Milestones :: Perspectives

Polio Eradication

Dr Tedros Adhanom Ghebreyesus, WHO Director-General and Chair of the Polio Oversight Board, issued a personal response [first text below] to the joint statement published in January by the Chairs of the main, independent, advisory and oversight committees of the GPEI [second text below].

March 2019
Dear Chairs of the GCC, IHR Emergency Committee, 1MB and SAGE,
On behalf of the Global Polio Eradication Initiative (OPEi) and as current Chair of the Polio Oversight Board, I would like to thank you for your recently-published joint communique on the polio eradication effort. Your assessment of the current global situation, and what needs to happen to achieve success, is as accurate as it is motivating. Thank you for this strong call for action.

Let me assure you: all partners of the OPEi fully agree with you.

As a global community, we have been engaged in this fight for 31 years now. Wild poliovirus cases now persist in only a handful of districts of just two countries – Pakistan and Afghanistan.

In January, I was joined by Dr Al Mandhari, Regional Director for the Eastern Mediterranean, and Dr Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation, as we visited both countries where we witnessed first-hand the tremendous efforts being undertaken to interrupt the remaining chains of wild polio transmission there. I have rarely been so impressed by public health efforts being undertaken as in these two areas, as both countries work hand-in-hand to tackle this joint epidemiological block, as both countries engage and mobilise all levels of public and civil society to support this effort.

As you rightly point out, eradication is an “all-or-nothing” approach. We either eradicate, or we do not. And the truth is, everything in place for success to be achieved. The Endgame Plan through 2013-2018 has brought us to the brink of being polio-free. And the Strategic Plan 2019-2023 aims to build on the lessons learned since 2013. Its aim is to increase performance everywhere, including using the proven tools of eradication and building blocks that have been established, while using opportunities to innovate using local knowledge and insights to overcome obstacles that in the past have seemed insurmountable. The key is to optimise all these approaches, and if the Plan is fully financed and implemented at all levels, a lasting polio-free world will be secured for all future generations to come.

That is why I commit to you today: we will rise to your call to action, and we will excel in our jobs, and this will lead to the success we all want to see. As you challenge us, we commit to making it our overriding objective to find and reach that last unvaccinated child before the poliovirus does. We will give the poliovirus nowhere to hide.

Your continued guidance, independent assessments and oversight will be critical to help us in securing this success. It is this guidance which has been instrumental in helping bring us to the threshold of a polio-free world, and it will be your continued guidance which will help us finally cross this threshold. Please continue with your assessments. Continue to critically evaluate what we are doing. Continue to issue your joint statements to draw attention to what needs to be done. We must have this oversight.

On behalf of our partners at Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation, and mostly on behalf of the children of the world, thank you!

Dr Tedros Ghebreyesus
Director-General, World Health Organization
Chair, Polio Oversight Board of the Global Polio Eradication Initiative

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January 2019
Dear Polio Eradicator,

The global polio eradication effort is 31 years old.

The world is tantalizingly close to being free of polio. From 350,000 wild poliovirus cases every year in 1988, in 2018 the world reported just 29 cases of this devastating disabling disease because of extraordinary global efforts. Wild poliovirus transmission is endemic in only a handful of districts worldwide. The aim of the 2013-2018 Endgame Plan had been to be finished with this job by end 2018. This is not the case, and the Plan has to now be revised and extended through 2023.

This is an effort that cannot be sustained indefinitely: 31 years is long enough. It is resource intensive. It is intensive on the countries affected. It is intensive on donors. It is intensive on health services. It is intensive on communities. Most of all, it is intensive on those children and their families who bear the burden of this terrible disease, needlessly.

There is no reason why polio should persist anywhere in the world.

To succeed by 2023, all involved in this effort must find ways to excel in their roles. If this happens, success will follow.

This means stepping up the level of performance even further. It means using the proven tools of eradication and building blocks that have been established in parts of the world that have been free of polio for years. The vaccines, the cold chains, the networks of vaccinators, the surveillance capacity, the governance, policy, financing and oversight structures must be at peak levels of performance. There must be an unrelenting focus to tighten the management of the effort at all levels.

It also means looking for opportunities to innovate, using local knowledge and insights to overcome obstacles that in the past have seemed insurmountable. It means looking at new and different ways to reach children. It means really understanding the views of parents, and communities, who are unwilling to accept the vaccine and finding ways to address their concerns and come together with them. It means more effectively engaging with communities and better serving their needs than we have been doing thus far. Each person must dedicate themselves to one clear objective – to reach that very last child with polio vaccine.

Please commit to finding that very last child first, before the poliovirus does. Give the poliovirus nowhere to hide.

Whatever barrier to reaching that very last child, the programme has the expertise and experience to overcome it. Let everyone perfect what we know works. Let everyone free their mind to come up with new ideas and transformative solutions. We must all treat this as the public health emergency that it is.

As a global community, we have stood before where we stand today, with smallpox. The scourge of smallpox is gone, for which the world is a much better place. Let us make history again. It is time to finish the job of polio eradication now. The philosopher, poet and essayist Ralph Waldo Emerson said: “To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition, to know even one life has breathed easier because you have lived – this is to have succeeded.”

Eradicate polio, and make the world a better place for future generations.

Thank you.

Professor Alejandro Cravioto
   Chair of the Strategic Advisory Group of Experts on immunization (SAGE)

Sir Liam Donaldson
   Chair of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative

Professor Helen Rees
   Chair of the Emergency Committee of the International Health Regulations (IHR) Regarding
      the International Spread of Poliovirus

Professor David Salisbury
   Chair of the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC)