Risks and opportunities as funding for polio disappears with the disease
Leila Stennett and Laura Kerr
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.
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.
In all 16 priority countries, three main barriers increase the risks posed by GPEI winding down: existing immunisation and health systems are fragile; there will be pressures from simultaneous GPEI and Gavi transitions (which will occur for half these countries by the early 2020s); and shifting the focus from vertical disease eradication efforts to a routine immunisation system approach will bring great challenges.
The risks are therefore high. If the impact is not urgently analysed and understood by countries, development partners and donors, and the barriers underlying this process acknowledged and addressed, polio and immunisation systems will be disrupted. Crucially, a mismanaged transition could mean:
- Polio could return – continued vaccinations up to 2030 are required to ensure polio eradication is sustained.
- The benefits for polio and vaccination systems from the $US 15 billion invested in the GPEI could be lost.
- Resources for WHO and national health systems could decline, undermining national health goals and the Sustainable Development Goals.
An unsuccessful and mismanaged transition will not only put past investments at risk but also increase the likelihood that the barriers mentioned above will not be overcome, and that the opportunity to strengthen routine immunisation will be missed. For these risks to be averted, potential gaps in health programs must be comprehensively analysed, the challenges identified must be addressed promptly, and transition plans costed, funded, and implemented—all before current financial assistance from GPEI ends.
As such, planning for the post-GPEI era must be a political priority in 2018. RESULTS International Australia and RESULTS UK are calling for a high-level meeting next May on the sidelines of the World Health Assembly 2018 to put this issue at the forefront of global health policy. Bringing a wider array of immunisation and health stakeholders into the conversation about GPEI wind down is critical. This meeting should involve heads of all GPEI partner organisations, leadership from Gavi and the World Bank, Heads of State from the 16 priority countries, leading bilateral donors to polio and immunisation efforts, and civil society.
If current barriers and challenges are left unaddressed, the wind down of GPEI could have serious ramifications for immunisation programs and global health security well beyond GPEI’s 16 priority countries. We must ensure that at this final juncture, this process does not undermine all the good work that has been done towards polio eradication.