Risks and opportunities as funding for polio disappears with the disease

Authors : Laura Kerr and Leila Stennett

Laura Kerr is the Policy Advocacy Officer for Child Health at RESULTS UK. Leila Stennett is the Campaigns Director at RESULTS Australia & Secretariat of the Australian TB Caucus.

As 2017 draws to an end, the world is on the cusp of both stopping the transmission of poliomyelitis and eradicating polioviruses. After smallpox, this would be the second disease to have been eradicated. The end of polio is an opportunity—one that cannot be missed—to build on the legacy of disease eradication, apply the knowledge and resources gained to other infectious diseases, and strengthen routine immunisation.

Progress towards polio eradication to date has relied on a three-decade campaign led by the Global Polio Eradication Initiative (GPEI), one of the world’s largest global health partnerships, which combines the efforts of national governments, multilateral agencies, and private philanthropic support. Once the GPEI achieves its mandate to eradicate polio, it will cease to exist. With eradication expected by 2020 or 2021, the GPEI has already begun its wind down process, and with current funding it will only be able to operate to 2020.

Widespread vaccination campaigns have achieved outstanding results in reducing polio cases.  At the same time, global immunisation rates have stalled, barely changing in the last eight years. One in ten children still receives no vaccines at all. Full immunisation rates are also dismal—only 7% of children in the world’s 68 poorest countries receive all recommended vaccines, leaving far too many children unimmunised against preventable diseases.

The dissolution of a partnership the size of GPEI is unprecedented. GPEI investments have supported polio vaccinations, trained and supported human resources, as well as provided technical programmatic support. These investments have had an impact well beyond polio eradication in many countries, supporting routine immunisation systems and allowing for other health services to be delivered. The risk now is that when GPEI activities come to a close, these services will also be affected, leaving significant gaps, especially for existing essential immunisation services.  A telling example is that 70% of global vaccine-preventable surveillance funding comes from GPEI.

The impact of GPEI’s activities tapering off will be felt most acutely in the 16 GPEI priority countries that receive 95% of current funding. One of these is South Sudan, where in the middle of a civil war the population has very little access to essential health services. GPEI funding is supporting polio campaigns that reach an impressive 80% of the population but 60% of staff are also trained in routine immunisation and funding and partner support is being used across the full immunisation programme. GPEI-funded personnel spend only about 27% of work time on polio eradication and the rest on delivering other essential health services, including maternal and child nutrition, and responding to humanitarian emergencies. With more than a 75% reduction in GPEI funding between 2017 and 2019, in addition to a 50% reduction between 2016-2017, the country has little scope to replace the resources from GPEI with domestic sources, putting the entire vaccination system at risk.

To read the full article go to The Lancet Global Health Blog.