Five ways to turn polio program wind-down into health system scale-up

World Immunization Week ACTION Blog Series | April 24 – 30, 2018

Endorsed by the World Health Assembly at its May 2012 meeting, World Immunization Week highlights the effectiveness of vaccines as protection from preventable infectious diseases. More than 180 countries use the annual campaign to encourage policymakers, donors, and the public to play their part in increasing greater immunization coverage worldwide.

The World Immunization Week advocacy campaign is premised on the evidence, proven by decades of research, that vaccines are a safe and effective way to prevent many childhood diseases and deaths. This year’s theme, “#Vaccines work!” affirms the benefits of vaccines as invaluable in promoting health security and helping countries accelerate sustainable development. ACTION believes further that “a healthy society is a productive society” and supports immunization programs as central to ending poverty.

ACTION’s blog series for World Immunization Week offers a perspective from Pakistan of the fight to end poverty for good, the role of women in successful immunization efforts, ways to ensure that polio funding wind-down means a scale up for health systems funding, improving immunization rates in Africa, and lessons learned from immunization campaigns and transition in Latin America and the Caribbean.

Five ways to turn polio program wind-down into health system scale-up

Hannah Bowen, ACTION Secretariat Director

This World Immunization Week, we’re exploring how to be “protected together” through immunization, and one of the best examples is polio eradication. Through world-wide cross-sector cooperation, the Global Polio Eradication Initiative (GPEI) has helped protect us all by removing the threat of paralysis and death from this preventable disease. As we get closer to the goal of a polio-free world, we must plan ahead so that polio eradication does not lead to the end of aggressive immunization efforts or of creating sustainable health systems.

After the massive celebration, there is a risk that the wind-down of GPEI could mean just scaling back, programmatically and financially, and moving on. But, as our partners RESULTS UK and RESULTS Australia have pointed out, moving on could mean decimating the capacity of health systems in more than a dozen low- and middle-income countries, as well as global capacity for disease surveillance. We cannot let that happen. Instead, we must make polio eradication a launching pad for scaling up our work to make routine immunizations available to all kids.

To make sure that the milestone of polio eradication is a springboard for universal health coverage, rather than a cliff from which health funding plummets, governments and their partners in civil society, business, and international institutions can follow this five-step path:

  1. Plan for keeping polio at bay.
    The first step is already underway, and that is ensuring that “polio essential functions” continue smoothly as long as needed. GPEI is working to develop a Polio Post-Certification Strategy, which focuses on controlling or removing possible sources of poliovirus, protecting people from re-emergence of the disease by using inactivated polio vaccine, and maintaining strong detection and surveillance capacity in order to rapidly respond to any sign of the virus. We all have a responsibility to ensure that governments, civil society, and international institutions know what this strategy contains, who will lead on each of its activities, and how these activities will be funded after GPEI winds down.
  2. Build on polio’s legacy to reach every child with routine immunization.
    Even though the fight against polio has included some polio-specific strategies such as vaccination campaigns, the progress we have seen (and the end goal that is now within sight) would not have been possible without efforts around the world to build better health systems. The urgency and precision of polio eradication have given us all a compelling rallying cry to hire and train health workers able to reach all families, to mobilize and support communities, build labs, share surveillance data, establish supply chains, and set bold goals.
    All those elements of a strong health system are also necessary to deliver more than polio vaccines, and we can use the momentum created by their success in fighting polio to justify even greater ambition: these systems work, and all our kids deserve their support to grow up healthy. The urgency remains: UNICEF reported that over 19 million infants missed out on the full course of routine immunizations in 2016.
  3. Know how much immunization and other primary health care services cost.
    The infusion of global resources into national health systems can be a two-edged sword: while enabling massive health gains, this approach can also distort the mapping of health system priorities, needs, and resources. In many low- and middle-income countries, it is not an easy task to track down all the elements contributing to more equitable access to health, since they’re not always captured in health budget lines. The polio transition planning process is a huge opportunity, in countries with GPEI support, to do this mapping and get a clear and comprehensive picture of what it will cost to reach all kids with routine immunization and all families with primary healthcare.
  4. Be prepared to make the investment.
    Though it is important to know the price tag of reaching universal and equitable access to immunization and other health services, it is equally important to view that expenditure as an investment rather than a burden. Recent analysis tells us that every $1 invested in people by providing childhood immunization returns $44 in economic and social benefits. In a globally-connected world, we all reap those benefits.
  5. Rethink the role of joint global funding for health.
    GPEI was established at a time when truly global cross-sector responses were still rare. Today, we have a multitude of actors contributing to the global pool of resources available for improving health. These include Gavi, the Vaccine Alliance, which helps support routine immunization in low-income countries; the Global Fund to Fight AIDS, TB and Malaria; the Global Financing Facility in support of Every Woman, Every Child; the World Bank and regional development banks; bilateral development assistance agencies; and philanthropic donors and private sector companies.

While its structure and plans are unique, GPEI is not the only institution considering winding down support for health; many others are using transition plans to scale back support based on economic growth and/or disease reduction. It is true that these institutions need to evolve their models of partnership—but to account for the fact that the gaps in health equity look different today than in the past, rather than to reduce their role in improving health. As ACTION reported last September, more rapid evolution is needed—as well as more coordination. A broader realignment of resources to match reality is needed if we are going to achieve the vision in the Sustainable Development Goal of health for all.