A panel discussion on Germany’s contribution to the global fight against polio
On 24 October 2019, World Polio Day, Global Citizen and Rotary International hosted an evening event in the heart of Berlin focusing on Germany’s contribution to polio eradication and GPEI’s ‘Polio Endgame Strategy’. Keynotes by BMZ and WHO representatives were followed by a lively discussion on the need to continue global efforts on the last mile – and beyond.
Sonja Steffen, patron of the event and member of the Bundestag with a particular commitment to polio eradication, Carolin Albrecht, Global Citizen’s Germany Director, and Anne von Fallois, Rotary International’s National Advocacy Advisor in Germany, welcomed their guests, including representatives of the World Health Organization and the Federal Ministry for Economic Cooperation and Development (BMZ), Rotarians and global health experts from various German government and non-government organisations and academia.
‘Imagine Neil Armstrong had turned around just before reaching the moon’
Anne von Fallois explained that Rotary International has been a partner of the Global Polio Eradication Initiative (GPEI) since its beginnings in 1988 and that its clubs worldwide have raised 2,2 billion USD for it. In view of the upcoming pledging event in Abu Dhabi in November, she called upon the German government to keep up its commitment: ‘Polio eradication is a man-on-the-moon project and we are almost there. Imagine Neil Armstrong had turned around just before reaching the moon!’
Despite impressive progress, we must stay vigilant
Martin Jäger, State Secretary at BMZ, reminded participants that in the 1950s – not such a long time ago – a polio epidemic affected 50,000 young people in the United States, 5,000 of whom died. During the same period, 34,000 German children and adolescents also caught the disease, with 10% of them dying and many others being left with impairments for life. Jäger underscored that the international community’s joint efforts since that time – through GPEI and Gavi, the Vaccine Alliance – have led to impressive progress: The number of countries with polio cases has fallen from 157 to three – Afghanistan, Nigeria and Pakistan – with Nigeria having been certified as polio-free this year. The current count of polio cases (94 in 2019) is, according to Jäger, no reason for campaigners to rest on their laurels. Polio outbreaks like the one in Tadjikistan in 2010, where 700 new cases occurred in a very short time, show that ‘we must stay vigilant’.
This, for Jäger, means continuing the efforts towards complete global eradication, an objective the BMZ has pursued with full support of the German Bundestag. As third-largest donor in polio eradication, Germany committed and paid out a total of over 500 Mio. EUR since its beginnings in 1988. Between 2013 and 2017, Germany supported GPEI’s Polio-Endgame Strategy – which was then expected to be the last mile of polio eradication – with 100 million EUR. According to Jäger, Germany will continue its support to both GPEI and Gavi. ‘Whilst I do not want to preempt parliamentary budget negotiations’, said Jäger, ‘I am convinced that we will honour our commitments’.
Whether we will succeed is now a question of social and political will
Christopher Maher, Special Polio Advisor to the WHO Director, thanked the German government and German Rotarians for an exemplary partnership. According to him, Germany had not only contributed substantial financial contributions over the years, but its political leaders, Chancellor Angela Merkel and Minister Gerd Müller, have ensured that polio eradication has remained high on the agenda for both the G7 and the G20.
‘Until we eradicate polio in Pakistan and Afghanistan’, Maher said, ‘all countries continue to be at risk’. He emphasised that succeeding was no longer a question of technical approaches – these are well known – but rather of social and political will. ‘At the pledging event, we hope that Germany will remain a strong supporter, not just financially but also morally.’
In remote and war-torn Afghanistan, fighting polio is a desperate struggle
In the panel discussion that followed, moderator Martina Merten asked Laiq Karimi, formerly a polio eradication supervisor in Afghanistan, which challenges he foresees on the last mile towards polio eradication in his country. Karimi described the difficult conditions vaccination teams face in the remote and war-torn areas of rural Afghanistan: It was not possible to recruit women for these teams which meant, in turn, that mothers in villages would not agree for young men they did not know to see, let alone vaccinate their children. While vaccination campaigns, once launched in a country or region, are designed and budgeted to be completed in five days, this time is insufficient to win the trust of such villagers by talking with their elders or, ideally, by recruiting and training people from their midst to join vaccination teams. Summer temperatures of over 40 degrees Celsius in areas without a power grid make it near-impossible to maintain the cold chain the vaccines require. ‘To make this work in Afghanistan we need longer campaigns, more staff and more resources’, said Karimi.
It’s time to move from a disease-focus towards holistic health systems strengthening
Asked about her vision for the so-called transition period, when responsibility for case detection and containment would become a national responsibility, Tanya Herfurth, Founding Member and President of the Young Leaders for Global Health (YLH), proposed that global health funding formerly allocated to the eradication of specific diseases should be continued, yet ‘re-purposed’ to help countries establish and maintain a sustainable health workforce. Many community health workers, most of them women, whose salaries are currently funded through GPEI have improved the health of their communities, won their trust and become bread-winners for their families. Is it not imperative to continue funding them as an essential component of countries’ health systems? Herfurth drew a connection between the continued polio infections in Afghanistan and Pakistan and the populations’ lack of trust in their health systems. In her view, only investments in holistic health system strengthening, including in a sufficient number of trusted community health workers, can help to overcome this challenge.
Eradicating polio is just a milestone on the way towards sustainably strengthened health systems
Dr Georg Kippels, head of the parliamentary advisory committee for the End Polio Now campaign, stressed that parliamentarians regard it as essential to provide the bodies fighting the polio epidemic with the financial and technical resources they need to completely eradicate the disease, including the extra means needed to ensure health workers’ safety in contexts where they might be attacked, as has happened in Pakistan.
He agreed that the disease-focus that has characterised global health efforts over the past two decades had to be overcome and replaced by an orientation towards Universal Health Coverage and sustainable health systems strengthening: ‘When we reach polio eradication it will be an impressive success, and yet, it will only be one milestone on our long way towards sustainably strengthened health systems around the globe.’
We need concerted action to get the job done
When Merten invited the audience to join the discussion, Joachim Schüürmann, senior health advisor at KfW Entwicklungsbank, recounted the lessons he learned from polio eradication efforts in India, now almost a decade ago. In his view, India’s success was based on its government’s determination to end polio and on the concerted action taken by GPEI, GAVI and bilateral partners: while GAVI had laid the foundation for routine vaccinations by funding vaccines and cool chain equipment, GPEI provided the strategic umbrella for flexible action and enabled WHO to strengthen the capacities of the local teams; the bilateral partners supported the strategic measures, filled gaps and helped the Indian government in integrating polio eradication into its national health programme. ‘It is not a question of either/or. To get the job done, we need concerted action among all three of these actors.’
Going the last mile will not be easy, but it can be done
Asked which conclusions she had drawn from the discussion, Ilse Hahn, Head of BMZ Division Health, Population Policy and Social Protection, said that it was clear that reaching the last mile of global polio eradication would not be easy. The social and political situations in Afghanistan and Pakistan highlight the complexity of the challenge. According to Hahn, BMZ is fully committed to supporting global polio eradication efforts and to do so for as long as it is necessary. In addition to multilateral support, however, the determination of the affected countries’ governments was essential. The examples of India and Nigeria have shown that where national and global partners join forces, a once-elusive goal can eventually be reached.
Anna v. Roenne, October 2019