Establishing vaccine infrastructure: Learning from the polio endgame It is a truism of current public health thinking that the pursuit of single disease eradication is inefficient and inequitable in meeting sustainable development goals. The Global Polio Eradication Initiative (GPEI), spearheaded by Rotary International, is an initiative that has touched every Commonwealth member state with a far broader impact than the obvious protection of children from polio; it is a contribution towards a possible new UN development goal of combating communicable diseases and providing universal health coverage (UHC) by 2030. Building on the previous Commonwealth Health Ministers Meeting, which looked at health in the post-2015 development agenda, now is a good opportunity to look at some of the best practices from the perspectives of civil society, and the public and private sectors in relation to UHC. The WHO1 offers a useful definition of the prerequisites of UHC: • A strong, efficient, well-run health system • A system for financing health services • Access to essential medicines and technologies • A sufficient capacity of well-trained, motivated health workers The GPEI offers not only one of the most complete advances towards the ideal of UHC, but also puts into practice a holistic approach to disease eradication that progresses multiple development goals as we transition to the Sustainable Development Goals (SDGs) at the end of this year. It advances, in particular, at least nine of the 17 SDGs, including engaging with the challenges of poverty, disease prevention, gender equality, economic development, resilient infrastructure and equity. As Michael Sidibé (2014), executive director of UNAIDS, wrote in this publication last year, it is vital to address ‘the social determinants of health more broadly – poverty, discrimination, gender violence and inequity, sexual and reproductive health and education’. Ending polio Rotary, a non-profit organisation, had the audacity to take on the challenge of seeking a polio-free world. In 1985 it launched its PolioPlus programme, the first initiative to tackle global polio eradication through the mass vaccination of children. Three years later, the GPEI was formed, with the mission of ending polio forever. The idea was that by fighting to eradicate polio, the global infrastructures to fight other diseases would also be strengthened. The underlying principle of UHC is equity and the notion of equity is also at the core of polio eradication. The GPEI has brought vital health interventions (not only polio vaccination) to some of the 66 Commonwealth Health Partnerships 2015 poorest and most disadvantaged populations over the last three decades. The boat-dwelling fishing communities in Cambodia and Vietnam, nomads in Pakistan, Afghanistan and Somalia, and construction workers in Delhi have all been reached by the initiative. Broader health interventions In many countries, polio vaccination campaigns are linked with other health interventions. During measles vaccination campaigns, for instance, the oral polio vaccine is frequently given alongside the one for measles. Vitamin A has been widely distributed for many years during polio campaigns, and has resulted in measurable improvements in indicators associated with vitamin A deficiency in many countries. In Nigeria, health clinics set up as part of the polio programme infrastructure have served as a staging post for multiple medical interventions, including measles vaccination, treatment of intestinal parasites, distribution of Vitamin A and bed nets to protect against malarial mosquitos. The ‘plus’ in PolioPlus means that Rotarians are doing more than stopping the spread of polio in the last three countries in which it is endemic: they are also building a legacy of infrastructure and partnerships that will support the fight against infectious disease long after polio is gone. For example, most vaccines require refrigeration from the time they leave the manufacturer until they reach the recipients. Rotary has focused on setting up viable ‘cold chains’ in each country, from refrigeration units in major cities to kerosene refrigerators in areas without electricity, to carrying cases that allow the vaccine to be kept cold during vaccination campaigns in rural areas. The cold chain created to distribute the polio vaccine has been used to transport other vaccines, such as measles, tetanus and diphtheria. An estimated one-third of the cold chain capacity in Sub-Saharan Africa was created to support polio eradication. The work of the GPEI and Rotary has also benefited the GAVI Alliance, an international organisation focused on improved access to new and underused vaccines for children living in the world’s poorest countries. GAVI’s successful Pentavalent2 vaccination campaign drew upon the infrastructure and cold chains that had been established. Ebola response Most recently, the influence of the GPEI can be credited for what the World Health Organization (WHO) described as Nigeria’s ‘world-class’ public health response to thwart the Ebola virus last year (Courage, 2014). Judith Diment
Commonwealth Health Partnerships 2015
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