vaccine-derived poliovirus type 2.

Polio cases also fell from 111 in 2019 to 84 in 2020. But how this will be sustained is unclear, the emergency committee under the International Health Regulations on polio, said in February, adding that transmission has expanded in previously polio-free areas of north Sindh and south Punjab. The poliovirus also continues to spread from Pakistan to Afghanistan, where polio cases doubled in 2020.

“The ongoing frequency of WPV1 [wild poliovirus] international spread between the two countries and the increased vulnerability in other countries where routine immunization and polio prevention activities have both been adversely affected by the COVID-19 pandemic are two major factors that suggest the risk of international spread may be at the highest level since 2014,” according to the committee.

Cutting assistance now for polio eradication work when the COVID-19 pandemic has put pressure on countries’ health systems is wrong and may require more financial resources in the long-term, said Dr. Rana Jawad Asghar, CEO at Global Health Strategists & Implementers, a consulting firm on population health, based in Pakistan.

“I think it may have much bigger consequences than the people who decided [to cut funding to the GPEI] fully realize it,” he said.

While it’s not clear to him how much money from the GPEI goes to polio work in Pakistan, he said the country is still reliant on foreign assistance for polio eradication activities. While he believes the government should pay more for polio eradication work, it’s challenging for the country, which is also experiencing a surge in COVID-19 cases. Running effective polio campaigns in a big country like Pakistan would require huge resources, he said.

But those thinking of cutting aid for polio also need to consider the polio workers already risking their lives to reach every child while being paid little.

“This is not just random public health work in Pakistan … and most of those who go for house-to-house vaccinations are always in danger of being killed. And you know, every year we get some incidents when these polio workers get killed, or even [the] police forces trying to protect them … they do also get killed. So I think whenever we have to make a decision, we need to look at the bigger picture,” he said.

Difficult decisions

It’s unclear at this point where the ax would fall on GPEI’s programming. Rosenbauer said the partners now have to do scenario planning to understand what they need to do “if these cuts go through,” noting that discussions are ongoing with the U.K. government.

“From what we understand, this is proposed, and we, of course, hope that this decision is not final and will not be implemented of course,” he said.

But apart from the funding, the decision by GPEI on where to scale down or cut back on activities will be based on the epidemiological situation of polio in countries. Ideally, they would want to focus their polio activities in the two endemic countries of Pakistan and Afghanistan while responding to outbreaks and implementing preventive measures in countries at risk of polio reinfection.

“If we don't get enough money for that, then we need to prioritize our resources. And of course, our highest priority are the endemic countries. And then the second priority are the outbreak countries. And the third priority would be the high-risk countries. So then we would typically need to kind of look at, okay, where will we need to cut activities? And probably it would be in the high-risk countries,” said Rosenbauer.

Filling the gap in funding won’t be easy, given budgetary pressures in countries because of COVID-19, said Judith Diment, a member of Rotary International’s PolioPlus Committee and Chair of the Polio Advocacy Task Force in the UK.

But the cuts couldn’t have come at a worse time, she added, saying “we're so close [to eradicating polio] and to have a cut in the funding now is very unfortunate.”

The U.K. government is also cutting aid to the core funding of UNICEF, a GPEI partner. U.K. aid to the United Nations agency has been reduced from £40 million in 2020 to £16 million for 2021, a reduction of 60%, said Joanna Rea, UNICEF UK’s director of advocacy.

Like funding for GPEI, U.K. aid to UNICEF’s core programs is flexible, allowing the U.N. agency to respond quickly to emergencies. It also helped the U.N. agency respond to COVID-19 in 2020.

“We didn't have any specific funding to respond to a global pandemic. So we're able to use this flexible money to support children with their education and health, [and] ensure they're protected through,” she said.

Rea said they will have to make some “difficult decisions and choices” on what to do with the reduced funding. Nothing’s been decided yet, and they’re still trying to assess what the cuts will mean for their work. But she is concerned about the impact it will have on the world’s children. The U.N. agency works in over 190 countries globally, and child immunizations is a big program of work, as well as protecting vulnerable children including refugees, and education.

UNICEF UK believes the decision of the U.K. government is final for 2021. But like many in the U.K. aid community, they’re calling on the government to return to spending 0.7% of gross national income on aid in 2022, which the government has enshrined into law.

“This is a matter for … quite extensive parliamentary debate in the U.K. at the moment, and a lot of members of parliament are raising this as an issue. There is provision in the law for the U.K. government to miss the target for one year. But again, that's being challenged in parliament,” said Rea.