What We Do

Polio

Strategy Overview

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Children crossing the border from Pakistan to Afghanistan are given oral polio vaccine through a program implemented by Rotary International.

our goal:

to eradicate polio worldwide.

The Challenge

At A Glance

In 1988, when the Global Polio Eradication Initiative (GPEI) was launched, polio was present in more than 125 countries and paralyzed about 1,000 children per day. Thanks to immunization efforts that have reached nearly 3 billion children, the incidence of polio has decreased by 99 percent since then.

In 2012, polio was stopped in India, which was long considered the most difficult place to end the disease. In 2015, Nigeria—Africa’s last polio-endemic country—was also declared polio-free. Today, polio can be found only in Pakistan and Afghanistan.

Despite this progress, if we fail to completely eradicate the disease, we could witness a resurgence of 200,000 new cases annually, making this a critical priority in global health.

The Bill & Melinda Gates Foundation is committed to eradicating polio worldwide, and that’s why we are a key supporter and partner of the GPEI.

The GPEI is led by national governments, the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention, and UNICEF. Our polio strategy, part of the foundation’s Global Development Division, is led by Director Jay Wenger.

Over the past three decades, the world has made tremendous progress toward the eradication of polio. In 1988—when wild poliovirus was present in more than 125 countries and paralyzed 350,000 people every year, primarily young children—the World Health Assembly set a goal to eliminate the disease, and the Global Polio Eradication Initiative (GPEI) was launched. Since then, immunization efforts have reduced the number of cases by more than 99 percent, saving more than 13 million children from paralysis. In 2012, India stopped the virus, and in 2015, Nigeria was removed from the list of endemic countries. Today, polio is found only in Pakistan and Afghanistan, and fewer than 100 cases were reported in 2015.

Despite this progress, if we fail to fully eradicate this highly contagious disease, within a decade, we could witness a resurgence of as many as 200,000 new cases annually. Since 2008, more than 20 countries have experienced polio outbreaks—some of them multiple times. Efforts to reach unvaccinated children are often hampered by security risks and geographic and cultural barriers. Furthermore, vaccination campaigns cost approximately US$1 billion per year, a price that is not sustainable over the long term.

The Opportunity

At the World Health Assembly in 2012, 194 member states declared that the eradication of polio is a “programmatic emergency for global public health.” At the 2013 Global Vaccine Summit in Abu Dhabi, donors pledged $4 billion to fund GPEI’s new six-year plan to eradicate polio and eliminate the disease. Experts estimate that in the two decades following eradication, countries will receive between US$40 billion and US$50 billion in net benefits, approximately 85 percent of which will go to low-income countries. This figure does not include additional health improvements resulting from other GPEI efforts, such as vitamin A supplementation or the much larger net benefits of eradication for countries that eliminated polio before the GPEI started.

India—long considered the most difficult place to end polio due to its population density, high migration rates, poor sanitation, high birth rates, and low rates of routine immunization—is a prime example of how a fully funded program with dedicated leaders and workers can achieve success.

Polio vaccination teams pick up supplies at a railway station in the state of Bihar in northern India.

A number of factors contributed to India’s success: highly targeted, data-driven planning; well-trained and motivated staff; rigorous monitoring; effective communications; mobilization of trusted community and religious leaders; political will at all levels; and adequate funding. India has served as a model for other regions and has shared technical assistance and best practices with countries including Nigeria, Afghanistan, and Pakistan.

Global collaboration and innovation have produced new tools and approaches that can help improve logistical planning for polio eradication. In addition, refinements to the polio vaccine have improved the immune response to the remaining types of the disease. (Wild type 2 poliovirus was eliminated in 1999, and wild type 3 has not been reported anywhere since 2012.) New diagnostic, monitoring, mapping, and modeling tools are allowing faster and more accurate tracking of polio cases and transmission patterns.

To slow the spread of polio in their countries, Pakistan and Afghanistan have implemented national emergency plans overseen by their heads of state. These programs increase accountability and improve the quality of polio vaccination campaigns from the national to the local level. WHO is providing unprecedented levels of technical assistance to these countries, and improved vaccination campaigns are helping reach more children.

The GPEI six-year plan serves as the basis for all activities required to stop polio, including the use of data and analysis to set country-level vaccination targets, as well as the use of new tools and approaches to implement programs. According to a 2015 midterm review, the GPEI program is largely on track but will need an additional US$1.5 billion to end polio by 2019, one year later than planned.

Eradicating polio is an important milestone for the Decade of Vaccines, a shared commitment by nearly 200 countries to extend the benefits of vaccines to every person by 2020. It also would establish a model we could use to deliver vaccines for other preventable diseases and protect children in the poorest, least accessible areas.

Our Strategy

Polio eradication is one of our top priorities, and as a major supporter of the GPEI, we contribute technical and financial resources to accelerate targeted vaccination campaigns, community mobilization, and routine immunizations. We also partner to improve polio surveillance and outbreak response; develop safer, more effective vaccines; and galvanize financial and political support for polio eradication efforts.

We have a unique ability to contribute by taking big risks and making nontraditional investments. Examples include our investments in vaccine research; our funding of geographic information system (GIS) maps to replace hand-drawn maps for campaign planning; and our establishment of emergency operations centers in Nigeria, Pakistan, and Afghanistan.

Areas of Focus

Polio Vaccination Campaigns

Through improvements in outreach, staffing, and data collection and analysis, polio vaccination campaigns can achieve the required immunization coverage to reach GPEI goals. Our priority is to improve the quality of campaigns in Afghanistan and Pakistan, as well as other countries that are at risk of polio importation. As the program nears eradication, it’s more important than ever that countries keep high-quality campaigns going, even if they do not have active cases.

Children receiving oral polio vaccine at an event inaugurating a polio vaccination campaign in Kano, Nigeria.

GPEI’s polio eradication strategy focuses on national and local campaigns that provide all children in the highest-risk countries with multiple doses of oral polio vaccine. Efforts include door-to-door immunization in areas where poliovirus is known or suspected, as well as in areas at risk of re-importation, with limited access to healthcare, high population density and mobility, poor sanitation, and low routine immunization coverage.

We support work to understand social, cultural, political, and religious barriers to improving vaccination coverage, and we seek ways to work with local political leaders and health professionals. We also prioritize expanded staffing and training of vaccination teams, as well as greater technical assistance.

We promote the use of sophisticated mapping tools to identify households in villages and help vaccination teams locate children who have not yet been reached. Such tools also help vaccination teams identify nomadic populations.

Routine Immunization Systems

Currently, 20 percent of the world’s children do not receive all the immunizations they need. Reaching every community requires understanding local barriers to access as well as the use of sophisticated tracking and planning tools. A coordinated immunization system can also serve as a platform for other important health interventions. We are working with our partners to strengthen routine immunization programs for polio and other preventable diseases, including diphtheria, tetanus, whooping cough, and measles.

Surveillance and Monitoring

It is essential to pinpoint where and how the wild poliovirus is still circulating, and to verify eradication. A strong surveillance system helps us accurately target campaigns, adjust programs quickly, and swiftly address outbreaks.

Doctors investigate a suspected case of polio in an infant in the state of Bihar, India.

Polio surveillance is especially challenging because only a small percentage of infections result in clinically apparent paralytic disease. To confirm the disease, we must analyze stool specimens to see if poliovirus is present.

Through our investments to evaluate surveillance efforts in the highest-risk areas, we have discovered the need for improved environmental surveillance: testing sewage water samples for evidence of poliovirus transmission in the surrounding community. We have invested in a technology that promises more sensitive sampling with lower specimen volume, as well as more hygienic collection. We also fund efforts to develop less expensive and more reliable lab tools, such as a diagnostic kit that local labs can use to rule out negative samples and send positive specimens to reference labs for confirmation.

Product Development and Market Access

Although current vaccines and detection tools have proven highly effective in eliminating the virus from most countries, they may not completely eradicate the disease. We are working with partners to improve existing tools while accelerating the development of safer vaccines, better diagnostic tools, new antiviral drugs, and other products. We also work with partners, suppliers, and governments to ensure sufficient vaccine supply and demand and to promote market competition.

The oral polio vaccine, which is most commonly used in the developing world, is safe, effective, easy to administer, and inexpensive. But this vaccine consists of live, weakened viruses, which in very rare cases can cause paralysis. In settings with very low oral polio vaccine coverage, the live weakened virus in the vaccine can also mutate and begin to circulate in the population. We are supporting the development of new oral polio vaccine formulations that do not pose this risk. We are also transitioning from using the oral vaccine to the injectable inactivated polio vaccine, which does not carry the same risk. We assist in efforts to lower the cost of the injectable vaccine and implement the training, supply, delivery, and communications infrastructure to expand its use.

Data-Driven Decision Making

Data collection and sharing are critical to eradicating polio. We work to improve data access to inform decision-making, track progress, improve environmental surveillance, and guide the development of vaccines and diagnostic tools. We are also working with partners to develop a decision framework that identifies key decision areas, the data needed to inform decisions, and the staff and partners needed to analyze the data and create models. We support a data-access platform at WHO that ensures key polio data are standardized, quality-assured, and available for analysis and decision-making.

Containment Policy

Once wild poliovirus transmission has stopped globally, it will be important to ensure safe handling and containment of materials in laboratory and vaccine-production facilities. Reintroduction of the wild poliovirus would present the potentially serious consequences of re-establishing the disease. As part of the GPEI partnership, we are developing a post-eradication containment policy that will be adopted by the World Health Assembly.

Legacy Planning

In its two decades of operation, the GPEI has trained and mobilized millions of staff and volunteers, identified and reached households and communities that had been untouched by other initiatives, and established a robust global surveillance and response system.

Through polio eradication efforts, GPEI partners have learned how to overcome logistical, geographic, social, political, cultural, ethnic, gender, financial, and other barriers to working with people in the poorest and least accessible areas. The fight against polio has created new ways of addressing human health in the developing world—through political engagement, funding, planning and management strategies, research, and more.

The GPEI has developed a wide range of assets, including detailed knowledge of high-risk groups and migration patterns; effective planning and monitoring procedures; highly trained technical staff; local and regional technical advisory bodies; and commitments based on successful partnerships among global, national, religious, and local leaders. These assets have already been used to respond to other public health threats, including Ebola, meningitis in western and central Africa, H1N1 flu in Sub-Saharan Africa and the Asian subcontinent, and flooding and tsunami disasters in South Asia.

We are continuing to work with the GPEI to identify ways the polio infrastructure—including supply chains, surveillance and laboratory systems, and social mobilization networks—can be used to support other health initiatives and immunization programs in the long term.

Advocacy and Communications

A woman delivering vaccines house-to-house in Sokoto, Nigeria.

We work closely with GPEI partners to mobilize funding and sustained global and national political momentum for polio eradication. This involves promoting efforts to increase polio funding from government donors and cultivating new and nontraditional donors. We also encourage leaders of polio-affected countries to follow through on their commitments to ongoing campaigns, and we help them identify and implement sources of financing for those campaigns.

We also align and mobilize other advocates, including influential community members such as religious leaders, volunteer organizations, and employers. With partners such as Rotary International, UNICEF, RESULTS, the UN Foundation, and the Global Poverty Project, we use traditional and social media to raise awareness of polio eradication and immunization activities in both donor countries and countries where polio is a threat. We support efforts to tailor communications to particular social, cultural, and political contexts to build demand for vaccination and to dispel myths about the safety and efficacy of vaccines.

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