Mapping the future of the polio network

Polio may be on the brink of eradication, but less clear is the future of the vast global infrastructure set up to fight it

When Ebola was imported into Nigeria in 2014, polio surveillance officers were among the first to detect its spread. In the subsequent rush to corral the highly contagious and deadly virus, the same workers led the frontline response, helping to stop Ebola gaining a foothold in Africa’s most populous metropolis. 

In many African and Asian countries, tens of thousands of polio workers lead vaccination drives to quash other diseases, including measles and cholera, to detect outbreaks and promote safe hygiene, breastfeeding and other practices. For regions with unstable politics and weak healthcare systems, these workers have become lynchpins in efforts to bolster health services, and tackle preventable illnesses and deaths. But polio officials fear that funding for the network may dry up after the virus’ eradication, resulting in the loss of a public health resource that is now crucial to many developing countries.

 “The big question is, what happens once we eradicate polio,” says Oliver Rosenbauer, a spokesperson for the Global Polio Eradication Initiative (GPEI), the body charged with dealing with the disease. “The tragedy of smallpox eradication was that the huge infrastructure that had been built to eliminate the disease was allowed to collapse. This cannot be allowed to happen again with polio.”

"The countries we work in have the weakest healthcare systems, and this infrastructure plays a vital role in filling the gaps"The campaign to eliminate polio combines medical officers with a web of social mobilisation staff, and other volunteers, who operate in more than 70 countries; including the three where polio remains endemic: Nigeria, Pakistan and Afghanistan.

In bringing polio to the brink of eradication, the GPEI has become expert in delivering healthcare in remote, resource-starved regions that are often riven by conflict and political unrest, at an estimated cost of $1bn a year.

As a result, polio workers have also led the march in helping to roll out new and underutilised vaccines, distribute Vitamin A supplements, and respond to humanitarian crises. Ninety per cent of staff on the ground now spend half their time working on non polio-related activities, according to Rosenbauer.

 “This is a network that carries out surveillance not only for polio, but for measles, for yellow fever, meningitis, neonatal tetanus and more,” says Lea Hegg, senior programme officer, polio team, with the Bill & Melinda Gates Foundation, one of the five partners of the GPEI. “The countries we work in now are those with the weakest healthcare systems, and this infrastructure plays a vital role in filling the gaps.”

Health experts believe there is a good chance polio will be eradicated by 2019. With a deadline in sight, there is increasing pressure for officials to channel alternative sources of funding to keep the polio network alive.

“I think there is a lack of awareness among some donors of the value of this,” says Hegg. “After the Ebola crisis, many groups are looking to improve pandemic and disaster preparedness networks, or just raise coverage of public health services. The [polio] infrastructure is so expansive, and the staff so prepared; it would just require a slight pivot for it to be used for this purpose.” "To what degree do we want to invest in saving lives in these countries? Are we willing to go the extra mile?"

Of the World Health Organisation’s 1,000 immunisation officers in Africa, the polio programme currently funds more than 950 of them, says Rosenbauer.

“That is the reality. Unless we find other funding sources, is the WHO’s immunisation support to Africa going to be allowed to collapse? These are the discussions we are having now at a global and national level," he says.

In the 16 countries where GPEI has the most investment – including Nigeria, Somalia and Sudan - efforts are underway to gauge which of the core services offered through the polio network could be absorbed into existing public health systems. Ideally governments will eventually take full ownership of these services, says Hegg, but interim funding will be needed to keep the polio network active until that can happen.

“It’s a strategic decision, but putting an investment into this existing infrastructure will get the results we need, until governments are able to step into the gap,” she says. “Really, it comes down to a fundamental public health question: to what degree do we want to invest in saving lives in these countries? Are we willing to go the extra mile?”