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Global Health Centre

Polio eradication: overcoming the final barriers and ensuring a lasting legacy for health systems

Project Overview

Lead Research Team: Suerie Moon

Researchers and Collaborators: Stephen Matlin, Ryan Whitacre, Surhabi Agarwal

Former Contributors: Ilona Kickbusch, Michaela Told, Fumi Kurihara, Julianne Piper,  Emilia Richard, Marianne Haslegrave

Project Funder: Bill and Melinda Gates Foundation

Project Status: Ongoing until end December 2020

Key Words: global health governance, Europe, health economy, health financing, health systems, legacy planning, polio eradication, social and political barriers

The Global Health Centre is exploring critical dimensions of the global effort to eradicate polio, including how European countries are overcoming the final barriers to disease eradication and ensuring lasting legacies for health systems. Polio eradication would be a momentous achievement. To date, global initiatives for the treatment and prevention of polio have prevented hundreds of thousands of cases of permanent paralysis, especially among children, and greatly reduced mortality. With sustained efforts to reduce the global burden of disease, it may be possible to eradicate polio. Indeed, polio could become the second disease eradicated after smallpox. However, there remain significant barriers to eradication, including effectively leveraging existing capacity, and guaranteeing ongoing funding commitments.

Global Polio Eradication Initiative

With the end of polio in sight, the Global Polio Eradication Initiative (GPEI) is working to overcome the final barriers to polio eradication, and ensure lasting legacies for health systems. This initiative is positioned within the shifting landscape of global health, and shaped by the UN agreement on the 2030 Sustainable Development Goals (SDGs) which has drawn emphasis away from ‘vertical’ programmes addressing specific diseases, and towards broader ambitions of the continuously evolving global health governance system and universal health coverage agenda. The work of GPEI, and other disease-specific eradication initiatives, must be viewed in this broader context of ongoing and potential future programmes for the eradication of infectious diseases.

This project aims to support the legacy of the polio eradication campaign, post-GPEI, through evaluating how the past accomplishments of this programme can be leveraged to achieve the SDGs. Over the past five years, GHC has conducted policy dialogues with European actors to explore various perspectives on addressing the social and political barriers to polio eradication, and the challenges to polio transition planning. Currently, the team is extending insights from policy dialogues through ongoing research on the global health financing commitments of select European countries post-eradication, and the legacies of other disease eradication campaigns.

Global health financing post-eradication with a focus on WHO

Through in-depth interviews with key representatives from donor countries and analysis of global health budgets, this research explores commitments of select European governments to global health financing, as part of the MDG-to-SDG shift from disease-specific programmes to health systems strengthening, and specifically post-GPEI. With approximately 20 to 30% of WHO’s budget dependent on the GPEI, the end of polio eradication efforts is assumed to have far-reaching implications. Understanding decisions of key donors is, therefore, important to assess the potential financing ramifications of the GPEI’s transition.

Legacies of disease eradication from the 20th century

This comparative historical analysis examines seven disease eradication campaigns conducted during the 20th century - these include dengue, guinea worm, hookworm, malaria, polio, smallpox, yaws, and yellow fever. By exploring the governmental and programmatic elements of these eradication campaigns, we are deriving broad lessons about global health governance. We are also analysing how these ‘vertical’ disease eradication programmes have impacted the capacities of ‘horizontal’ health systems, and thus, how eradication campaigns have left lasting legacies, which can be leveraged to strengthen ongoing initiatives to improve global health.