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# History of the Alliance

In this video, Svea Closser traces back to the history of the Global Polio Eradication Initiative. (Step 2.3)
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SVEA CLOSSER: Welcome back. In this section, we’ll be talking about the history of the Global Polio Eradication Initiative alliance. The GPEI was the first global partnership aimed at one disease, and it’s formed the model for many that followed. So understanding its history is, in many ways, the history of partnerships across global health. Our story starts in the Americas with Albert Sabin, the developer of the oral polio vaccine. Sabin’s story is described in detail in a reading that you have access to by Hampton, and I encourage you to read that for more detail. But the short version is that Sabin was a celebrity in the United States for stopping polio.
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And he had the ear of both political leaders as well as leaders of Rotary, a service club, who’s going to figure into our story in a moment. Sabin was a brilliant man. He was also very competitive and sometimes abrasive as well as being generous. So a complicated figure. He wanted to secure his legacy, and he was convinced that oral polio vaccine was the tool for achieving the eradication of polio globally. And he’d been advocating that people should be trying to do that for years. In 1980, Sabin heard of a polio epidemic in Brazil. He offered his assistance to the Brazilian government.
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The collaboration was not seamless, but the effort of a large number of volunteers and community health workers in a national immunization program in Brazil decreased polio cases in the country. Another key actor in the early days of the Global Polio Eradication Initiative was Rotary International, a service club. Rotary began its efforts to eliminate polio in the Philippines in 1979. Volunteers administered drops of oral polio vaccines to children at a health center. The Rotary International president and the Minister of Health of the Philippines launched those efforts. The project’s success led Rotary to make polio eradication a top priority.
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Rotary was an international service organization with members across the world, and they were looking for a goal to bring their members together as they celebrated their centennial. Polio immunization seemed to be a perfect way to do this, and Sabin lent his star power to encourage Rotarians to be involved. In 1981, based in part on the experience in Brazil, the Pan American Health Organization, or PAHO, concluded that elimination of the disease in the western hemisphere was feasible. In 1984, Ciro de Quadros, the committed and charismatic man who had become the leader of the polio elimination effort in the Americas, met with James Grant who was then Executive Director of UNICEF.
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UNICEF, with its focus on children, was already committed to routine childhood immunization. Ciro de Quadros convinced Grant that polio could be what he called a banner disease for immunizations in general. The idea was that by holding campaigns or special immunization days around polio and getting people excited about vaccination. There would then be increased support for routine immunization as well. In 1988, the World Health Assembly voted to eradicate polio globally. The World Health Assembly resolution was a direct result of the Pan American Health Organization’s focus on polio eradication, which had begun in 1985. Realizing the complexity and spread of polio and the challenges involved in eradication, Rotary went to the World Health Assembly asking for help from WHO and UNICEF.
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And the assembly unanimously voted to eradicate polio. A major milestone in the polio eradication effort came in 1994 when polio was completely eliminated from the Americas, both North and South America, through supplemental immunization activities held on special vaccination days. This was a huge milestone which gave a lot of steam to the eradication effort globally. So this short video is about the experience in Peru, the last country in the Americas with a polio case.
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SVEA CLOSSER: Polio in Peru, and in the rest of the Americas, was achieved through a collaboration between the Pan American Health Organization, UNICEF, Rotary, and USAID. This was the first major international partnership of UN, bilateral and private agencies in the health sector, and it was a major change from the more insular way in which these agencies had traditionally worked. These days, such collaborations are the norm, but polio eradication in the Americas was the model upon which the modern global public health partnerships have been built.
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When the World Health Assembly voted to eradicate polio, they voted that they would do it by the year 2000, so this was perhaps an optimistic goal in retrospect, but that was the goal that they initially set. In 1994, the certification of polio eradication in the Americas led to a rapid scale-up of a global effort. In 1995, 18 countries in Europe and Central Asia launched operation MECACAR, the subject of the video you watched in the introduction, which created synchronized national immunization days across the region. And in 1996, 46 heads of state across Africa launched the Kick Polio Out of Africa campaign.
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When polio was eliminated from the Americas in 1994, six years after the declaration of polio eradication by the World Health Assembly, many countries in South Asia and sub-Saharan Africa had started neither vaccination campaigns nor polio surveillance. So just six years away from the eradication deadline, many countries in the world still hadn’t done much to try to eliminate polio in their countries. As you can see, countries across South Asia and sub-Saharan Africa, a few of them had implemented national immunization days, but most had not. Similar trends with surveillance, as you can see on the bottom chart, countries in green had implemented AFP surveillance or surveillance for polio. The ones in yellow had not.
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So again, much of sub-Saharan Africa and South Asia did not yet have surveillance for polio. Yet despite this, enthusiasm ran high, and projections about how quickly polio would be eliminated were very optimistic. The annual costs of eradicating polio were estimated at $150 million. As it turned out, the eradication of polio would prove much more difficult and much more expensive than any of the partners projected. In 2020, polio is still with us, and the current costs of the eradication effort are over$1 billion, with a b, per year.

Svea Closser, MPH, PhD Bloomberg School of Public Health, Johns Hopkins University, USA

In this lecture, Dr. Closser takes us back to one of the first coordinated efforts for polio elimination in 1980s in the Americas – based on which polio eradication was deemed feasible and soon declared a priority. This alliance for polio eradication was the first major international partnership in public health.

What lessons can be learnt for successful alliance-building from the initiative’s experience in Peru, the last country in the Americas with a polio case?