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A Balancing Act: What happens when polio funding ends?

This blog is co-authored by RESULTS UK’s Laura Kerr (Child Health Policy Officer) and RESULTS Australia’s Leila Stennett (Campaigns Director).

On Monday, RESULTS UK and RESULTS Australia launched A Balancing Act: Risks and opportunities as polio and its funding disappears. This new joint publication explores what is happening as the Global Polio Eradication Initiative (GPEI) winds down—and what the future holds—as international financing for polio changes and declines.

Why is it important to assess the impact of polio eradication now? Well, one in ten children receive no vaccines at all. None. They are left vulnerable to preventable diseases like measles, pneumonia, and polio, and for us at RESULTS, that is unacceptable. Global immunisation rates are as high as they have ever been and this should rightly be celebrated, but progress towards globally agreed goals has stalled, and without concerted efforts to improve these, more than one million children’s lives will be lost unnecessarily every year from diseases we can prevent through immunisation.

A Turning Point: An Opportunity That Cannot Be Missed

As the world draws closer than it has ever been to polio eradication, which we expect to be certified in 2020 or 2021, international funding for polio is changing. Historic investments made through GPEI, one of the largest global health partnership in the world, have reached US$16 billion, but support to countries will halve between 2017-2019. Once polio has been eradicated, the GPEI will wind down and cease to exist.

The 16 countries that receive 95% of GPEI funding are at a turning point, and there are significant challenges ahead as their funding for polio, which in many cases has been used to support the wider immunisation and health system, comes to an end in the next few short years. The wind down of GPEI comes with real and significant risks and challenges, these must be acknowledged and cannot be ignored.

But, the wind down of GPEI is also unique, and the opportunity it presents for immunisation is just as rare. Here are three reasons why:

  • A partnership the size of GPEI has never been wound down on this scale. For over 30 years, they have led global polio eradication efforts, reaching children who could not be reached by any other health services, caught in conflict and in some of the world’s most isolated places. Many of the lessons that have been learned, as well as many of the assets, must be transferred and mainstreamed into immunisation systems—strengthening their ability to reach more children.
  • Doing things differently in global health is not always easy. A large change in financing or programmatic support that allows us to consider what has been working and what needs to change—and have some time and financial capacity to make those changes—is a rare chance to redirect priorities.
  • Improving immunisation systems has an impact beyond ensuring more children are reached by vital life-saving vaccines. A strong immunisation system is at the bedrock of a functioning health systems, which is a stepping stone towards Sustainable Development Goal 3 and universal health coverage for all.

At a time when independent experts are calling on “a need to intensify global efforts to promote immunization and address the systemic weaknesses that are limiting equitable access to life-saving and life-changing vaccines,” any opportunity to re-think why immunisation systems are failing, and who they are failing, must be taken.

Seizing the Opportunity: The Barriers

A Balancing Act highlights three principal barriers which could prevent the opportunity to strengthen routine immunisation from being taken:

  • Existing routine immunisation systems are weak and fragile. Only three countries out of the above mentioned 16 have achieved the globally agreed coverage target of 90%. The average immunisation rate in the 16 countries is just 71% with four countries falling 50%.
  • All but one of the 16 countries are receiving financial support from Gavi, the Vaccine Alliance (Gavi).  Eight of these are currently facing financing changes from Gavi (and are transitioning), increasing pressures to increase domestic resources for immunisation over the same short time as GPEI funding comes to an end. This double demand for extra domestic resources threatens existing services and a country’s ability to improve coverage and equity. Government expenditure on routine immunisation in the 16 priority countries (excluding Somalia) is on average only 31% of total immunisation budgets.
  • Polio eradication efforts have relied on mass immunisation campaigns but to move closer to achieving globally agreed immunisation coverage, equity and elimination targets, efforts must focus on strengthening routine immunisation systems. This will require a fundamental shift in thinking, as well as in programming and financing, which will not be simple.

RESULTS Call to Action

A Balancing Act highlights the urgent need for political attention on the issue of GPEI wind down. RESULTS Australia and RESULTS UK are calling on the GPEI and WHO to convene a high-level meeting on the sidelines of the World Health Assembly in May 2018 to explore the barriers, gaps, and challenges which urgently need to be addressed, and how to move forward as an international community to make sure the unique opportunity to strengthen routine immunisation is taken. This meeting would be the start of a process which ensures we can benefit from the resources, knowledge and systems we have created to achieve the historic eradication of polio.

GPEI wind down provides an unprecedented opportunity to address the current barriers to improving immunisation, that if not taken, will be an injustice to the millions of unimmunised children around the world.