Global health goals: lessons from the worldwide effort to eradicate poliomyelitis

Abstract

The Global Polio Eradication Initiative was launched in 1988. Assessment of the politics, production, financing, and economics of this international effort has suggested six lessons that might be pertinent to the pursuit of other global health goals. First, such goals should be based on technically sound strategies with proven operational feasibility in a large geographical area. Second, before launching an initiative, an informed collective decision must be negotiated and agreed in an appropriate international forum to keep to a minimum long-term risks in financing and implementation. Third, if substantial community engagement is envisaged, efficient deployment of sufficient resources at that level necessitates a defined, time-limited input by the community within a properly managed partnership. Fourth, although the so-called fair-share concept is arguably the best way to finance such goals, its limitations must be recognised early and alternative strategies developed for settings where it does not work. Fifth, international health goals must be designed and pursued within existing health systems if they are to secure and sustain broad support. Finally, countries, regions, or populations most likely to delay the achievement of a global health goal should be identified at the outset to ensure provision of sufficient resources and attention. The greatest threats to poliomyelitis eradication are a financing gap of US 210 million dollars and difficulties in strategy implementation in at most five countries.

Global public health mandates in a diverse world: the polio eradication initiative and the expanded programme on immunization in sub-Saharan Africa and South Asia

“…The indirect benefits actually achieved by the campaign include widespread vitamin A distribution; enhanced global surveillance capacity; and improved worldwide cooperation between enterovirus laboratories [11,13]. The evidence regarding effects on non-polio, routine immunisation services remains controversial [15]. Some researchers raised concerns that polio mass campaigns have adversely affected the non-polio EPI vaccine coverage by disrupting the routine health service delivery [11,[16][17][18][19].…”

“…Some researchers raised concerns that polio mass campaigns have adversely affected the non-polio EPI vaccine coverage by disrupting the routine health service delivery [11,[16][17][18][19]. Others argue that the effects of declining economies, or of major health system reforms, were responsible for lower EPI antigen coverage rates in some countries or population segments [15].…”

The role of risk analysis in polio eradication: modeling possibilities, probabilities and outcomes to inform choices

“…Remarkably, the world succeeded in eradicating type 2 WPVs [2] and the annual burden of all paralytic polio cases dropped by approximately 99% between 1988 and 2000, which yielded significant health and economic benefits [3]. This progress occurred despite the reality that some countries did not begin active surveillance for paralytic cases and aggressive vaccination until shortly before the year 2000, and some regionally coordinated vaccination efforts only began after the year 2000 [4]. Now, 12 years after the initial target, unfortunately we still face challenges with respect to eradicating WPV types 1 and 3, and planning for the final stages (or 'end game') reveals previously un(der)appreciated complex and dynamic risks, and difficult choices [5,6].…”

Eradicating polio: today's challenges and tomorrow's legacy

“…The tremendous progress made towards global polio eradication between 1988 and the end of 2002 was the result of multiple factors (Aylward et al, 2003). There was a strong 'core' partnership of four agencies that were willing to commit time, expertise and resources over long periods of time: the WHO, Rotary International, the United States Centers for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF).…”