Chapter 4: Polio Eradication: the final challenge
A new kind of partnership
As international interest in a global effort to eradicate polio began to build up 20 years ago, there was limited experience with large-scale international health initiatives and with partnerships. In the mid-1980s, however, as an increasing number of countries in South America -- most notably, Brazil -- successfully applied the Cuban model of mass campaigns and heightened surveillance to control polio, a new kind of partnership began to emerge with this common purpose.
By 1988, the year in which the World Health Assembly voted to launch a global initiative to eradicate polio (3), four agencies had begun to form the core of the "polio partnership": the World Health Organization, Rotary International, the United Nations Children's Fund (UNICEF) and the United States Centers for Disease Control and Prevention (CDC). Over the following 15 years, the polio partnership has grown to become an extensive network of national governments, international agencies, private corporations, foundations, bilateral donors, humanitarian organizations, nongovernmental organizations and development banks. The work of the partnership continues to be governed by a common, multiyear strategic plan and overseen by international technical committees at the country, regional and global levels. The close relationship between national health authorities and this international partnership was critical to the extremely rapid scaling-up of eradication activities in the mid-1990s, as the initiative began building on the early momentum in the Americas and the Western Pacific Region and extended its activities to all countries of all regions. By the end of the decade, over 500 million children were regularly being reached with OPV through the efforts of 10 million volunteers in every low-income and middle-income country in the world.
From the outset, this partnership sought to bring a new efficiency to international support for national health efforts. It relied heavily on strategies and management processes that had been established by the Pan American Health Organization (PAHO) in its work to achieve regional elimination of polio. This goal was realized in 1991, when a young Peruvian boy named Luis Fermin Tenorio became the last child ever to be paralysed by a wild poliovirus in the Region of the Americas. The global partnership adopted PAHO's proven four-pronged strategy: high coverage with routine OPV immunization, national polio immunization days, surveillance and laboratory investigation of acute flaccid paralysis (AFP) cases, and massive house-to-house "mop-up" campaigns (4). PAHO's Interagency Coordinating Committee (ICC) mechanism brought together partner inputs at the country level to ensure sufficient resources, while promoting transparent budgeting and efficiencies. The ICCs, convened regularly by national ministries of health, ensured that national authorities were always at the centre of key decisions on strategy implementation. The global partnership also emphasizes engagement at the highest political levels in both donor and endemic countries.