We must celebrate the end of polio - but the end of polio funding puts other programmes at risk

In 1988 there were 350,000 cases of polio worldwide. So far, this year there have been 13. The disease has gone from a global pandemic to a severe, but local, challenge.

The world has come a long way in 30 years. Over that time global coverage of the polio vaccine has increased from 65 per cent to well over 80 per cent, and at least 16 million cases of polio have been prevented.

That’s 16 million children who have been spared debilitating paralysis, 16 million children who have been able to go to school, learn, get a job and contribute to society. And 16 million children who have grown up, unaware of the suffering that they might have experienced.

At the centre of these efforts is the Global Polio Eradication Initiative (GPEI), which, with a budget of more than $1 billion a year and a presence in 16 countries, has spearheaded the fight against the disease with the polio vaccine. But GPEI’s work goes much further than vaccines.

Since the initiative's inception in 1988, many of the 20 million volunteers who have been trained to administer polio vaccines have also delivered other essential vaccinations and health interventions.

For example, GPEI-trained health workers have delivered 1.3 billion doses of vitamin A, which have helped save 1.5 million lives and reaped up to $17 billion in economic benefits.

Funding from GPEI has also transformed monitoring of disease outbreaks through the Global Polio Eradication Laboratory Network. These 146 laboratories around the world identify and confirm cases of polio but also monitor other life-threatening diseases, such as measles, rubella, and maternal and neonatal tetanus, all major health threats in their own right.

Hundreds of World Health Organization and Unicef staff are funded by GPEI to undertake disease surveillance activities, going door to door to find and confirm suspected disease outbreaks and preventing them from spreading further.

Such systems helped stop the spread of Ebola in Nigeria in 2014 while the outbreak was raging in Guinea, Liberia and Sierra Leone.

However, the GPEI was set up to achieve one goal only - the eradication of polio. As we inch closer to achieving this, the GPEI will begin to scale back its operations and with that comes a significant reduction in funding.

The rate of this withdrawal is rapid. GPEI estimates its funding will drop by 50 per cent between 2017 and 2019 alone, and many of those resources are focused in just 16 countries that receive over 90 per cent of GPEI support.

Take Ethiopia for example, a low-income country where more than a quarter of children do not receive basic vaccinations. Ethiopia will lose 88 per cent of its polio-related funding between 2016 and 2019; the stark reduction from $23.5million to $4.6million between 2017-18 is already being felt.

Even with expected increases in government funding, a $12 million gap exists after 2019 – putting critical elements of childhood vaccination programmes against polio and other childhood killers like rotavirus and pneumonia at risk.

Many of the countries that will lose polio funding are also set to lose funding from Gavi, the Vaccine Alliance - an organisation that helps low-income countries purchase life-saving vaccines.

Sudan, which has one of the highest immunisation rates in Africa, currently only funds nine per cent of its immunisation programme.

Under its current arrangement with Gavi, it will have to increase its share of vaccine costs from $3.1 million to $17.2 million in 2022 at the same time as losing 70 per cent of its funding from the GPEI. This double financial hit could put their high vaccination rate in jeopardy. Sharp funding reductions in short timeframes can have catastrophic impacts.

Many of the 16 countries that are losing funding now are struggling to pay for interventions and surveillance systems previously funded by GPEI and Gavi and it won’t be long until some essential health programmes have to be scaled back or terminated altogether.

These include essential surveillance activities, ability to respond to disease outbreaks, and any additional immunisation campaigns.

I strongly believe that governments should fund health from their own coffers – overseas aid can’t and shouldn’t last forever. However, it is unrealistic to expect governments to magic up millions at short notice. Leadership and continued support from GPEI and donors is needed to help countries manage these changes in a gradual and sustainable way.

In another 30 years, I hope we can look back and celebrate the eradication of polio and the legacy of the global polio programme. Right now, I’m scared that we’re jeopardising this legacy with poor planning and coordination, and a narrow focus on eradication.

The GPEI has helped prevent millions of cases of polio and other infectious diseases. But millions of lives could be at risk if we don’t plan for what happens once we reach the end goal and when the GPEI ceases to exist.

It is is the time for the GPEI, donors, and country governments to work together and map out how essential programmes previously funded by the GPEI will be financed in the future, only by doing this can we ensure polio’s lasting legacy.