Polio eradication strategy must be adjusted for local contexts

"It has been a particularly busy couple of months for the Global Polio Eradication Initiative (GPEI)," SciDev.Net Director Nick Ishmael Perkins writes in a SciDev.Net editorial. "The deadly attacks on vaccinators in Pakistan brought renewed global attention to the campaign, and then Bill Gates went public with his personal commitment to end polio," he states, adding, "The GPEI has responded with a strategy for what it calls the 'endgame.'" He writes the eradication of smallpox "is often cited by the polio eradication campaign as a model from which to learn" but notes "the context in which the GPEI operates suggests we can only learn so much from past success." He continues, "Indeed, the similarities between the two campaigns are striking," but "we shouldn't overstate similarities between the two campaigns," he continues, noting "[a] 1988 report by the WHO that documents the eradication of smallpox reveals some telling differences between the two campaigns."

"We now operate in a more multipolar world and influence, support or opposition can come from more places. Global campaigns can no longer rely on centralized power structures," Perkins writes. "On the one hand, global campaigns are keen to integrate with local health structures because a lack of national ownership is a liability," he continues, adding, "On the other, health systems in developing countries face critical challenges, around providing equal access to care and a reliance on treatment over prevention." He concludes, "Resolving this dilemma is possible -- but it is clear that the way forward will require more sophisticated engagement with local health structures than we have seen so far. One word which recurs throughout the polio endgame strategy is 'microplanning'" (2/22).