Global Health Diplomacy and the Eradication of Polio

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Written by John E. Lange and Kate Dodson, Guest Contributors

Infectious diseases do not respect borders. In today’s era of easy transportation, what happens in one country can have implications for other countries near and far.

An increasing number of institutions—governments, international organizations and non-state actors—engage in global health diplomacy to shape policy in response to health challenges.

Medicine alone cannot put an end to preventable disease in developing countries. Extensive public and private healthcare systems and programs also require political support, resources from domestic sources as well as donors, and collaboration among a multitude of partners: host governments, non-governmental organizations (NGOs), the business community, international organizations, development assistance agencies, and many others.

There may be no better example of the indispensable role of global health diplomacy than in the world’s effort to eradicate polio.

Since 1988, two United Nations agencies—the World Health Organization (WHO) and UNICEF—along with Rotary International and the U.S. Centers for Disease Control and Prevention have spearheaded the Global Polio Eradication Initiative (GPEI). In recent years, these core partners have been joined by the Bill & Melinda Gates Foundation. When GPEI began in 1988, more than 1,000 children worldwide were paralyzed from polio every day. In 2013, that number was down to 417—for the entire year.

Polio has been eliminated in some of the most difficult environments. Following India’s remarkable success in eliminating polio, there now are only three countries where polio transmission has never been stopped (Afghanistan, Nigeria, and Pakistan). Though others, where polio had once been eliminated, are now experiencing new outbreaks, in which the disease has arrived into the country from elsewhere.

GPEI’s many partners engage in global health diplomacy at many levels and in many forms to advance the goal of polio eradication. A prime example of that engagement took place at the United Nations in September 2012. At a high-level event titled “Our Commitment to the Next Generation: The Legacy of a Polio-Free World,” UN Secretary-General Ban Ki-moon declared, “This decisive moment is a matter of health and justice. Every child should have the right to start life with equal protection from this disease.”

According to a summary of the event, key leaders vowed to step up the fight to eradicate polio in a display of solidarity. The Presidents of Afghanistan, Nigeria, and Pakistan joined top officials from public and private sector donors to outline what is needed to stop polio: long-term commitment of resources; applying innovative best practices; and continued leadership and accountability at all levels of government.

The event during the UN General Assembly was moderated by the UN Foundation and built on the May 2012 declaration by the World Health Assembly designating the completion of polio eradication a programmatic emergency for global public health and calling for the creation of a comprehensive, long-term strategy to eradicate polio. The resulting Polio Eradication Endgame & Strategic Plan 2013-2018 was created in consultation with national health authorities, global health initiatives, scientific experts, donors, and other stakeholders and provides a shared roadmap for global efforts to end polio.

The global commitment to ending polio received another big boost at a vaccine summit in Abu Dhabi in 2013 organized by the government of Abu Dhabi, the UN, and the Gates Foundation. At the summit, public and private sector donors stepped up to commit $4 billion for the effort to end polio over the six-year strategic plan. This offered a prime example of public-private cooperation to tackle global health challenges and the value of high-level global health diplomacy to overcoming those challenges.

Today, the fight to end polio faces new challenges; health diplomacy and partnerships will remain critical to finishing the job. Success will require strong support from political leaders, ranging from heads of state and cabinet ministers to state and provincial leaders to local government officials, along with support from ethnic and religious leaders, non-governmental organizations, the business sector and many others.

The biggest challenges facing GPEI relate to political and security concerns, particularly in the three endemic countries, but also in other countries involved in ongoing conflicts. In the past year, for example, we have seen polio re-emerge in Syria, a country that had not had a case of polio in 14 years. We have also seen polio spread from Cameroon to Equatorial Guinea, from Pakistan to Afghanistan, and from Syria to Iraq. In May 2014, the World Health Organization declared polio a “public health emergency of international concern,” calling the international spread of polio in 2014 an “extraordinary event.”

This polio emergency signals the international community’s collective commitment to ending polio. It takes immense political will for countries to agree on exceptional measures, like those recommended by WHO. The fact that these recommendations have been made at the request of a committee comprised of representatives from more than a dozen countries, under International Health Regulations agreed upon by all countries of the world, indicates the shared sense of duty and resolve to finish the job of eradicating polio.

If we are to achieve a polio-free world, addressing security and access issues will be essential. And global health diplomacy—undertaken by GPEI’s partners as well as by many players in polio-affected countries—will continue to play a central role in generating the political will, policy direction and resources necessary to finish the job.

Ambassador John E. Lange (Ret.) is the Senior Fellow for Global Health Diplomacy at the United Nations Foundation. Kate Dodson is the Vice President for Global Health at the United Nations Foundation.

This article was originally published in the Diplomatic Courier’s July/August 2014 print edition.