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Polio Transition - The missing link to eradication?

Polio eradication is within our grasp. Many reports, recommendations, and committees exist, alongside political will to drive efforts towards eradicating polio for good by 2023.

But the landscape of public health is not the same as it was 30 years ago. As we near eradication, the Global Polio Eradication Initiative (GPEI), who have spearheaded eradication efforts, will no longer exist. It is already changing the way it supports polio endemic and non-endemic countries: post 2023, global efforts will be centred on the technical and programmatic elements required to ensure the world remains polio free. Countries will be responsible for delivering strong essential immunisation systems which can continue to deliver the polio vaccine.

A lot will change when polio is eradicated, but some of the most important elements of this foreseen moment require dire attention now. The ongoing process of polio funding changes in countries is called ‘polio transition’. 

Of all the issues with polio transition, what sticks out the most is the lack of a clear, and politically interesting or exciting, end goal. It does not have global committees and groups to drive political attention to it, and to hold governments and donors to account on commitments made or lack thereof. It has limited analysis and reports, apart from the critical work of the Transition Independent Monitoring Board (TIMB), but even this important accountability committee has struggled to figure out their role in the ongoing transition process and existing system.

We do not need goals and processes for the sake of having them. We need them to ensure we are building sustainable and country led immunisation and health systems which can survive without GPEI and donor support - ones which can deliver polio and other essential and life-saving vaccines to every child.

RESULTS UK and ACTION, the Global Health Advocacy Partnership are concerned that the global ambition level for polio transition is too low - we are missing an opportunity to not only accelerate progress towards eradication, but to tackle global stalling immunisation rates and in some ways risking progress achieved to date.

To highlight our concerns, we are pleased to launch, “Polio Transition Planning: Assessing country progress, risks, and ambition”. This new policy brief analyses seven transition country plans which are publicly available of the sixteen GPEI priority countries who currently receive polio funding, Angola, Bangladesh, Cameroon, Chad, Democratic Republic of Congo, Ethiopia and South Sudan. In these seven countries we found that:

  • The average basic immunisation rate was only 65%. With the Inactivated Polio Vaccine (IPV) only reaching just over 50% of children. This leaves almost every second child vulnerable to vaccine preventable diseases and shows weaknesses in the systems which will be required to keep the world polio-free
  • Governments spend on average only $27 per capita on health from domestic resources (excluding South Sudan), showing not enough is being invested in the health system
  • The total cost of continuing polio essential functions to be an estimated minimum of $666 million over the next five years. Without this funding, eradication and immunisation systems are at risk

Our analysis of the transition plans also highlights that in many countries there are significant risks to surveillance and laboratory systems, programme management, social mobilisation - putting at risk the overall function of entire health systems.

To overcome these challenges and risks, we call on the following actions:

  • A global governance mechanism to be set up to guide and monitor the transition process
  • An investment case for transition which sets out clearly country and global financial requirements and gaps
  • Increased attention and analysis of the country level risks, challenges and opportunities for polio transition

Polio transition is not separate to eradication. It is a process happening now, and one which needs focused efforts on building systems based on evidence, implementing tailored public health interventions and country ownership which can sustain eradication progress and keep the world polio free for generations to come.

Without increased political attention and concrete efforts, we are failing to see the missing link of eradication efforts.

This blog was co-authored by Laura Kerr (RESULTS UK) and Yanira Garcia (ACTION Secretariat). You can read the full report here.