Global Polio Eradication And The Commonwealth; One Resilient Common Polio Free Future: Transforming Our Common Wealth

The continued commitment of the Commonwealth is urgently needed to protect progress toward a polio free world which has strengthened health systems, enhanced disease surveillance and outbreak response capacity, promoted immunization, and demonstrated the full potential for positive impact when governments, international agencies and civil society are united toward a common goal. While cases of polio have declined by more than 99.9% since the goal of global polio eradication was set in 1988, outbreaks of polio and detections of poliovirus in countries long considered polio free are a reminder that poliovirus anywhere is a threat everywhere. Rotary International calls for the Commonwealth’s continued commitment toward the goal of a polio free world and propose the following statement for inclusion in the Leaders’ Statement:

We reaffirm our unwavering commitment to the global eradication of polio. Recognizing the significant strides made in reducing polio cases worldwide, we pledge to intensify our efforts to ensure that no child suffers from this preventable disease through sustained funding, collaboration among member states and with the Global Polio Eradication Initiative to ensure that all children have access to life saving polio vaccines.

Continued commitment to polio is also consistent with the Commonwealth’s commitment to similar global health initiatives such as HIV, AIDs, Malaria, Tuberculosis and Neglected Tropical Diseases, and could potentially be included together with those.

Harnessing the lessons of global polio eradication to create a resilient polio free Commonwealth

The Global Polio Eradication Initiative (GPEI) was founded on a model of partnership and connection that ranges from the community to the global level. The core partners of the GPEI include the World Health Organization, UNICEF, the US Centers for Disease Control and Prevention, the Bill & Melinda Gates Foundation, Rotary International and Gavi, the Vaccine Alliance. These agencies work in close collaboration with governments and multilateral organizations including the Commonwealth. The Commonwealth has consistently reaffirmed commitment to the goal of global polio eradication as part of the leaders’ statements in 2011, 2015 and 2018 and most recently in 2022, where leaders “urged the continued intensified effort to eradicate polio, even amid other pressing health and development issues.” The Commonwealth’s strong history of leadership on polio eradication provides a shining example of what the Commonwealth can achieve together and was highlighted by King Charles in 2018 as a model for other Commonwealth global health initiatives.

Resilience in the face of adversity

During its history, the GPEI has encountered and overcome numerous obstacles to reaching every child with polio vaccine, including conflict and insecurity, natural disasters, and disease. Each challenge has provided an opportunity for the program to adapt and refine approaches. Today, the GPEI’s workforce and infrastructure is at the forefront of efforts to reach the world’s most vulnerable children with polio vaccine and other essential health services. The lessons learned while adapting to overcome challenges have become best practices which have led to a 99.99% decrease in polio cases since 1988.

With its large global health workforce and infrastructure, GPEI has often served as first responders to outbreaks of disease and other crises, including natural disasters. During the COVID-19 pandemic theGPEI pivoted to assist with pandemic response and vaccine distribution by partnering with communities to educate the public about the disease and combat the spread of misinformation. The GPEI’s polio surveillance network also supported COVID-19 case detection, contact tracing, laboratory testing and data management. informed planning and distribution of Covid vaccines.

GPEI coordination mechanisms, particularly use of Emergency Operations Centers, command and control centers which support intense coordination and adjustment of strategies at the country level, have provided vital support to address outbreaks. In 2014, in Nigeria, this structure played a key role in addressing the Ebola outbreak, and more recently supported the response to COVID-19 and the planning and distribution of covid vaccine. Many other innovations, including the use of geographical satellite systems and microplanning, mobile payment systems and drones, have allowed progress to connect the hardest to reach to immunization services.

One of key lessons learned by the GPEI is that women, particularly when they are working in their own communities, are incredibly effective as they are trusted. Polio-endemic, at-risk, and outbreak countries regularly engage women as health officials in immunization activities, constituting about 68% of the frontline workforce. In Nigeria, 80% of frontline workers are women, followed by 60% in Pakistan and 20% in Afghanistan. The GPEI Gender Equality Strategy works to address gender-related barriers to immunization and to significantly improve the representation of women at all levels of the programme. These efforts are empowering women and overcoming gender-related barriers in some of the most conservative and traditional cultures in the world.

The GPEI continues to develop transformative strategies to address remaining challenges such as reaching children who are inaccessible because they live in areas of insecurity or are part of mobile or remote populations. Those living in such communities frequently lack access to other essential health resources. The GPEI is working to identify opportunities to ensure complementary services are integrated with polio eradication activities to improve vaccine acceptance and meet broader community needs.

The Commonwealth’s historic leadership in support of a polio free world

At the 2011 and 2015 summits, Heads of Government and Ministers of Australia, Canada, Malta, Nigeria, Pakistan, and the United Kingdom (UK) came together during dedicated events and offered renewed financial and political support to the eradication of polio for children in all countries and for all future generations, marking a turning point for the programme.

In 2011- Australia: leaders called for “accelerating action and financial support to eradicate polio including by improving routine immunization systems.”

In 2015 – Malta: leaders further elaborated: “Since 1988, polio cases have decreased by over 99%. This is a remarkable achievement, but more needs to be done to make polio the second disease in human history to be eradicated. To this end, we agreed that accelerated action and renewed financial support are needed to eradicate polio.”

In 2018 – United Kingdom: leaders emphasized their continued support for international health including efforts to tackle polio and other diseases/malaria; and called for an increase in national health expenditure throughout the Commonwealth.

In 2022 – Rwanda: leaders urged the continued intensified effort to eradicate polio, even amid other pressing health and development issues and“resolved to continue the fight against other serious public health challenges such as HIV and AIDS, polio, and tuberculosis (TB).”

Commonwealth member states account collectively for nearly a quarter of the global investments in polio eradication. This includes Australia ($124 million); Bangladesh (US$100 million); Canada (US$793 million); India ($1.32 billion); Malaysia ($20 million); New Zealand (US$8 million); Nigeria (US$250 million); Pakistan ($58 million); and the United Kingdom (US$1.76 billion). The Commonwealth’s sustained political and financial leadership is critical to fulfill the promise of a polio free world. Continued support for global polio eradication builds on the strengths of the Commonwealth to identify and address global challenges which impact member states and delivers a more prosperous, secure, sustainable, and fair future for all its citizens, particularly its young people. GPEI’s vivid partnerships with numerous Commonwealth countries to improve the health security and offer Commonwealth and all children a life free of disease strongly resonates with such a vision.

Status of polio eradication progress

• Thanks to the power of vaccines and decades of global collaboration, wild polio cases have fallen 99.9% since 1988, and 20 million people are walking today who would have otherwise been paralyzed by polio. • Intensive efforts to reach every child with the polio vaccine have also led to improvements in broader health services like routine immunization, disease monitoring, and emergency response, strengthening the health of underserved communities around the world.

• The COVID-19 pandemic disrupted immunization efforts resulting in setbacks in population immunity and leading to outbreaks of variant poliovirus. Fourteen Commonwealth countries have experienced outbreaks or detections of variant poliovirus polio since the start of the pandemic. This includes detection of variant poliovirus in Canada and the United Kingdom, countries long considered polio-free.

• The GPEI is experienced in reaching children living in the most complex environments in the world: Seven of the top ten countries on the World Bank’s Fragile State Index are countries that are polio endemic have had outbreaks of variant polio since 2023. Eight of the top ten countries vulnerable to climate change are polio endemic or have experienced outbreaks of variant polio since 2023.

• These challenges threaten thirty years of progress and the cumulative investment by Commonwealth member states of more than US$4.3 billion which has brought us to the threshold of a polio free world.

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