Healthcare Getting It Right : Polio Prevention and Eradication

Polio prevention and eradication work is excellent all over the world.

Global work toward polio eradication and transmission interruption is strong, though underappreciated [1]. Funding labor, supply and operations should be just as strong. Stating some of the obvious should help keep it simple.

The primary evaluation of both funding and operations to prevent polio should be transmission prevention and eradication success. If we have not achieved our goal, we are not doing enough.
The Global Alliance for Vaccines and Immunization (GAVI), the Global Polio Eradication Initiative (GPEI), Rotary and other organizations excel with philanthropic and nonprofit leadership [2,3,4,5,]. They should be supported [6,7].
Polio is often cited as only endemic in Afghanistan and Pakistan. The World Health Organisation recently listed 7 countries infected with WPV1, cVDPV1 or cVDPV3 that have risk to international spread, 27 countries infected with cVDPV2, with or without evidence of local transmission, and other countries vulnerable to infection [8].

The amount of dollars these agencies need to eradicate polio from the two remaining endemic countries, as well as tackle the infection transmission in the 30+ countries with known recent cases, should be clear. There should be consensus from all. Countries not needing outside support should also ask what can be done to help.

The remaining gaps between inter-agency polio prevention workflows could be analyzed and addressed.
A plan to prevent inactivated poliovirus (IPV) vaccine delays as countries switch from oral poliovirus (OPV) should be detailed. If IPV delays contributed to cVDPV2 or any oral poliovirus strain not covered in recent OPV, funding and global trade strategies should be improved.
Long-term transition goals from OPV to IPV should be clear, and steps that industry can take to help the world achieve these goals should see industry commitment.
Labor could be outlined for increased funding, and labor could potentially be tied to integrated care.
Primary care integration, pediatrician integration and other forms of vaccine integration should be designed for sustainability.
Quality to vaccine administration could be continuously evaluated with standard metrics across all nonprofit donors and agencies.
Military involvement in polio vaccination campaigns may or may not be quantified, and improvement to data could include this consideration.
Economic advisory should request consensus across global and nonprofit polio work, with the goal of long-term financing for polio eradication work.
Geopolitical pressure could and should enforce anti-corruption and other barriers once vaccines are accessible to a country.

The United States has achieved sustained success with polio prevention and eradication. The US can further these efforts.

IPV and polio vaccine coverage data aggregation could improve, perhaps with improved technology. The CDC citation from 2016 [9] may no longer reliable for polio coverage rates in the US, and these citations are frequently the source for media [10].
Pediatric vaccination coordination between public health and primary care providers could be analyzed for gaps. Interventions to the gaps could be funded with expectations toward sustainable operations.

Knowledge and education on scheduling, administration, storage and handling is notable and should continue to be funded.
Reimbursement opportunities between government payors and medical homes, if there are any, could be clarified with respect to IPV.
Immunization administration refreshers should be an educational opportunity accessible by all licensed care providers, including LVNs and RNs, in the local jurisdiction. It is not enough to say a nurse should know how to give a shot. That concept divorces immunization from professionalism, dissolves subject matter expertise and diminishes the specialty of the care. Nurses and clinicians who vaccinate should know how to vaccinate, and nurses and clinicians who don’t know how to vaccinate should not vaccinate. Period.

WHO recommendations for countries with and without local transmission of polio include the US [8] due to recent polio detection. These points, such as immunization coverage and surveillance cooperation, should be decided on and continuously evaluated.

Planning for the WHO recommendations if transmission occurs (traveler documentation, targeted doses, Advisory Group coordination) should begin now, not after the fact [8].
Criteria for enhanced activities in the US could have consensus to either match WHO or take a more conservative approach.

Water, sewage and other environmental surveillance and prevention factors could be analyzed for prevention work gaps [11]. State comparisons and collegiality to improvement could be examined.
USAID and any other government-sponsored polio prevention international funding should be tied to metrics that are consistent across nonprofit and global health polio efforts.
ASTHO, NACCHO, APHA and other organizations could assess for labor and epidemiology inconsistencies and needs across states, as well as in the international arena.
ASTHO, NACHCO, APHA and federal government could seek improvements in immunization data technology.
A strategic plan to tackle projected declining immunization rates should be clear, from a national to regional to global scope [12,13].
Immunization rates for children in US military families may or may not be match to the general US population. Research and military statements are conflicting, and it’s unclear how the polio immunization statistic could be easily obtained for the military family population. Consensus around best approach to the data is also unclear, especially during a period of pandemic-related setbacks amid continuing military moves. Because the data is not clear, the need for improvement is also unknown. Lack of clarity to the data and unknowns around accuracy of the data have complicated an otherwise simple aspect to polio prevention.
Separation between global health assistance and geopolitics, including special US security operations, should be honored. There should be no room for deceit with vaccines, including from US special forces and from US clandestine work. If vaccine programs cannot be respected, they should be reassigned under other leadership. Agencies including the State Department should be accountable for unprofessionalism and poor decision-making. There is no room for deceit with vaccines.

Simply put. the world continues to excel with polio prevention and eradication. We are not where we need to be yet. Sustained financing with continued improvements to polio campaigns will get us there.

References

1. https://www.who.int/publications/m/item/mid-term-evaluation-of-the-implementation-of-the-strategic-action-plan-on-polio-transition-(2018-2023)--management-response---september-2022

2. https://polioeradication.org/gpei-strategy-2022-2026/

3. https://www.gavi.org/vaccineswork/tag/polio

4. https://www.gavi.org/vaccineswork/crossroads-polio-eradication-experience-india-shows-why-still-achievable

5. https://www.rotary.org/en/our-causes/ending-polio

6. https://polioeradication.org/financing/polio-eradication-pledging-moment-18-october-2022/

7. https://www.endpolio.org/donate

8. https://www.who.int/news/item/01-11-2022-statement-of-the-thirty-third-polio-ihr-emergency-committee

9. https://www.cdc.gov/nchs/fastats/immunize.htm

10. https://abcnews.go.com/Health/us-states-highest-lowest-polio-vaccination-rates/story?id=88539770

11. https://newscast.astho.org/270-tracking-polio-in-new-york