Key Concept

Key Evidence: A systematic review of 8 African countries that had wild polio virus transmission and significant polio eradication activities found evidence that the huge investments made in polio have strengthened capacity in almost all aspects of the overall immunization systems, especially in the areas of microplanning, service delivery, capacity-building (especially supportive supervision and on-the-job training), and program management. This led to substantial increases in coverage of other routine vaccinations – BCG, DPT, measles – in all 8 countries over a 25-year period (1989-2014), including a more than a 3-fold increase in DPT3 coverage in 2 countries and a more than a 2-fold increase in 3 other countries.

Anya B-Pm, Motouri E, Aschalew T et al. 2016. Contribution of polio eradication initiative to strengthening routine immunization: lessons learnt in the WHO African region. Vaccine. 34(43).
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Key Evidence: The expertise and assets gained through efforts to eradicate polio at least partially explain the improvement between 2013 and 2015 in vaccination coverage of DPT3 in six out of ten “focus” countries of the Polio Eradication Endgame strategic plan. This includes substantial increases in vaccination rates in India, Nigeria, and Ethiopia, which, combined, reduced the number of children not fully vaccinated with DPT by 2 million in 2 years.

van den Ent MMVX, Mallya A, Sandhu H et al. 2017. Experiences and lessons from polio eradication in 10 focus countries of the polio endgame strategic plan. Journal of Infectious Diseases. 216(1).
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Key Evidence: Communications and organizing skills and strategies developed by the India Social Mobilization Network (SMNet) — a 7,000 largely female work force created in 3 states as part of the polio eradication program to address deep-rooted sociocultural resistance to immunization in some of the most marginalized and at-risk communities- lead to strengthening of communications and social mobilization capacity of the national immunization program and contributed to sharp increases in immunization coverage of all routine childhood vaccines. These strategies, which can be applied to other health goals and priorities, included training and use of religious leaders, teachers, shopkeepers and others as community “influencers”; highly-skilled interpersonal communications; media management and evidence-based planning.

From the VoICE Editors: The authors report successes such as Uttar Pradesh, rates of full immunization coverage increased from 36% in 2009 to 81% in 2016.

Deutsch N, Singh P, Singh V et al. 2017. Legacy of polio- use of India’s Social Mobilization Network for strengthening of the Universal Immunization Program in India. Journal of Infectious Diseases. 216(S1).
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Key Evidence: A survey of 23 countries in all WHO regions found that activities to eliminate measles and rubella, including vaccination campaigns, have strengthened the countries’ overall routine immunization systems in a number of ways. These include microplanning that led to revised catchment populations and denominators for target-age children, expansion of cold chain systems that extended the reach of immunization, strengthening of surveillance and of outbreak preparedness and response for vaccine-preventable and other diseases.

Biellik RJ and Orenstein WA 2018. Strengthening routine immunization through measles-rubella elimination. Vaccine. 36(37).
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Key Evidence: Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. Polio eradication legacy efforts include documenting and applying the lessons learned from polio eradication and transitioning the capacities, assets, and processes of polio to other key health priorities.

Cochi, S.L., Hegg, L., Kaur, A., et al 2016. The Global Polio Eradication Initiative: progress, lessons learned, and polio legacy transition planning. Health Affairs. 35(2).
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Key Evidence: Efforts to eliminate measles — which has been called a public health “canary in the coalmine” since it’s a sign of weak health systems — can also serve to strengthen immunization programs as well as the broader health systems. These efforts include improving infection prevention and control practices in health care facilities, disease surveillance and outbreak detection systems, and countries’ ability to prepare for and respond to infectious disease outbreaks.

Hagan JE, Greiner A, Luvsanshavar UO et al. 2017. Use of diagonal approach of health system strengthening and measles elimination after a large nationwide outbreak in Mongolia. Emerging Infectious Diseases. 23.
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