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1. There are 10 months to go to hit the World Health Assembly’s goal of stopping global polio transmission by the end of 2012. Currently the eradication program is not on track to meet this goal.
2. Success in
India – one of the four polio endemic countries – shows that unswerving political commitment, outstanding public health leadership, clear lines of accountability, intolerance of weak performance and the systematic enforcement of best practice can stop polio.
3. Elsewhere in affected countries, programs are falling short in most, if not all, of the areas where
India has excelled.
4. In these next 10 months every drop of vaccine will count, every vaccinator will count, every team leader will count, every laboratory specimen will count, every piece of data will count, every parent will count, but most of all every child will count.
5. Science has delivered to human civilization the chance to eliminate one of the malevolent forces of nature, an invisible enemy that obliterates childhoods, maims bodies and scars families and communities. For only the second time in history, the world is poised to rid itself of a disease that has destroyed millions of lives. This opportunity must not be lost.
6. If the program can make the shift in performance from good to great – drawing on the analysis in this and our earlier reports – then the next 10 months will be looked back on by future generations as the countdown to the final knock-out blow to the polio virus.
7. The program’s 2010-12 Strategic Plan aimed to stop transmission in two endemic countries by end-2011. Its success in
India was magnificent. By sharp contrast, the other three endemic countries each had more polio cases in 2011 than in 2010.
8. Transmission was supposed to be stopped by end-2010 in the four ‘re-established’ countries. This failed in
Chad and DR Congo. A year on, polio retains a powerful grip in at least the latter two of these.
9. More positively, the plan aimed to stop outbreaks within six months. The program has successfully done so in every case but one.
10. Six countries still have persistent transmission:
· Nigeria’s 2011 emergency plan had no meaningful impact. Its 2012 plan must be of a different order entirely. This needs urgent attention
· Pakistan has deep problems, but has recently strengthened its approach
· Afghanistan has not got to grips with how to reach enough children in insecure areas
· Angola looks promising, with no polio case since July 2011
· Chad’s program is building visibly but slowly from a very low baseline
· DR Congo moved in the right direction in 2011 but we retain substantial concerns, particularly about Katanga.
11. The reason that polio will not be eradicated on the program’s present trajectory is straightforward: performance is of variable quality and consistently falls below best practice in all the polio affected areas.
12. There is no single or simple solution to this problem of sub-standard performance but three big actions would transform the prospects of the elimination goal being met: Greater use of the key strategies of change management, including much greater emphasis on ‘people factors’; identifying and finding definitive solutions to systemic problems that are barriers to success; taking to heart and fully adopting the lessons learned from India’s success.
13. Our previous reports have discussed these issues extensively. The program’s partners are starting to demonstrate that they understand these points and can act on them.
14. The program continues to provide illustrations of the fact that it needs to persist with this change in thinking. As just one example: in the 18 months of our existence we have heard little strategic discussion of a key component of the polio eradication workforce: the humble vaccinator. In contrast, we know from multiple sources, and from firsthand experience, that too many of these workers are underrated, rarely thanked, frequently criticized, often under-paid, poorly motivated, and weakly-skilled. Being an excellent vaccinator means being well-organized, a good communicator, and having the tenacity to track down every last child. It is the program’s responsibility to value, train and inspire this immensely important group of people, arguably the most important in the program. Their collective actions can drive the eradication effort to failure or elevate it to success.
15. The body of our report provides a number of other examples.
16. WHO’s Executive Board has declared polio eradication a “programmatic emergency for global public health”. These are strong words, but justified. Countries, partners and all who have a stake in polio eradication need to understand the severity of the situation. The impact of an emergency response will not come from what they say, but from what they now do.