Key Actors

SVEA CLOSSER: In this section, we’ll go over the key actors in the Global Polio Eradication Initiative. And stick with me for this. I know that describing bureaucratic actors may not sound like the most exciting thing for you to do, but understanding who these different actors are will actually turn out to be key in understanding why polio elimination has worked in some areas and not in others. When the Eradication Initiative began, the partnership was between CDC and the United States, Rotary, WHO, and UNICEF. The same partners who had been involved in the Eradication Initiative in the Americas. The Pan American Health Organization, mentioned before, falls under the WHO. So Rotary was involved in advocacy with governments, including the US government.

They pushed very hard and lobbied very hard for the US government to donate to the project. They had some support in the field and with volunteer recruitment among their membership during campaigns. And they’re a major private sector donor. The CDC, or the US Centers for Disease Control and Prevention, provided mostly scientific and technical expertise and set up a global laboratory network to test for polio. The World Health Organization took responsibility for the surveillance project globally, as well as some of the planning and management of the actual immunization campaigns. And finally, UNICEF took responsibility for procuring and distributing polio vaccines, as well as developing communication strategies aimed at getting parents to enthusiastically accept vaccination of their children.

So take a minute and think about why the initiative was organized in this way and whether that kind of division of labor is something that you might choose if you were starting an initiative like this. So there could certainly be differences of opinion on this one, but the idea was that they split up responsibilities so that each of them was responsible for a different piece of what needed to happen. And that working together, they could cover everything that needed managing. But, of course, WHO, UNICEF, the American CDC, and Rotary International could not achieve this in every country of the world by themselves. Governments of the majority of the world’s countries were key critical partners in pursuing the eradication goal.

But let’s take a minute and think about this language of partnership that I just used. I just called them critical partners. This partnership was sometimes complicated. Officially, UN agencies like WHO and UNICEF were in these countries to support those countries’ local polio elimination programs. But in reality, not all countries were equally committed to polio eradication. While it wasn’t usually the case that any governments really opposed it, some had other interests or other priorities. Some countries enthusiastically embraced and owned polio eradication. In other places, they didn’t. And when they didn’t, these international partners, WHO, UNICEF, CDC, and Rotary, ended up running the show in practice, a role that many were not completely comfortable with. Governments are critically important.

And we will have much, much more to say about them in this course. At the moment, though, let’s focus on the global alliance, which has been made up of international organizations. And this is not at all to dismiss the critical role governments have played. We’ll shift our focus to governments in the next module. So beyond those four partners and most of the governments of the world, other collaborators in the Global Polio Eradication Initiative include USAID, the CORE Group, World Vision, military actors, development banks, donor governments, the European Commission, humanitarian organization, corporate partners, you get the idea. It’s a very large, very complex collaboration.

And not only is there a large and complex constellation of people implementing the project, there’s also a huge number of different donors. From the Bill and Melinda Gates Foundation, Rotary International, the United States government, and private philanthropies, the biggest donors, to a number of other bilateral country donors, relationships with all of these donors have to be cultivated and managed. So when one thinks about actually implementing something like a polio campaign, which is fairly simple in practice, the number of actors involved and the number of agendas involved can make things quite complex, in reality.

As a global-level policymaker commented, quote, “There’s often disagreement in what strategy to apply, so building consensus– because every partner comes to the table with their own pressures, with their own priorities in a partnership– so accommodating them in the program in a way that contributes positively and doesn’t actually detract from the program is an important leadership and management challenge.” So how these challenges were met and how the initiative has been reorganized is the focus of the next lecture.