1. Rebecca Bell Balsillie School of International Affairs rbell@balsillie school.ca THE ROAD TO GLOBAL POLIO ERADICATION: CHALLENGES AND OPPORTUNITIES

2. POLIO & THE GLOBAL RESPONSE Acute viral disease that can damage the digestive tract and the nervous system Can lead to Acute Flaccid Paralysis Two vaccines: Oral Polio Vaccine (OPV) Inactivated Polio Vaccine (IPV) Circulating vaccine-derived polioviruses Wild Poliovirus http://www.polioeradication.org/Polioandprevention/Thevaccines/Inactivatedpoliov accine(IPV).aspx

3.  Global Polio Eradication Initiative  Public-private partnership including the WHO, Rotary International, the US Centres for Disease Control and Prevention, and UNICEF.  Endgame Strategic Plan for 2013-2018  Transferable improvements for other health challenges  MDG 4.A/SDG 3.2  Reduce by two thirds, between 1990 and 2015, the under-five mortality rate  By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality…and under-5 mortality to at least as low as 25 per 1,000 live births POLIO: A BACKGROUND

4. POLITICS POLITICS POLITICS http://www.polioeradication.org/Dataandmonitoring/Poliothisweek/Poliocasesworldwide.aspx

5.  Removed from the polio- endemic list in September, 2015  Will require 3 years without WPV for official certification of polio eradication  Boycott of OPV vaccinations in 2003  Immunization rate dropped below 20%  Neutrality of the WHO in question  Restrictions of Health Care Workers (HCWs)  Traditional Medicine & Healers  Boko Haram  Misinformation & Mistrust  Gendered restrictions NIGERIA http://www.polioeradication.org/MediaRoom/Photos/Photocollections.a spx#prettyPhoto

6.  Conflict-related movement to and from Afghanistan  2450km Border allows for ease of cross-border transmission  Religious & Cultural Values  Mistrust, Social Unrest & Violence  CIA Hepatitis B Campaign  Remote locations PAKISTAN http://www.polioeradication.org/MediaRoom/Photos/Photocollections. aspx#prettyPhoto

7.  Insecurity, conflict & Political Unrest  Misconceptions about vaccines  Gendered Family Roles  Mistrust of foreign medicine & health care workers  Vaccine delivery, logistics  Health care infrastructure  Funding & Sustained Interest CHALLENGES http://www.polioeradication.org/MediaRoom/Photos/Photocollection s.aspx#prettyPhoto

8.  Vaccine Hesitancy vs. Anti-Vaccine  Optimized Vaccines  Improved Health Care Infrastructure  Increased Promotion of Vaccination Initiatives  Cooperation between diverse actors  Neutrality of Vaccination Campaigns  Incentive Structures OPPORTUNITIES

9.  Considering that international vaccination campaigns like the Global Polio Eradication Initiative require immense resources and capacity, their planning is done in a top-down manner. How could the GPEI and other large scale health campaigns encourage and involve grassroots level actors to help participate and be included in planning and praxis?  How could gender mainstreaming help mitigate some of the gender-based issues regarding decision-making in the household and ease restrictions for Health Care Workers? FOOD FOR THOUGHT/QUESTIONS