Final Research Report
"It is ultimately the political dimension and the strength of political linkages made that will determine the fate of this global health initiative."
The Global Health Centre (GHC) at the Graduate Institute of International and Development Studies in Geneva, Switzerland, engaged in a project (2015-2016) to explore the critical dimensions of the global effort to eradicate polio, focusing on overcoming the final social and political barriers and ensuring a lasting legacy for health systems as well as the role of European countries in this effort. One outcome of the project is this research report, which reflects on: eradication-related challenges; the European dimension; learning lessons: resilience and transition, translation, and legacy; and cross-cutting issues for global health.
The report begins with a call to action - 10 actions, to be precise - for European actors to ensure the polio endgame and a lasting legacy.
- European governments should sustain and increase financial support to polio eradication.
- On the one hand, European institutions should contribute effectively to strengthen the political will of European governments and on the other, the European governments should provide political support and implement the recommendations of the European institutions in the countries still affected by polio or in countries at risk.
- European institutions and European governments should act together to ensure continuing capacity for resilience following certification and realise the long-term benefits of polio assets for health systems and Universal Health Coverage (UHC).
- European actors must recognise and promote linkages between polio eradication and other health initiatives, such as Sustainable Development Goal (SDG) 3, strengthening of health systems, achieving UHC, and strengthening global health security.
- European institutions should show leadership in multi-stakeholder negotiations and collaborations to ensure the success of the Global Polio Eradication Initiative (GPEI) and its partners.
- "Missed children" constitute a significant risk for Europe. Strengthening Europe's polio resilience and containment capacities should be coordinated between World Health Organization (WHO) EURO, the European Centers for Disease Control (ECDC), the European Commission (EC), and European governments.
- European actors must act together, fostering dialogue and maximising collaboration and coherence among their constituents. The European institutions should play a leading role in ensuring that diverse actors investing in polio eradication work together.
- European institutions and governments need to act together to ensure that polio transition processes not only benefit national health systems but also result in the effective capture of valuable polio assets for European and multilateral institutions.
- European institutions should be pro-active in bringing together the key actors dealing with transition processes (e.g. the GPEI, the Global Fund, Gavi, and others) to facilitate better coordination and complementarity.
- European institutions should support and reinforce the role of the Polio Transition Independent Monitoring Board (TIMB).
GHC explains that, in its nearly 30 year of existence, the GPEI operated within and adapted to significantly changing global and European context. The issues, risks and challenges that have arisen "are connected through a political thread. It relates to the choices that different actors make about their priorities and their preferences for how to balance them. From the global donors and managers to local communities, families and individuals, this political thread interweaves with and links the circles of influence comprising the diverse actors involved in polio eradication." The report outlines 3 dimensions of the global polio eradication efforts:
- Critical needs must be met to ensure that eradication is achieved and sustained;
- There is a pressing call to effectively capture and transition polio assets, both at global and national levels; and
- Beyond physical resources, the GPEI represents immense knowledge, experiences, and processes, which need to be absorbed by the global health community.
GHC urges that Europe has a role in play in all of these aspects. For instance, Europe has an opportunity to take leadership and ensure accountability with regard to its support for this global project. "Individual European actors have made important political contributions to polio eradication. However, it was consistently noted [in interviews carried out as part of the GHC project] throughout the research that these contributions are rarely coherent or coordinated across the region. This is considered a significant weakness in the polio eradication story."
The issue of migrants and refugees is an opportunity to encourage stronger European engagement in both the endgame and legacy of polio eradication, according to GHC. However, "[f]ears surrounding the mass influx of migrants and refugees to Europe have included concerns that infectious diseases, including polio, will be carried into the region." It is here where European cooperation - collective coordinated action - is described as vital to strengthen Europe's polio resilience and containment capacities.
The report looks ahead to legacy planning, noting that such planning, "at country level must be complemented by translating relevant knowledge and systems at the global level, with the goals of contributing to the planning of future disease eradication campaigns or other global health initiatives and strengthening global health governance more broadly." As noted here, the transitioning of assets from the GPEI to country ownership and into "horizontal" programmes "is an opportunity for the Initiative to align itself with the broader SDG objectives, not only at the country level, but in attempting to attract support among existing and potential contributors." The transition of lessons learned, assets, and knowledge is not only for national institutions, GHC stresses; making the most of the polio legacy also requires translation of learning by diverse bilateral and multilateral assistance partners and stakeholders to benefit the overall global health architecture, governance, and future health initiatives.
"Many interviewees emphasized the value of linking polio with other issues that are emerging or are already in the limelight, especially broader health goals, to sustain the financial and political support for the endgame of polio eradication and/or to ensure the preservation of valuable polio assets beyond certification." The final section of the report examines some of those cross-cutting issues for global health, describing, for example, the gender and community issues that are inter-related and central. These factors include: systems of hierarchy and governance; political, religious, cultural, and social factors; and attitudes and embedded mistrust of certain authorities and actors in different contexts. "According to some interviewees, female vaccinators have not only contributed immensely to these efforts, but have also taken steps towards empowerment and greater autonomy. This research revealed once again that gender issues should not be tackled as they arise, but should be central to the initial planning and implementation of health initiatives."
A concluding thought: "Achieving polio eradication and strengthening resilience require partnerships and prioritization across boundaries and sectors."
Emails from Robert Steinglass and Stephen A. Matlin to The Communication Initiative on January 9 2018 and January 14 2018, respectively, and GHC website, January 12 2018. Image credit: Berlin 2016, © GHC/A. Berry