Chapter 4: Polio Eradication: the final challenge
Effectively engaging political leaders
The most visible element of the polio eradication initiative has been the National Immunization Days (NIDs), as they require the immunization of every child under 5 years of age (nearly 20% of a country's population) over a period of 1--3 days, several times a year for a number of years in a row. In many countries, the scale and logistic complexity of these activities were even greater than those of campaigns undertaken during the height of the smallpox eradication effort. Consequently, the commitment of political leaders has been central to their success. This support has been generated by actively and continuously advocating for such leaders to play a role in three key areas: oversight, access to non-health resources, and accountability.
The oversight of polio activities by political leaders has often begun with their personal participation in highly visible events such as the launching of NIDs and, ideally, has continued with their monitoring of progress. Following the example of South America, most countries have had their NIDs launched by the head of state or other prominent political figure. For example, in China, President Jiang Zemin immunized the first child in the national polio campaign in 1993. In the same year, King Sihanouk played a similar role in Cambodia. In 1996, President Nelson Mandela of South Africa launched the "Kick Polio Out of Africa" campaign at the Organization of African Unity (OAU) meeting in Yaoundé, Cameroon, and committed the OAU to regularly monitoring progress (5). Among donor countries, polio has received similar support -- most noticeably when the G8 Heads of Government discussed their role in closing the funding gap for eradication activities during their meetings of 2002 and 2003 (6).
This high-level visibility has been critical to achieving the second, and perhaps most important goal of political advocacy: access to government and nongovernmental resources which lie outside the health sector. Because of the huge numbers of people and vehicles that are required to implement NIDs, such activities are beyond the logistic and communication capacity of the health sector in many countries. Consequently, countries have drawn heavily on ministries of information, transport, defence and others to help solve the challenge of rapidly reaching all children, in all corners of a country. Countries have also engaged the private sector, often on an extraordinary scale. In the Philippines, for example, more than 140 private companies have regularly donated personnel, vehicles, facilities and financial support. The effective mobilization of such support has been possible only when the highest political leadership, at both national and subnational levels, endorsed the initiative publicly and took the necessary steps to put these resources at the disposal of health authorities. Thus, the delivery of this health service became a government and societal responsibility, with the responsibility of the health sector moving from implementation to management and monitoring.
This personal engagement of political leaders in the oversight and implementation of activities leads naturally to the third goal of political advocacy: heightened accountability, both within and outside the health sector. Only the highest-level political leadership has the necessary authority to ensure this accountability, particularly in the non-health ministries whose personnel and resources are so important in ensuring that all children are reached with OPV.
Such high-level engagement of political leaders has brought additional, often extraordinary, benefits. Recognizing that poliovirus knew no borders, in April 1995 leaders of 18 countries of Asia, Europe and the Eastern Mediterranean began coordinating the OPV immunization of 56 million children. Similar activities followed in Africa, where the conflict-affected countries of Angola, the Democratic Republic of the Congo, Gabon, and the Republic of the Congo synchronized three rounds of NIDs from July 2001, reaching 15 million children. Throughout the past 15 years, in countries such as Afghanistan, Angola, Sierra Leone and Sri Lanka, warring parties have laid down their weapons to participate in "days of tranquility" so that their children might be immunized against polio (7). Progress towards eradication in countries of the Eastern Mediterranean and South-East Asia Regions is detailed in Boxes 4.1 and 4.2.