Peter Crowley :
When the international community set out in 1988 to wipe polio off the face of the earth, it was an audacious move. Only once before – with the eradication of smallpox in 1974 – had humankind managed to pull off such a feat.
And yet, country by country, region by region, there has been tremendous progress in the fight against polio. Cases are down by 99.9 percent. Only two countries still have circulating wild polio virus – Afghanistan and Pakistan – and we’re seeing fewer and fewer cases there too.
How did we get this far?
1. Data. With a wealth of data, for one thing. Polio eradication as a program has very specific targets, and very specific indicators of success against those targets. In terms of tracking and measuring progress, the data makes plain where we’re succeeding and where we are not. And with this inherent measurability comes a high level of accountability.
2. Innovation. We’ve also understood that the same tactics and strategies that got us this far are unlikely to get us to our ultimate goal. In this final stretch we have learned to innovate in every part of how we approach eradication: in the way we communicate, monitor the program and track the virus – and in the use of other techniques to help contain the disease and reduce risk. Innovation has enabled us to operate more effectively in the world’s most complex environments, places where it can be particularly difficult to reach all children with the necessary vaccinations.
3. Community engagement. Our ability to identify and enlist the help of local community leaders and social influencers has been an instrumental catalyst for the progress to date. It’s not enough for vaccinators to knock on every door and find every child; we need the support of trusted social, religious and medical institutions to champion vaccination, and we need parents and caregivers to say “yes” to the vaccine every time it is offered.
4. Research. Top quality research has helped us understand local attitudes towards the vaccine, the vaccinators and the program itself. This understanding is used to inform the design of tailored communications that are going to resonate with parents and caregivers, as well as new ways to deliver the vaccine that meet parent and community needs more directly.
5. Community links. Strong community support is even more important when it comes to reaching children living in conflict zones. In Afghanistan, for example, polio cases have tended to be concentrated in areas that are heavily affected by violence and insecurity. Serving such areas requires tactical analysis down to very local levels. Success may require reaching out to a particularly influential local leader to facilitate access, modifying the normal door-to-door campaign approach, or addressing community concerns about the vaccination teams and the management of the program.
“The willingness of every parent repeatedly to vaccinate their child may be the single most critical reason for success to date. Often, it is the parents of children who have contracted the virus who become our strongest advocates.”
We have found that the most effective vaccination teams have members who are from the local area, and are already known and respected by the local community. Gender plays a role as well; mothers are more likely to open the door to a vaccinator who is a woman, or perhaps a mother herself. Training vaccinators to respond to parents’ concerns knowledgeably and politely helps ensure that once a door has been opened – an opening that may have taken months or even years to achieve – the vaccine will be accepted.
In fact, the willingness of every parent repeatedly to vaccinate their child may be the single most critical reason for success to date. Often, it is the parents of children who have contracted the virus who become our strongest advocates.
I remember well the case of an Afghan father in an area that had become insecure and inaccessible, and whose own child had become paralyzed by the disease. This father came out to the nearest health facility in search of vaccine, and returned to his village to launch his own vaccination campaign, to spare his neighbors’ children from meeting the same fate. We owe a lot to these parents, and to polio survivors as well, who, through their own testimonials, do much to sway the skeptics in their midst.
Success also hinges on who’s in charge. The efforts of organizations such as UNICEF, Rotary International, the World Health Organization, the U.S. Centers for Disease Control and Prevention and the Bill & Melinda Gates Foundation – the core partners in the global eradication movement – can only go so far in a country battling polio without the commitment and leadership of that country’s own government. When India took ownership over its own anti-polio program, this was the game changer that enabled success in eliminating the disease in 2014.
Recent progress in Nigeria – which as of July had achieved its first polio-free year – also would not have happened without the dedication and drive displayed from the head of state all the way down to the lowest administrative level.
We have seen a similar shift in Pakistan. Strong and highly competent individuals now provide leadership within the polio program there. A national emergency operations center is in place. There are mechanisms for implementation, quality control and accountability – and a real willingness on the part of the government to look hard at the program, recognize the weaknesses and explore ways to address them. These are all very encouraging signs.
Our partners have been instrumental in securing these levels of cooperation. Rotary, for one, has played a pivotal role in garnering support from governments in polio-affected countries as well as donor governments that help fund anti-polio activities around the world. Rotary’s own contributions to the cause total $1.5 billion to date, while hundreds of thousands of its members continue to volunteer on all fronts – advocating, fundraising, and participating in vaccination campaigns from Karachi, to Jalalabad, to Kano.
We still face setbacks. The recent outbreaks of circulating vaccine-derived polio virus in Ukraine and Laos are a stark reminder of what happens when there are lapses in routine immunization. In Ukraine, polio immunization coverage has fallen sharply in recent times and this year, the reported level of immunization against polio among children under 12 months is as low as 14 percent. We must work harder to prevent these lapses, by intensifying our efforts, and by strengthening and maintaining optimal levels of immunity around the world.
It has been a mammoth undertaking and while success is now tantalizingly close, many challenges still remain. I believe that polio can and will be eradicated. I believe we are on the verge of something historic, and we must continue to be audacious in our ambitions. Because when we achieve eradication, we will be leaving behind not only a world that is free of this paralyzing disease, but also a legacy of systems, learning and innovations that can support our continuing quest for a healthy future for all children, everywhere.
(Peter Crowley has a varied and extensive background in international development, including in some of the most challenging country contexts).
