What Lessons Can We Learn From Polio in Tackling COVID-19?
Polio used to be one of the deadliest diseases in the world. Now, it’s 99.9% eradicated.
In the 1980s, polio paralysed more than 1,000 children around the world every day.
Now, it’s been 99.9% eradicated, with the virus surviving only among the world’s poorest and most marginalised communities. For context, as efforts to reach marginalised children with vaccinations continue, the 100% eradication of polio would make it only the second disease eradicated by humans ever, after smallpox.
COVID-19 is more than a health issue. As countries grapple with the virus, it’s becoming increasingly clear that coronavirus affects all of us both in the short- and long-term. Millions of jobs have been lost globally, hunger and food insecurity have increased, 1.4 billion children have seen their education interrupted, and inequalities globally and within countries are being intensified.
The steps taken to manage the spread of COVID-19 globally may be unprecedented, but there are many lessons we can learn in how we’ve tackled health crises before — such as polio, and how it has been almost entirely eliminated as a public health threat.
1. Global cooperation
Tackling a global health crisis starts with global solidarity, according to the Global Polio Eradication Initiative (GPEI), a public-private partnership that leads efforts to eradicate polio.
GPEI was formed in 1988 in partnership with the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), and the Bill & Melinda Gates Foundation.
At the time, polio could be found in 125 countries.
Today, Nigeria, Pakistan, and Afghanistan are the only countries where polio still exists — a challenge the World Health Organization said is a result of insecurity, poor sanitation, and weak health systems. GPEI’s launch, as well as national and local partnerships in countries where they have a footprint, is credited with the almost total eradication of polio.
These partnerships are far-reaching. They include donors like the G7 countries ( France, Germany, Canada, Italy, Japan, the United Kingdom, and the United States) and the private sector. There are 20 million volunteers and 200 countries that are involved in the work to eradicate polio, while GPEI also works with the research and scientific community.
Most importantly, these partnerships prioritise the role played by health care workers, communities, and families in tackling a health crisis. GPEI worked to ensure that communities and individual caregivers were provided with facts about polio and polio vaccination, to combat the spread of health misinformation, and ensure that communities and caregivers were equipped with the knowledge they need.
“Since its formation, GPEI has trained and mobilised millions of volunteers and health workers and gained access to homes not reached by other health initiatives to immunise children,” said End Polio Now, a campaign by Rotary International.
Another organisation that credits its success to effective global partnerships is Gavi, the Vaccine Alliance, which works closely with GPEI. Gavi was founded in 2000 by the Bill and Melinda Gates Foundation, the World Bank, WHO, and UNICEF, among other partners.
Gavi CEO Seth Berkley has said that its partnerships with United Nations agencies, governments, and philanthropists, alongside the vaccine industry, the private sector, and civil society, have enabled Gavi to reach 760 million children since 2000 with routine immunisations — saving 13 million lives globally.
“Gavi represents that sum of its partners’ individual strengths, from the World Health Organization’s scientific expertise and UNICEF's procurement system, to the financial know-how of the World Bank, and the market knowledge of the vaccine industry,” Gavi explained.
Global solidarity is also needed to tackle COVID-19 successfully, the World Health Organization said in March when it launched the COVID-19 Solidarity Response Fund. The fund is a first-of-its-kind and allows private individuals, corporations, and institutions anywhere in the world to come together to directly contribute to the global response to COVID-19.
To help strengthen the global response to COVID-19, Global Citizen launched the One World: Together At Home campaign to support health care and frontline workers, as well as help drive funding commitments to support the World Health Organization (WHO) and its Solidarity Response Fund.
Now, under the patronage of the European Commission, we've launched the Global Goal: Unite for Our Future campaign, to keep driving forward the momentum, and further support those organisations leading the way in developing COVID-19 tests, treatments, and vaccines, and ensure the global cooperation needed to make sure these tools reach everyone, equally. You can take action to support the campaign here.
“We are at a critical point in the global response to COVID-19 — we need everyone to get involved in this massive effort to keep the world safe,” said Dr. Tedros Adhanom Ghebreyesus, director-general at WHO.
2. Testing, testing, testing
Testing and early detection of COVID-19 must remain a priority, even as the world unites behind efforts towards developing vaccines and treatments as soon as possible.
One of the most important aspects of the fight to eradicate polio has been detection, according to the United Nations Children’s Fund (UNICEF). Doctors and health care workers in high-risk areas regularly test children, while local governments test water sources like rivers for polio-causing bacteria.
In order to help prevent massive outbreaks, GPEI and its partners have established sampling sites in areas that are prone to outbreaks.
GPEI has an extensive testing strategy that uses community and family engagement, science and research, as well as its own control systems. One of them is microplanning, which the organisation said is key in reaching remote and high-risk populations.
Microplanning helps health care workers to identify priority communities, address potential barriers, and develop a plan for a successful immunisation campaign.
“This strategy has helped keep India polio-free for five years. Now the Mewat district of India is using microplanning to increase its rates of vaccination against measles and rubella,” GPEI said.
GPEI’s teams in Nigeria, meanwhile, use polio surveillance systems that identify new cases and where they originate. Teams also test sewage systems and water sources, which helps them identify polio cases even in the absence of symptoms.
In Nigeria, the surveillance system established to tackle polio is also now being used to identify people with symptoms of yellow fever. It’s credited with helping Nigeria tackle a yellow fever outbreak, with some 8 million people being vaccinated as a result.
GPEI added: “Since polio is a transmittable disease, health workers use contact tracing to learn who has come in contact with people who might be infected.” The organisation added that contact tracing was also critical to containing an Ebola outbreak in Nigeria in 2014.
Similarly, early detection plays a vital role in tackling COVID-19. Testing allows affected people to isolate themselves so that the virus doesn’t spread further.
It also makes it possible for authorities to trace where people who test positive for the virus have been, and who they might have come into contact with, again to prevent the virus spreading.
"Testing is the only way to identify flare-ups and hot spots so that appropriate containment measures can be implemented," Gabrielle Landry Chappuis, the director of external affairs at the Foundation for Innovative New Diagnostics (FIND), told Global Citizen.
She added: "It allows economies to reopen — and stay open. In the future, it will be vital for the introduction of vaccines and therapeutics. Most importantly, it is actionable now: testing, tracing, and isolating confirmed cases works."
Testing is also important because, with both polio and COVID-19, it’s possible that people who are infected won’t show symptoms.
According to UNICEF, 90% of people infected with polio don’t show any symptoms and of those that do, symptoms are usually mild ones like fever, fatigue, and headaches. But around one in every 200 cases, however, results in paralysis.
Meanwhile, according to the CDC, about 35% of people who have coronavirus don’t show any signs of it, making testing essential for identifying all positive cases of COVID-19 and limiting its spread.
3. Proper funding
Money is needed to ensure fast, safe, and equitable development of vaccines and treatments. More than $9 billion has been invested in eradicating polio, and more funds are still being invested to make sure that every child can be reached with immunisation programmes.
At the moment, it costs $1 billion annually to continue work towards the complete eradication of polio, according to a report in the Journal of Infectious Diseases.
“Even if the last case of polio is identified this year, a huge amount of work will remain to ensure that it stays gone, which means vaccinating children for at least three more years,” said UNICEF.
Gavi said cost is also one of the challenges involved in developing a safe and effective vaccine to combat COVID-19.
Significant funding is needed urgently in the coming months to ensure that COVID-19 tests, treatments, and vaccines are developed at a scale that ensures that every person who needs health care gets it.
The development of tests, vaccines, and therapeutics against COVID-19 will require billions, while more funding will be needed to manufacture and distribute enough anti-COVID-19 tools to address the global need rapidly and equitably.
Combating COVID-19, as with combating polio, will require global cooperation, and global funding efforts. You can take action here to call on world leaders to step up funding to help ensure that everyone, everywhere, can access the tools needed to put an end to the pandemic.
TheGlobal Goal: Unite for Our Futurecampaign is working to support several organisations leading the global efforts to tackle COVID-19, whether through developing tests, vaccines, and treatments, or through ensuring that the most vulnerable are able to access health care.
These organisations, among others, include CEPI, which is driving vaccine development; Gavi, the Vaccine Alliance, which will be central to COVID-19 vaccine delivery, while also ensuring that no child misses out on routine vaccinations either; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the WHO’s COVID-19 Solidarity Response Fund, powered by the UN Foundation; FIND, which is dedicated to transforming diagnostics and testing; and global health initiative UNITAID.
Disclosure: The Bill and Melinda Gates Foundation is a funding partner of Global Citizen.
Editor's note: This piece has been updated to include a disclosure that the Bill and Melinda Gates Foundation is a funding partner of Global Citizen. We regret the oversight.