Abstract
Background: Investments made by countries and donors to support polio eradication and the Global Polio Eradication Initiative (GPEI) over the past 35 years provided financial support for significant health interventions beyond the prevention of polio. Prior economic analyses that sought to quantify the economic benefits of some interventions encountered insufficient data and evidence associated with non-polio-specific activities. The 2022-2026 GPEI Strategic Plan explicitly identified integration and gender equity as funded mandates that must move forward in parallel with polio eradication, but these goals remain vaguely defined from a health economic perspective. Methods: To ensure unambiguous and full accounting for all financial investments in the GPEI, polio eradication, and other desirable objectives, we identify the health economic analysis methods and inputs needed to ensure transparent financial accountability and cost-effective use of funds. Results: Sufficient inputs and methods exist to characterize the health and economic benefits of polio-specific activities, but we identified the need for additional information and method development for some non-polio-specific and cost-sharing activities. Donors who seek to support non-polio-specific objectives as part of the GPEI may want to provide dedicated support financing for which it may be difficult to apply typical health economic criteria and to expect net health and/or net economic benefits. Conclusions: Given the mixture of funding sources provided to the GPEI, which includes support by governments and private donors, we recommend that the GPEI separately account for financial needs that represent necessities for polio eradication from those used for other stated objectives. An added layer of specificity that identifies all funds according to each activity, the accountable party and/or parties, and the associated measurable health or other outcome(s), will enable improved health economic analyses and reporting to donors who seek to track returns on their investments.
Highlights
Several clinically significant diseases, including polio and measles, meet established international criteria for potential eradication[1], only a few have been targeted for eradication, and an even smaller number have been successfully eradicated
Given the mixture of Global Polio Eradication Initiative (GPEI) funding sources, which includes support by national governments and private donor sources, we anticipate that separate accounting will be required to provide clarity for donors and enable better management of expectations
With respect to supporting health economic analyses, we recommend that the GPEI separately account for the financial needs required and resources spent for: (1) polio-specific immunization and eradication activities and (2) non-polio-specific activities, which should enable better attribution of costs and benefits and improved reporting to funding sources who seek to track performance on different specific objectives
Summary
Several clinically significant diseases, including polio and measles, meet established international criteria for potential eradication[1], only a few have been targeted for eradication, and an even smaller number have been successfully eradicated. The 2018 WHA adopted the Strategic Action Plan on Polio Transition[33], which identified the capacities and assets required to achieve the following three objectives: (1) maintain a polio-free world after eradication, (2) strengthen immunization systems and surveillance for vaccine preventable diseases in support of the WHO Global Vaccine Action Plan, and (3) strengthen emergency preparedness, detection and response capacity in countries to meet the WHO International Health Regulations (2005). GPEI assumed as part of its polio transition planning that: (1) to the extent possible, countries will absorb the costs of sustaining polio assets, (2) countries will map out the role polio assets play in their health systems and close any deficits created by the loss of polio funding, (3) national plans will align with the vaccination targets endorsed by WHO, and (4) donors will be prepared to fill any remaining gap[36] Despite these initial expectations, as of 2021, efforts to transition the responsibility for supporting all polio functions and activities to national governments remain incomplete based on process indicators tracked by the WHO monitoring and evaluation dashboard[47]. The strategic framework of mapping two polio-specific goals to five broad objectives that go beyond polio eradication
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