Lessons from the polio eradication initiative can help us reach the MDGs

Dr Margaret Chan
Director-General of the World Health Organization

MDG Summit: Keynote address at the International Federation of Red Cross and Red Crescent Societies side event on Unfinished business: reaching the MDGs with lessons learned from polio eradication
New York, United States of America

20 September 2010

Mr Secretary-General, distinguished panellists, ladies and gentlemen,

I welcome the opportunity to speak at this event. The title is apt. Polio eradication is unfinished business. Persistence in moving towards the eradication goal, and changes made along the way, hold lessons for the wider MDG agenda.

Polio eradication demands that we deliver the most basic of health services, two drops of vaccine, to every last child. Scaling up to reach everyone in need is the core of the polio initiative, and the core of the MDG approach for reducing human misery.

For the health-related MDGs, this means scaling up the delivery of commodities, but also strengthening basic health services and infrastructures along the way. Polio has done both.

From the polio experience, I see three key lessons. They concern innovation in partnerships, innovation in strategies, and innovation in technologies. These lessons can help rid the world of this virus, once and for all. They can also help us reach the MDGs.

Ladies and Gentlemen,

One of the most important lessons offered by the Global Polio Eradication Initiative is the strength that comes from partnerships.

This entire initiative began because of the vision of Rotary International, one of the oldest civil society organizations in the world. Its more than one million members have been tireless partners in the polio eradication effort, volunteering to immunize children, advocating with political and community leaders, and mobilizing nearly 1 billion dollars.

In the past year, the International Federation of the Red Cross and Red Crescent Societies has massively scaled up its support for polio eradication. This support has enabled the eradication initiative to reach and mobilize the most remote communities in west Africa, and independently monitor the recent 19-country synchronized immunization campaigns.

Let me be very clear: the UN cannot achieve polio eradication without this kind of support from civil society organizations. You are on the ground, on the spot, in touch with grassroots and the leaders at the top.

And let me give you a clear challenge: we need your support going forward, particularly in helping us reach every child in Angola, in Chad, and in eastern Democratic Republic of the Congo.

Reaching the MDGs means reaching everyone in need, also in difficult and dangerous conflict zones where health needs are often greatest. Again, partnership with NGOs active in these areas has been critical.

Through organizations like the International Committee of the Red Cross and other NGOs, the initiative has negotiated Days of Tranquillity by working with all sides of the conflict, from international military forces, to peacekeeping operations, to armed militias. Such negotiations help guarantee safe passage for vaccination teams and secure access to children.

Reaching the MDGs requires courage as well as commitment. Polio eradication has taught us that even children living in the world’s most dangerous places can be reached.

We know, and our vaccination teams know, that every time we hold an immunization campaign in these areas we are risking lives. But we also know that we are saving lives.

Ladies and gentlemen,

As a second lesson, polio shows the importance of having flexible strategies that are constantly refined, as we are seeing this week with the MDGs.

To attain the MDGs, we need strategies that deliver interventions to hard-to-reach populations, strategies that build political and grassroots support, and strategies that enhance accountability. Sometimes, we need strategies that carve basic infrastructures out of virtually nothing.

For polio, efforts to reach migrant populations have elevated micro-planning to an art form. Every child under five, in every home, in every street, city, town, and village has a name. Even children in highly mobile populations are being tracked.

Every child that needs to be reached to attain the MDGs has already been reached by polio teams. The lesson: it can be done.

For example, in the vast, flooded Kosi River Area of Bihar State in India, our vaccination teams can travel for up to seven hours to reach the last child in the furthest village. They travel by boats and motorcycles, and wade through mud. That’s determination, and that’s a strategic plus.

This year, Mr Bill Gates went to meet that last child, travelling to this remotest region to see for himself just how difficult it is to reach, but also to see how effectively these campaigns are being conducted.

Needless to say, Mr Gates didn't wade through mud for the final miles. He took his helicopter. In his view, as stated to the press, the Indian polio programme is unmatched by any health programme in the world. Why? Because it reaches every child in one of the most populous, fastest-growing countries on earth. Because it can be done.

In the final pockets of polio transmission, highly localized challenges have demanded distinct area-specific approaches. Together with partners, the polio eradication initiative has mobilized massive, on-the-ground technical assistance and infrastructure in these most at-risk areas.

UNICEF has ensured the timely procurement and delivery of more than 2 billion doses of oral polio vaccine to these far corners of the world.

To deliver this vaccine, the polio initiative has built a functioning cold chain, transportation, and communication system. This is a key infrastructure which greatly assists in strengthening local health systems and other immunization services. This is how scaling up the delivery of commodities can build infrastructure.

Polio has also developed an independent monitoring system to evaluate the reach and effectiveness of immunization activities and help identify areas of weakness.

The initiative has worked extensively with local civil society organizations, mainstream and traditional media, religious and traditional leaders, and the communities themselves. This builds grassroots support, another lesson for the MDG agenda.

To ensure buy-in from politicians and communities, the initiative has systematically advocated with leaders at national and sub-national levels and developed accountability mechanisms, such as the Abuja commitments in northern Nigeria. Doing so relied on strong support from partners like Rotary International, the Bill and Melinda Gates Foundation, the UN Foundation, and the Organization of the Islamic Conference.

As we have learned, the engagement of traditional leadership is critical. Take the state of Kano in northern Nigeria. Five years ago, this state suspended all polio immunization campaigns for two years. Even 18 months ago, Kano was the global epicentre of type 1 polio.

But thanks to the leadership of officials like Dr Muhammad Pate, who is with us today, this state has experienced an extraordinary turnaround through effective dialogue with communities and engagement with traditional leaders.

Twice in the past year, the Emir of Kano has launched two immunization campaigns by standing in front of the state's media, vaccinating his grandson, and calling on Kano's citizens to do the same.

As a final lesson, the eradication initiative shows the importance of technical innovation. We now have a full toolbox of vaccines, having developed and fast-tracked the introduction of monovalent and bivalent oral polio vaccines. This innovation has allowed the programme to tailor solutions to problems.

With excellent support from the US CDC, the programme has built sensitive surveillance systems globally, which are the world’s first defence against outbreaks. The programme has also established an accredited laboratory network, staffed with trained lab technicians.

Real-time scientific procedures were developed to rapidly identify polio cases and genetically track each virus. This tells us, for example, that Angola's outbreak came not from Nigeria, but all the way from northern India.

Ladies and gentlemen,

I have a final lesson that is also being discussed this week: the need for financial sustainability.

Polio is unfinished business but it is also good business. Polio eradication will save the world billions of dollars each year. The economics are sound. They have been studied and published. Yet even this close to the final goal, the lack of funding is the greatest risk facing this historic effort.

We have few opportunities in our lives to deliver a historic goal such as polio eradication. I therefore call on donors to capitalize on this historic opportunity, and help fund the full implementation of the new polio eradication strategic plan for 2010-2012.

The strategy is already having an impact. In Nigeria, case numbers have fallen by a striking 99%. The Horn of Africa is again polio-free. West Africa has not had a case since the first of May. In India, cases are down by 87%. But we must not let down our guard.

Nigeria and India are still recording cases, and outbreaks are still occurring. This is precisely the time when we need to be more vigilant and more aggressive in our actions to finish the job.

Polio also tells us something about the rewards of steadfast commitment to ambitious goals. When eradication is achieved, we will have delivered a perpetual gift: no child will ever again suffer life-long paralysis from polio.

Equally important, this enormous effort will have established partnerships, infrastructure, and new knowledge that can help other programmes reach everyone in need, everywhere.

Thank you.