The marathon to eradicate polio is on its final lap: the world is more than 99% of the way to success. After millennia of living with poliovirus and suffering the paralysis it causes, today nearly all the world’s people live in polio-free countries; two of the three strains of wild poliovirus (WPV) have been eradicated. Some 20 million people are walking who would have been paralysed had it not been for the efforts of national governments and health workers. If eradicating polio has been a marathon, the finishing line is in sight.
But the final stretch is the hardest. Given that the polio eradication programme works in the world’s most challenging areas – in terms of geography, conflict, poverty, weak health infrastructure and communities left behind – the difficulty of crossing the finishing line to global eradication should surprise no one.
The coming five years may provide the last opportunity to eradicate polio. The COVID-19 pandemic has fundamentally changed the international environment within which humankind operates, which is now less – not more – conducive to success. As this investment case is being written, Malawi has declared a national health emergency after discovering polio circulating in the country. Afghanistan faces a generational upheaval, leading to the collapse of its economy and the unspooling of its already fragile health system. Ukraine – a country that has historically struggled to ensure vaccination coverage and prevent polio outbreaks even in peacetime – is in a full-fledged conflict with its attendant destruction of health care. The COVID-19 pandemic has disrupted health systems, including essential immunization activities, and has set back the fight against AIDS, tuberculosis and malaria, threatening the future of the next generation.
Time is against us. To succeed in eradicating polio, we must act now.
A NEW STRATEGY THAT WILL GET THE JOB DONE
The upheaval of the COVID-19 pandemic demanded the agility and adaptability of the polio eradication community, and a new approach focused on the critical path to achieving and sustaining zero polio. In 2021, the Global Polio Eradication Initiative (GPEI) updated its 2019–2023 strategy and launched a new one, entitled Delivering on a Promise covering the period 2022–2026.
The strategy outlines the use of all the collective, accumulated experience, new technologies – including an improved vaccine – and a broader approach to the actions needed to achieve the goal through a five-year action plan for success.
The strategy’s transformative elements are accountability and political will from all stakeholders, community engagement and the integration of eradication efforts with other health partners and goals. The commitment of the two remaining endemic countries with WPV, Pakistan and Afghanistan, is strong; a combination of improved immunization operations, trust-building approaches and collaboration with a broader coalition of health services has improved the programme’s ability to serve unvaccinated children.
US$ 4.8 BILLION OVER FIVE YEARS TO FREE THE WORLD FROM POLIO
The five-year cost for the new strategy is US$ 4.8 billion. Securing this amount will enable the programme to fund the critical path to implement the Polio Eradication Strategy 2022–2026. This cost includes funding that will also benefit essential health system functions beyond polio eradication. It incorporates transitioning surveillance and technical assistance in all but 11 high-risk countries and the two endemic countries to WHO, a process beginning in 2022; establishing the minimum threshold for non-endemic country vaccination activities to keep immunity high; and planning to maintain that figure for the next five years.
Investments in polio eradication – whether they consist in planning with partners for the formal transition of polio programme elements into other health care priorities, or using the existing capacities to respond to health emergencies – are also investments that will build a healthier world generally. An investment in the Polio Eradication Strategy 2022–2026 will reap rewards tomorrow and for decades to come.
A CLEAR CHOICE
It is up to us: either we honour our collective commitment to eradicate polio, or we decide not to do so.
Polio, like all viruses, does not care about our intentions or choices; it only exploits human weakness. If the investment is neglected and/or if the final push for eradication is postponed, polio will spring back, reversing years of progress and increasing the cost of the final battle. A delayed investment is also a choice – a choice with tragic and costly consequences.
Polio is not a problem that can wait while we hope for a better time to act. It is an emergency, and our window of opportunity will not stay open forever.
This effort will require boldness and courage from governments, from institutions and from each and every person who wants to help health workers end polio in their lifetime. But it is a boldness that is easy to justify because the solution boils down to a simple proposition, an easy choice.
Together, we can deliver on our promise to eradicate polio.