Laura Kerr, Policy Advocacy Officer, RESULTS UK, and Leila Stennett, Campaigns Officer, RESULTS International Australia and member of the Gavi CSO Steering Committee

International financing for polio and global immunisation is changing. The Global Polio Eradication Initiative (GPEI), a partnership which supports around US$1 billion in annual investments in polio eradication efforts, is winding down. When polio is eradicated, with certification hopefully taking place in 2020 or 2021, GPEI will have fulfilled its mandate and cease to exist. This process has already begun, and financial support from GPEI to countries will halve between 2017 and 2019. Half of GPEI’s 16 priority countries, which receive the majority of its support, are also preparing for or progressing through the process of transitioning from Gavi support – working towards full financial responsibility for their own immunisation programmes.

What will these changes mean for immunisation? A new report from RESULTS Australia and RESULTS UK, A Balancing Act: the risks and opportunities as polio and its funding disappears, explores the financing changes as GPEI winds down, and addresses why we must use this as an opportunity to strengthen routine immunisation.

Tom Maguire/RESULTS UK

The opportunity to strengthen routine immunisation

Currently, 1 in 10 infants miss out on receiving any vaccines at all, and in the world’s 68 poorest countries only 7% of children are fully immunised. The world still has a long way to go before all children receive all the recommended life-saving vaccines they need to grow up to live healthy and happy lives. 

In many countries we know what challenges lie in reaching all children with the vaccines they need. What is harder is working out how to solve this challenge. And even if we do know how can we make the changes we want through the systems, processes, and financing which already exist?

The wind down of a global health partnership the size of GPEI is unprecedented and will fundamentally change how the world approaches polio vaccination. Yet, if well planned and coordinated with immunisation and health systems stakeholders, ambition and determination could turn a potentially risky situation into a chance to transform immunisation systems. A chance that is unlikely to present itself again in this decade.

Polio funding compared to other types in the African region. Source: p24 of the RESULTS report.

Here are two examples of why RESULTS believes the wind down of GPEI is an opportunity that can’t be missed:

Improve existing weak systems

Currently 70% of global funding for surveillance is from GPEI. 146 polio laboratories, of which 84% are also certified and used by the Measles and Rubella Network, are at risk when funding from GPEI ends. Globally, surveillance systems and laboratories are underfunded, but changes on this scale present the chance to evaluate what does a functioning surveillance system look like for all vaccine preventable diseases? What if current systems could be improved and expanded, in a more cost-efficient way? This could help us track and understand more about vaccine preventable diseases improving our response to outbreaks and epidemics.

Focus global efforts on a routine approach to immunisation

Polio eradication efforts have largely relied on mass immunisation campaigns and supplemental immunisation activities. The focus on ensuring every child received oral polio drops through these methods is arguably the only way we have got so close to eradication. However, focusing on a single disease can distract attention and funding from more complex routine systems (for both donors and in countries), and can distort the focus and expectations of immunisation in the community. Core immunity to diseases can only be built through strong routine immunisation systems and the Polio Independent Monitoring Board recognise that stronger routine immunisation could have provided a “rocket boost” for eradication efforts.  Children will never be fully immunised through vertical, disease specific efforts alone. As polio specific funding disappears and donors, country governments, and GPEI partners (such as UNICEF and WHO), have a chance to reflect on what lessons can be learned from eradication, both good and bad, it is the right time to consider what is now needed to improve coverage and equity. At this critical juncture, when ‘what comes next’ is being discussed, RESULTS recommends that now is the time to refocus global efforts on strengthening routine immunisation systems and move away from a vertical disease approach.

Now is the time to be proactive, leveraging the successes of polio eradication efforts, and taking advantage of this once in a generation opportunity. To simply be reactive, filling gaps which will be left and to continue with ‘business as usual’, would be an injustice to the millions of unimmunised children around the world.