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What is the best use for polio infrastructure and assets after eradication?
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Targeting broad health interventions is the best use of existing infrastructure
The global effort to eradicate polio has always been about much more than the eradication of a single disease. The vast infrastructure of human resources, equipment, technical capacity and public health expertise is already being used to address broader public health needs. Polio-funded staff on the ground spend on average 50% of their time working on activities broader than polio eradication — such as supporting maternal and child health interventions — and have been so far very effective in strengthening routine immunization. In the Bihar state of India, for example, the estimated proportion of children immunized against all vaccine-preventable diseases (over and beyond polio) increased from 20% to almost 80% over the past 15 years, thanks in part to the systematic utilization of the polio network that had been established in the state.
Such benefits need to continue even after polio has been eradicated, but they have to continue in a systematic and integrated manner. The great success of smallpox eradication was that it succeeded in eradicating smallpox — its great failure was that the network established to achieve this success was allowed to subsequently collapse. There is broad consensus that the same cannot be allowed to happen to the polio network.
Integrating this “PolioPlus” capacity into supporting maternal and child health and broader sustainable development goals makes both strategic and operational sense, as it is already happening on the ground, albeit in an ad hoc manner. There is already a broad coalition of partners in place to improve maternal and child health globally. Rotary, a key partner in the polio effort, also has identified maternal and child health as an institutional priority area, together with others such as water and sanitation, crucial to maintaining any improvements we manage to achieve in health outcomes.
It will now be key to institutionalize these activities at the global and regional levels to ensure this great network can support broader maternal and child health interventions, and the systems needed to deliver them, by building on the existing infrastructure. It is the best way to optimize this resource in the long term.
Flavia Bustreo, MD, MSc, is the assistant director-general for family, women’s and children’s health at WHO. Disclosure: Bustreo reports no relevant financial disclosures.
Public health should pursue routine immunization and measles elimination
Any targeted disease effort must be placed in the context of a broader health systems-strengthening approach, since no one would argue for the establishment of a global infrastructure to benefit only a single disease. This is, of course, also the case with the global polio eradication effort, also known as “PolioPlus.” The “Plus” in the title is indicative of the fact that the polio infrastructure benefits broader public health issues beyond polio, and there is much evidence to support this.
Having said that, there is a natural strategic and operational fit to further utilize the polio infrastructure to systematically support strengthening of routine immunization and measles elimination. Both are pathogens that can be prevented through simple administration of a vaccine, and both are biologically and operationally feasible to eradicate (unlike most diseases).
Most importantly, the polio effort is already greatly strengthening routine immunization and measles elimination efforts. In many countries, detailed polio campaign microplans are used to implement measles campaigns. Trained vaccinators at fixed sites co-administer measles vaccine alongside polio and other vaccines. Surveillance for polio is already helping conduct surveillance for measles and other vaccine-preventable diseases. And the public health benefits of eliminating measles are extremely significant, so from a humanitarian point of view, the elimination of measles globally would be a tremendous achievement.
All of this means that maintaining the polio infrastructure will continue to support the strengthening of routine immunization and measles elimination. Continuing to do so, in a broader health approach, has always been the case.
Peter M. Strebel, MBChB, MPH, is the priority area leader for accelerated disease control in the expanded program on immunization at WHO. Disclosure: Strebel reports no relevant financial disclosures.