Success Against a Resilient Foe: Philanthropy’s Long Fight to Eradicate Polio

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The article on the front page of the New York Times announced that the city was mobilizing to end polio with a drive to inoculate everyone under 40 in a matter of months. It was dated December 4, 1956.

Yet in July of this year, polio again reared its head in New York when an unvaccinated adult in suburban Rockland County, only six miles north of the Bronx, tested positive for the disease. Days later, the New York State Department of Health revealed that wastewater surveillance from June showed the presence of the disease in samples, indicating that others may be shedding the virus. Meanwhile, health authorities in the U.K. found evidence suggesting local spread of poliovirus in London, and quickly issued a firm directive that the unimmunized seek vaccines.

Many see polio as a disease of the past, a problem from the FDR era. Polio attacks the nervous system, and causes varying levels of paralysis. In the first decades of the 20th century, treatment in the U.S. was limited to rolling quarantines and “iron lung” respirators. It commonly affects children under age five, and typically spreads from person to person via contaminated water.

The people lining up for immunization today will be seeking a readily available vaccine developed by Jonas Salk nearly seven decades ago. Yet polio has proved to be tenacious — and is not to be taken lightly. Officials like Bryon Backenson, director of the Bureau of Communicable Diseases for New York State, said that many aren’t familiar with the disease, and “don’t understand the gravity of what polio actually is.”

Although polio hasn’t been eradicated fully, efforts to wipe the disease from the earth have actually been a resounding success, anchored by a global collaboration of governments, global health agencies and philanthropies that came together in the late 1980s. 

Dr. Kelly Henning, who leads Bloomberg Philanthropies’ Public Health Program, said that in 1988, there were 350,000 known cases of polio in 125 endemic countries. Today, the country count has dropped to two: Afghanistan and Pakistan. And the number of global cases has dropped by 99%. As of August 2, there were only 19 wild poliovirus cases on the planet.   

Leading health funders like Gates, Bloomberg Philanthropies and Rotary International have deployed billions for decades to bring those numbers down — and helped save millions of lives. Here, we look at a philanthropic success story driven by equal parts funding and resolve.

Coming together

Polio funders largely back work to wipe out the disease through the Global Polio Eradication Initiative, or GPEI, a public-private partnership led by national governments and global organizations like the World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance.

Launched in 1988 to put structure around a World Health Assembly resolution to eradicate polio, GPEI estimates that its work since then has allowed 16 million people worldwide to walk upright and saved 1.5 million lives. One philanthropic organizations was a founding member, Rotary International. Private and nongovernmental donors are a core element of GPEI’s funding mix, representing a full 36% of total contributions since inception, roughly $7 billion of a total of $19 billion raised.

The mission now is to tackle the “final 0.01%” of cases. In 2019, GPEI announced a five-year, $5.1 billion “endgame strategy” that maps out three goals in the fight to put polio in the history books: eradication through immunization, integration of surveillance and accountability, and certification and containment. In 2021, GPEI launched a new five-year eradication strategy: Delivering on a Promise.

Rotary, Gates and Bloomberg are three of the primary philanthropic funders that have backed GPEI’s work for years to bring an end to the disease.

Rotary International

Rotary International, the century-old global network of a million and a half civic-minded “people of action,” has been with GPEI since the start. The service organization has taken on some of the world’s most intractable issues, from peacebuilding to securing safe water and protecting the environment.

Rotary’s three-part structure is unique, comprising clubs, Rotary International and the Rotary Foundation. Forty-six thousand clubs operate locally around the world, and Rotary International is the global membership organization. Meanwhile, the Rotary Foundation is organized as a public charity and governed by an independent board. It’s headquartered in Evanston, Illinois, with associate foundations that span the globe, from Brazil to Japan. 

Since its inception more than 100 years ago, the foundation has invested the more than $4 billion raised by its members to “advance world understanding, goodwill and peace by improving health, providing quality education, improving the environment, and alleviating poverty.” Polio eradication is its top philanthropic priority.

The Rotary Foundation has earned a four-star rating from Charity Navigator, and regularly spends more than 90% of all funding on awards and programming. That number is made possible by the active local engagement of its volunteer leaders, members who, in the case of polio, engage with health workers to vaccinate children, recruit fellow volunteers, and assist with transportation and other logistics. On a more macro level, they also help secure support from governments, NGOs, corporations and the public.

Rotary’s been committed to the cause for decades. Its first polio program dates back to 1979, when it launched a multiyear project to immunize 6 million children in the Philippines. In 1985, efforts expanded through a “PolioPlus” program that Rotary calls the “world’s first and largest coordinated private-sector support of a public health initiative.” The program’s fundraising target quickly grew to $120 million.

In 1988, Rotary joined the WHO as a founding partner of the GPEI. Five years later, it mounted another 12-month campaign that brought its total investment in the polio eradication fight to $500 million. By then, the count of countries in which polio was endemic had dropped from 125 to six: Afghanistan, Egypt, India, Niger, Nigeria and Pakistan.

By 2009, Rotary’s members had raised $800 million to fight the disease. The lion’s share of that — $555 million — supported GPEI, spurred by a $200 million challenge grant from Gates. By 2011, Rotary funding for anti-polio work topped $1 billion. To date, the organization and its members have contributed more than $2.4 billion and countless volunteer hours to the fight.

Today, Rotary International is committed to raising $50 million a year for polio eradication, supporting operations, medical workers, laboratory equipment and educational materials. The Bill & Melinda Gates Foundation pledged to match that on a 2-to-1 basis, up to $150 million.

Bill & Melinda Gates Foundation

Ending polio has also been a decades-long commitment of the Gates Foundation. Dr. Jay Wenger, the foundation’s director of polio eradication, noted that the support grew along with the GPEI push in 1988, and a resolution by the WHO to eradicate polio once and for all by 2000. In 2007, BMGF joined GPEI as a core partner.

Gates’ focus areas include many of the GPEI priorities: vaccination campaigns, surveillance and monitoring, containment policy and data collection.

The foundation’s financial commitment has been huge. Wenger said that over time, Gates has contributed nearly $5 billion to the GPEI, making it the biggest donor “but for a number of bilaterals.” The foundation’s total investment in eradicating the disease stands at a massive $7 billion. Beyond that, Gates works with key donors like Rotary on matching funds, and as a go-between for banks and governments to facilitate financial agreements.

As with Rotary, Gates’ funding commitments have been backed by the time and attention of its people, from the “leadership chain down the line.” Right from the top, co-founder Bill Gates has worked with the crown prince of Abu Dhabi on a plan to reach difficult areas in Pakistan. As recently as February, Gates visited Pakistan’s National Emergency Operations Center in Islamabad to “see progress for himself,” poring over data and debating ways to reach kids in the next house-to-house vaccination campaign. Another example is Chris Elias, president of the foundation’s Global Development Division, who chairs GPEI’s global polio oversight board, which includes leaders from UNICEF and the U.S. CDC.

Bloomberg Philanthropies

Bloomberg Philanthropies also considers GPEI partnerships key to polio eradication, combining the strengths and expertise of organizations and agencies like the U.S. CDC and the WHO. Bloomberg Philanthropies has backed efforts to eradicate polio since 2013, when it made its first GPEI contribution. To date, support for the organization has climbed to $175 million.

Bloomberg’s polio eradication funding is one part of a broader interest in global public health that focuses on saving millions from dying of preventable causes in cities and low- and middle-income countries using strategic partnerships and proven strategies. Tactics include tobacco reduction, programs in obesity and drowning prevention, and a maternal and reproductive health initiative focused on sub-Saharan Africa and Latin America. 

A resilient foe

The three funders are in it for the long haul. Wenger said that while the polio fight is “in many ways a great success story so far, work is not finished.”

Situational factors in countries with ongoing cases have made the goal of full eradication elusive. Bloomberg’s Dr. Henning explained that “Pakistan and Afghanistan are the only two countries that have never stopped seeing cases. Ending the transmission of polio in these countries is challenging because the most at-risk populations can be difficult to access and may have vaccine hesitancy. Many affected communities face extreme poverty and all of the challenges associated with that. Some regions of these countries also present security risks due to non-state armed groups and political instability. Therefore, the conversation around polio eradication needs to observe and incorporate these upstream factors.”

Wenger says, “The bottom line is that we are still closer to getting rid of polio than ever before,” and new oral vaccine delivery has increased the chances of “finishing it off.” But that will take continued financial support — and not just from Gates. Wenger said funders will need to raise another $4.8 billion to cover the projected costs of implementing GPEI’s 2022-2026 eradication strategy. Germany and GPEI will co-host a pledging moment to raise funding at the World Health Summit in October.

And then there’s the disease’s tenacity, even in high-income countries like the United States. On August 4, New York State Health Commissioner Mary Bassett said the latest wastewater findings may indicate a much wider threat, and characterized the problem as “just the tip of the iceberg.”

Rotary acknowledged that reality, while maintaining confidence in the work. “While Rotary and its Global Polio Eradication Initiative partners were disappointed to be informed of the polio case in New York State, we remain optimistic,” said Carol Pandak, director of PolioPlus at Rotary International. “We will continue to address challenges such as weak health systems by creating greater urgency and accountability in polio outbreak countries, improving polio surveillance, and vaccine uptake in high-risk communities.”

Along with its GPEI partners, Pandak said, Rotary “will continue our work until we fulfill our promise of a polio-free world.”