Insufficient funding, lawlessness and the vaccination workers’ failure to operate in restive areas in endemic countries have emerged as major challenges to a new $5.5 billion global plan to halt all polio outbreaks by the end of next year and eradicate the paralysing virus in the next five years.
Polio spread across the world in 1950s but is now prevalent only in Pakistan, Afghanistan and Nigeria, all Islamic countries.
Halting all wild polio virus transmission by end of 2014, strengthening routine. Immunisation and withdrawing all oral polio vaccine from routine immunisation programmes, certifying eradication and containment of all wild polioviruses in all World Health Organisation regions, and legacy planning are the key objectives of the Polio Eradication and Endgame Strategic Plan (2013-2018) prepared by Global Polio Eradication Initiative, a public-private partnership led by national governments and spearheaded by WHO, United Nations Children’s Fund and Rotary International.
However, raising the $5.5 billion for the next five years and overcoming threats to vaccination workers in Pakistan and Nigeria are stated to be key hurdles.
In 2013, GPEI has a $700 million funding shortfall, which, a local WHO official says, is likely to get bigger in the days ahead and thus, adversely impacting on the endeavours to free the world of polio.
According to the plan seen by ‘The News’, all worldwide polio activities will require $5.5 billion from 2013 to 2018, so they must be funded sufficiently in advance to allow (plan) implementation as scheduled and at a high standard.
With this comes a warning that the larger the gap in financing, the more planned activities would need to be cut and the higher the risks of failure to complete polio eradication.
“Without the necessary donor confidence and funding, the programme will not reach eradication in the planned time frame and its focus and activities would necessarily be narrowed, in relation to the size of the funding gap. If extreme, this could include paring back of activities, which will occur using a pre-determined GPEI priority scheme.
“This mandates a list of the top five priorities that GPEI strives most to protect: core staff, surveillance/lab net, endemic country supplementary immunisation activities, outbreak response and high-risk/other country supplementary immunisation activities. All other programme aspects will be at risk of being cut.”
As part of its plan to secure full funding until 2018, GPEI has incorporated donor input into its polio eradication and endgame strategy on an ongoing basis.
Also, in addition to traditional funders, it is exploring innovative finance mechanisms and alternative sources of funding, including new donors. Besides, the careful stewardship of raised funds, active cost management and continued transparency with donors will also be ensured.
In the Polio Eradication and Endgame Strategic Plan, security and access issues in Pakistan and Nigeria, especially in light of killing of and attacks against vaccination workers, are seen as a ‘significant, on-going’ risk to polio eradication efforts. There is a warning that pending elections in Pakistan and Afghanistan, and the potential for rising tensions, may complicate already difficult situations.
According to GPEI, a series of contingencies may be utilised in regions where insecurity cannot be managed and access is restricted despite best efforts of national governments and the international community.
“(Polio) Eradication efforts will rely heavily on vaccination points in and out of conflict areas, with an effort to increase vaccination coverage of surrounding areas. Civil-military structures would be revisited to see how they may be helpful and GPEI will consider substantially increasing incentives for periods of calm. If all else fail, it may be necessary to have a cooling off or waiting period before resuming access negotiations.”
Across Pakistan, Nigeria and Afghanistan, the endemic countries, GPEI has established two near-term action items to improve vaccine delivery.
“The first is a security access operations plan with a ‘Stay and Deliver’ plan for each reservoir. Secondly, the programme will deepen its engagement and support from the Organisation of Islamic Cooperation, the Islamic Development Bank and other Islamic institutions in terms of financial, technical and communication assistance both to improve the overall strategic approach, and to inspire greater confidence in Muslim communities and constituencies in the remaining polio-endemic countries.”
As stated in the plan, partnership models that allow for acceptance of polio eradication efforts from all necessary stakeholders will be adopted; maximisation of the use of local versus international staff will be sought in light of experience with indigenous staff that they generally have greater freedom to operate and a better understanding of local complexities; social mobilisation led by Unicef will directly support this area, and finally, GPEI will explore the viability and potential of packaged health services delivery.
Also, security capacity, including an emphasis on training polio managers on security management, accountability and engagement strategies, will be enhanced to prepare staff for handling issues as they arise.
In the plan, there is a mention of the eventual switch from trivalent oral polio vaccine to bivalent oral polio vaccine in routine immunisation programmes (and the eventual cessation of all oral polio vaccines), including the universal introduction of at least one dose of inactivated polio vaccine.
According to an expert, since oral vaccine contains live polio virus, it can cause rare outbreaks and therefore, it should be replaced with bivalent oral polio vaccine, which has an inactivated virus and is delivered by an injection.
Source: The News International