Global Polio Eradication Initiative (GPEI)

The Global Polio Eradication Initiative (GPEI) is an international public health partnership launched in 1988 with the mission to eradicate poliomyelitis (polio) worldwide. It represents one of the most ambitious and coordinated disease eradication efforts in history, bringing together governments, health organisations, and civil society to combat a virus that once paralysed hundreds of thousands of children each year. Since its inception, the initiative has led to an extraordinary reduction in global polio cases by over 99%, saving millions of children from paralysis and disability.

Background and Establishment

By the mid-20th century, poliomyelitis had become one of the most feared diseases globally, causing widespread paralysis and death. In 1988, recognising the success of regional immunisation campaigns and the feasibility of eradication, the World Health Assembly (the decision-making body of the World Health Organization) adopted a resolution to eliminate the disease completely. This resolution led to the creation of the Global Polio Eradication Initiative, spearheaded by a coalition comprising:

• World Health Organization (WHO)
• Rotary International
• United States Centers for Disease Control and Prevention (CDC)
• United Nations Children’s Fund (UNICEF)
• Later joined by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance

The GPEI was modelled on the successful eradication of smallpox and has since become a blueprint for global health collaboration.

Goals and Strategies

The overarching goal of the GPEI is the complete eradication of all types of poliovirus from human circulation. Its strategy is based on four main pillars:

1. High Routine Immunisation Coverage – Ensuring every child receives the required doses of polio vaccine through national immunisation programmes.
2. Supplementary Immunisation Activities (SIAs) – Conducting mass vaccination campaigns to immunise children missed by routine systems, particularly in high-risk regions.
3. Surveillance for Poliovirus – Monitoring for signs of polio through acute flaccid paralysis (AFP) case detection and environmental testing of sewage and water sources.
4. Targeted Mop-Up Campaigns – Rapid localised vaccination responses following detection of new cases to interrupt virus transmission.

In recent years, an additional emphasis has been placed on transition planning to ensure that the systems and resources built for polio eradication continue to benefit other public health priorities once eradication is achieved.

Progress and Achievements

At the time of the GPEI’s launch, poliomyelitis paralysed an estimated 350,000 children annually in over 125 countries. Since then, the coordinated global effort has achieved remarkable milestones:

• By 2000, the number of polio-endemic countries had fallen to 20.
• In 2014, the World Health Organization South-East Asia Region (including India) was certified polio-free.
• In 2020, the African Region was declared free of wild poliovirus.
• Today, only Afghanistan and Pakistan remain endemic for wild poliovirus type 1.

Over 2.5 billion children have been immunised through more than 200 national immunisation campaigns. This massive operation has involved millions of health workers and volunteers, often reaching children in remote and conflict-affected regions.

Types of Poliovirus and Vaccine Use

Polio is caused by three wild poliovirus serotypes — types 1, 2, and 3.

• Wild Poliovirus Type 2 was certified eradicated in 2015.
• Wild Poliovirus Type 3 was certified eradicated in 2019.
• Type 1 remains in circulation in limited regions.

Two main vaccines have been pivotal to eradication efforts:

• Oral Poliovirus Vaccine (OPV): Developed by Dr Albert Sabin, it uses live attenuated virus and induces strong mucosal immunity, interrupting person-to-person transmission.
• Inactivated Poliovirus Vaccine (IPV): Developed by Dr Jonas Salk, it uses inactivated virus and is delivered via injection, providing systemic immunity without the risk of vaccine-derived infection.

Many countries now employ a combined vaccination strategy, transitioning to IPV as eradication nears to minimise the risk of vaccine-derived poliovirus (VDPV).

Challenges and Setbacks

Despite extraordinary progress, several challenges continue to threaten the goal of total eradication:

• Conflict and Insecurity: Ongoing violence and political instability in endemic regions, particularly in parts of Afghanistan and Pakistan, restrict access to children and endanger health workers.
• Misinformation and Vaccine Hesitancy: Myths about vaccine safety and mistrust of vaccination programmes hinder community acceptance.
• Operational Barriers: Logistical difficulties, such as reaching nomadic populations and maintaining cold-chain systems, limit vaccine coverage.
• Circulating Vaccine-Derived Polioviruses (cVDPV): In areas with low immunisation rates, the attenuated virus in OPV can mutate and cause new outbreaks.

To address this, the novel oral poliovirus vaccine type 2 (nOPV2) has been introduced, offering improved genetic stability and a reduced likelihood of mutation.

Funding and Partnerships

The GPEI’s success depends heavily on sustained financial and political support. Rotary International’s “End Polio Now” campaign alone has contributed over US$2.1 billion and mobilised grassroots support worldwide. The Bill & Melinda Gates Foundation provides substantial annual funding, often matching Rotary’s contributions.
Governments and donors collectively finance the initiative’s strategic plan, supporting vaccination drives, surveillance systems, and outbreak responses. Global coordination through WHO and UNICEF ensures vaccine delivery and public health communication in over 200 countries.

Legacy and Future Outlook

The eradication of polio would make it only the second human disease ever to be completely eliminated, following smallpox in 1980. The benefits extend beyond polio itself:

• Strengthened Health Systems: Polio infrastructure—such as disease surveillance, data collection, and cold-chain systems—has improved broader immunisation and outbreak responses.
• Economic Gains: Eradication is projected to save up to US$50 billion by 2035 due to reduced healthcare and vaccine costs.
• Pandemic Preparedness: The GPEI’s networks have been repurposed to support other global emergencies, including Ebola and COVID-19 responses.

Although challenges persist, global determination remains steadfast. The final stages of eradication require persistent effort, innovation, and international cooperation.