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Despite progress made in polio eradication, initiative phaseout poses threat to at-risk countries
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The Global Polio Eradication Initiative has been paramount in the near-eradication of polio; however, the dismantling of this program once eradication has been completed may leave many countries vulnerable to vaccine-preventable diseases because of lack of funding for routine immunizations.
“Rethinking how to achieve global health goals, such as universal immunization, can be daunting, especially when restricted within large global programs and financing mechanisms,” Laura Kerr, LLM, a policy advocacy officer for child health at RESULTS UK, and Leila Stennett, campaigns director at RESULTS Australia, wrote. “Yet the scale of the wind down of the [Global Polio Eradication Initiative] partnership is something that has never happened before.”
“The size of potential funding gaps and the impact this could have on existing systems provides the ideal opportunity to re-evaluate how disease eradication and vaccine-preventable disease systems have been functioning; how can countries, donors and technical agencies work together to find the practical solutions to the challenges which have stalled immunization rates for the last 8 years?” they continued.
In the first 9 months of 2017, only 11 cases of polio were reported. This is partially due to 86% of the world’s children becoming immunized in 2016. However, three countries continue to have an endemic status: Afghanistan, Nigeria and Pakistan.
Kerr notes that when eradication is completed, the efforts provided by the Global Polio Eradication Initiative (GPEI) thus far will come to a stop, leaving 16 countries with 50% less funding between 2017 and 2019. By 2019, all support will cease except within endemic or high-risk countries.
Currently, 70% of funding for global surveillance of polio is provided by GPEI, which has a network of 146 labs. Of these labs, 84% are also accredited in the Measles and Rubella Laboratory Network. Additionally, four countries account for more than 50% of total WHO staffing costs. When this funding is no longer supported, the full program will be dismantled in South Sudan.
“Only deliberate actions and urgent efforts now by GPEI partners, Gavi, bilateral donors and the wider immunization community can address the challenges and risks and ensure the historic investments in polio eradication are leveraged, seizing the chance to transform global efforts to avert vaccine-preventable diseases,” Kerr and Stennett wrote.
To ensure that these efforts are successful, Kerr and Stennett suggest that three barriers need to be addressed. The first includes weak immunization systems, and the authors claim that countries with these systems may not be able to provide adequate care because of a small budget or their inability to mainstream polio-essential functions into the services they deliver.
There are 16 countries that have been labeled as a priority, but average government expenditure on standard immunization falls at only 31% for 15 of these countries. Furthermore, eight of these countries are also phasing out of Gavi. The authors note that this may increase pressure on these countries’ resources for the upcoming 3 years. Kerr and Stennett also support a change from eliminating diseases that have a focus on mass vaccination campaigns to a systems and routine services approach.
In their report, the authors also offer five recommendations to keep polio vaccination rates up when GPEI winds down:
- GPEI should boost awareness of how the wind down will affect a multitude of positions, including those who work directly on polio transition. Experts who take part in polio oversight committees should be more involved on both global and regional levels to assist immunization stakeholders in understanding what needs to be done after eradication.
- An evaluation should be conducted concerning the joint affect of GPEI and Gavi transitions in those eight countries experiencing this change.
- Expanded Program on Immunization (EPI) staff in multiple countries should work together with polio staff to create a complete understanding of the decreased immunization and polio services, especially those that run on a community level.
- Countries who act as donors, such as the U.K. and Australia, should promote strengthened routine immunization programs and offer both technical and financial support.
- Domestic resources for immunization should be increased within a national health budget in countries that are shifting from GPEI to Gavi.
“The risks and challenges to polio and immunization in the next 3 years are serious,” Kerr and Stennett wrote. “However, if overcome, and with deliberate efforts to look beyond simply changing financing, there is an unprecedented opportunity to rethink what is needed to strengthen routine immunization, ensuring the millions of children who currently miss out, have access to life-saving vaccines.
“Ensuring more children are protected from vaccine-preventable diseases is a stepping stone to strengthen health systems and drive global progress on the health-related Sustainable Development Goals,” the authors continued. “For many reasons, it is an opportunity which should not be missed.” – Katherine Bortz
Resources:
RESULTS UK. A balancing act: Risks and opportunities as polio and its funding disappears.
Disclosures: Infectious Diseases in Children could not confirm relevant financial disclosures prior to publication.