Pivoting from Polio Eradication to Measles and Rubella Elimination: A Transition that Makes Sense Both for Children and Immunization Program Improvement

"Why not take advantage of the experience and infrastructure developed to eradicate polio to pursue the elimination of measles and rubella...?" This question is at the core of a commentary on the applicability of the Global Polio Eradication Initiative (GPEI) to the quest for measles and rubella eradication. Here, Stephen L. Cochi describes the end of vaccine preventable disease (VPD) deaths in children, which vaccination coverage can help accomplish, as "the ultimate step in achieving global equity" and as central to advancing achievement of the United Nations' Sustainable Development Goal (SDG) #3. There are 134,200 annual measles deaths still occurring worldwide.

Cochi explains that, during its nearly 30 years of operations, the GPEI has "mobilized and trained millions of volunteers, social mobilizers, and health workers; accessed households untouched by other health initiatives; mapped and brought health interventions to chronically neglected communities; and established a standardized, real-time global surveillance and response capacity....Many of these polio assets have been applied in tandem to measles elimination, which has similar strategies and program implementation infrastructure needs."

Rather than allow the infrastructure built by the GPEI to go to waste after the polio programme winds down, Cochi argues that it is necessary to link strategies for measles-rubella elimination with strategies for immunisation programme strengthening. He outlines four tactical approaches, including: Use advocacy for measles elimination to support institutions and policies needed for sustainable, high-quality immunisation programmes. "Measles outbreaks are much more effective than low vaccination coverage in gaining the attention of political leaders and building the political will needed to increase investments in immunization programs..."

The GPEI has documented many lessons learned - generated in challenging contexts in India, Nigeria, Pakistan, and Afghanistan - that Cochi says must be harnessed and applied to measles-rubella elimination, including:

• Knowledge and best practices accumulated on communications and community engagement, mobilising social and community support for vaccination, and using a targeted disease elimination initiative like measles or polio eradication as a springboard for broader health communication.
• The value of an advanced global, regional, and national laboratory network and real-time disease detection and response.
• The knowledge and experience acquired on how to reach every child, including the most underserved, migrants, nomads, people living in conflict zones, and others marginalised by circumstances that prevent or impede access to health services.
• Examples of outstanding programme monitoring and the use of accountability frameworks to assess performance in polio eradication, including in difficult settings.
• Partnership coordination, advocacy, and resource mobilisation, which were essential to achieving polio eradication goals. GPEI has assembled a committed global partnership led by Rotary International, the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Centers for Disease Control and Prevention, and the Bill & Melinda Gates Foundation, whose vanguard is 20 million frontline vaccinators.

"Even though it is hard work to transition, disease elimination programs are not a zero-sum game - successfully repurposing resources and knowledge from polio eradication to measles-rubella elimination is a win-win, especially for the world's children."