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have been the opposite – that constant delays discouraged
donors, which led to a lack of resources?
This is the catch. On one hand, the chronic lack of resources
has always been a big obstacle for the program; on the other,
failure to achieve the goals worried supporters. Right now,
for the first time in the program’s history, the Abu Dhabi
meeting conducted by Bill Gates secured [commitments for
most of] the resources needed to carry on this initiative until
completion. Now there is no longer the excuse of lack of
resources, and if the problems mentioned above are handled
properly, the program will end the way we all desire.
Since 1988, the polio eradication program has spent
US$10 billion. Until certification of the end of the
disease, targeted for 2018, another $5.5 billion will
be needed. That is more than half of all that has been
spent so far. Why is the final phase, the endgame, more
expensive than the previous one?
In general, in such programs it is necessary to increase
resources in the final phase, which is always the most difficult
of all. Problems with security, logistics, access to remote areas,
and populations that refuse to cooperate have to be overcome.
What are the lessons learned from fighting a global
disease, and how can they help us tackle similar
problems in the future?
An important lesson is that a program of this magnitude
cannot be launched without making sure there are enough
resources available. The strategies have to be re-evaluated
constantly, so any needed tweaking can be implemented
without compromising the results.
(1) INSTABILITY After attacks on aid workers in
Pakistan and Nigeria, national governments and
Rotary’s partner agencies began adapting operations to
protect the safety of health workers. In Nigeria, measures
such as “firewalling” – immunizing children traveling
through unstable areas to halt the spread of the virus –
were put in place. Health teams are also working with
security agencies to go quickly into dangerous areas to
immunize children, usually for a maximum of two days.
In Karachi, Pakistan, police protect teams doing door-to-
door campaigns. In other volatile areas, immunization
teams ride in vans escorted by police to avoid becoming
easy targets for terrorists.
(2) COMMUNITY APATHY To promote local
ownership of the eradication effort, the national
program in Afghanistan rolled out a communication
strategy with the theme “Ending polio is MY
RESPONSIBILITY.” In Nigeria, the Volunteer Community
Mobilizer Network has forged partnerships with religious
groups and leaders, including Tsangaya (Koranic)
schools, to target high-risk areas. Sani Musa Danja, a
popular Nigerian actor and musician, became a Rotary
polio ambassador to help with public education and to
counter propaganda against the oral polio vaccine. Food
and other necessities are also distributed to attract
families to immunization drives. In Pakistan, the
national PolioPlus committee has engaged with local
nongovernmental organizations in high-risk areas to con-
duct polio immunizations and other health interventions.
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During the Global Vaccine Summit in Abu Dhabi in 2013
you announced that we had reached the $4 billion mark.
You said, “Polio eradication now is no longer a public
health program, but a diplomatic one.” Could you explain
what you meant?
We have resources, a good plan, and excellent scientific
and technical support to end polio. The stumbling blocks
along the way are safety, terrorism, and social hurdles. To
achieve our goals, we have to use all of our diplomatic
expertise to open a dialogue with those who oppose the
After polio is gone, is there another disease that the world
After polio, measles and rubella could be tackled. Both are
already eradicated in the Americas.
How do you evaluate Rotary’s role in the Global Polio
Rotary is a very important partner in this initiative, not only
for its tremendous financial contribution but for the advocacy
with governments and the active work Rotarians perform
during immunization campaigns.
For many, including people in your home country
of Brazil, polio has become a thing of the past and
doesn’t pose a threat. What do you say to people who
think this way?
The world today is a small village. As long as polio occurs
somewhere on the planet, even in faraway lands, no country
in the world will ever be free of this disease. n
(3) ACCOUNTABILITY Each of the three
polio-endemic countries has tailored its
approach to developing effective immunization teams
and addressing community concerns. In Nigeria,
traditional leaders select team members. Nigerian
Rotarians from the south of the country, which is polio-
free, are helping to monitor immunization campaigns
in the north. India is providing technical assistance,
deploying its medical officers to Nigeria’s worst-
performing areas to apply lessons learned in its
eradication campaign. Afghanistan increased technical
support to high-risk districts, including adding full-time
district immunization managers. In Pakistan, a summit
was held in Islamabad to address issues in high-risk
districts. Rotary also launched a network of polio
resource centers to promote routine immunization of
newborns and infants, create awareness about polio,
and build confidence in the vaccine.
(4) MISSED CHILDREN Rather than relying
on maps drawn from memory, health workers
now use satellite imagery to identify settlements and
to ensure that they consistently reach remote places,
many of which have nomadic populations. Pakistan’s
top challenge is in North and South Waziristan in the
Federally Administered Tribal Areas, where militant
leaders banned polio immunizations in June 2012.
Many people fear for their lives if they allow their
children to be immunized. Because of conflict, many
families have fled the region. Rotary, Pakistan’s
government, UNICEF, and the World Health
Organization are working together to track transient
families and children missed by health workers
through mobile clinics at bus stands located at all
major railway stations and at all border exit and entry
points, where they reach 800 to 1,000 children daily.
Recently, Pakistan agreed to immunize children at
points set up in the international terminals of airports.
(5) INSUFFICIENT FUNDS Rotarians
around the world are engaging all levels of
government and the private sector, as well as the public,
to urge them to provide the necessary financial support
to eradicate polio worldwide. Advocacy is critical to
raising the $5.5 billion needed to finish the job.
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