Rotary International, PolioPlus
"When polio is finally gone, we will have the knowledge from the lessons learned with PolioPlus, such as the value of direct involvement by local Rotarians, the program for emergency funding, innovative tactics, and additional approaches for tackling other global issues, even those beyond public health."
This report, included in a special open-access edition of The Journal of Infectious Diseases (available at the link below) exploring polio endgame activities, examines the work and legacy of Rotary PolioPlus programme around the world. Through the programme, Rotary volunteers have: participated in national immunisation days (NIDs); assisted with surveillance; worked on local, national, and international advocacy programmes for polio eradication; assisted at immunisation posts and clinics; and mobilised their communities for immunisation activities (including poliovirus and other vaccines) and other health benefits.
Rotary is a global nonprofit civil society organisation of 1.2 million business and professional leaders spread across over 35,000 clubs in some 200 countries and geographic regions. Rotary members are committed to providing service to their communities and the world. The report explains how Rotary came to select polio, a global health problem of recognised international importance for which a vaccine was available, as one of focus areas. The programme was named PolioPlus, with the "Plus" signifying the importance of other childhood vaccinations as part of primary healthcare and reflected the strategy to provide other health initiatives along with polio. Timelines were set for completion of the programme, but these had to be revised as various events delayed progress.
"Rotary's unwavering commitment to complete the eradication of polio has been vital to the success of the program." That said, Rotary knew that eradicating a disease like polio, which in the late 1980s was endemic in 125 countries, required cooperation with other major organisations. The report explains how Rotary joined with the World Health Organization, the United Nations Children's Fund (UNICEF), and the United States' Centers for Disease Control and Prevention (CDC) as spearheading partners of the Global Polio Eradication Initiative (GPEI). Through this experience, Rotary learned that effective coalition building is needed for great impact and that the participation of expert advisors has been essential in meeting the changing needs of the programme. "[O]ne of the strengths of this initiative is the clear definition of roles for each partner."
The report delves into the role that Rotary members have been playing in actively participating in polio eradication efforts. They use their business acumen and passion for volunteerism to raise funds, build awareness, encourage national governments and others to donate to and otherwise support the polio eradication effort, and even participate in humanitarian diplomacy to overcome hurdles in reaching every community with the polio vaccine. "Rotary members are the grassroots agents of change, helping to bridge cultures to reach every community with the vaccine. By working with others to engage community and religious leaders, they enable health professionals to do their work. In addition, they have participated in a large number of national immunization days. With this hands-on experience, they are able to share their accounts of immunizing children to help educate their communities and further raise awareness and funds." One specific example of their work is engagement in specialised and general social mobilisation in Operation MECACAR (Mediterranean, Caucasus and Central Asian Republics), where Rotary helped convince the Roma minority communities of Bulgaria and Romania to participate in NIDs, despite these groups' deep-seated distrust of government programmes. Because of its nongovernmental status, Rotary has played a key role in cross-border immunisation efforts - for example in "Operación Limpieza" (Operation Mop-up) in Ecuador, Peru, and 7 other Latin American countries in the late 1980s - and in the delivery of the vaccine today to communities in the border area between Pakistan and Afghanistan. It is noted that the direct involvement of local Rotary members who speak the language has helped facilitate polio immunisation campaigns in many polio-affected countries.
Other examples of Rotary work in the field:
- In Pakistan, Rotary has trained female health workers in the use of cell phone data reporting, which allows real-time recording of immunisation coverage and public health surveys of populations, helping to focus polio immunisation drives. The national chair notes how "Lady Health Workers are trusted to enter households and have the interactions with mothers and children necessary to deliver the polio vaccine. They also provide education and services for antenatal care, maternal health, and routine immunization for other diseases, such as Hepatitis B, Tetanus and measles."
- In Nigeria and India, Rotary has worked with national groups, such as the Federation of Muslim Women's Associations; collaboration with traditional and religious institutions results in the design of activities meant to promote local ownership and accountability at all programme levels, deepen community involvement, and increase uptake of the oral and inactivated polio vaccines.
- Rotary members in South America distributed posters and coffee mugs with dedicated phone numbers to report cases of acute flaccid paralysis (AFP) as part of surveillance strategies.
The report explores Rotary's international advocacy, as well as its work at local and national levels. For example, in Pakistan, India, and Nigeria, Rotary and its partners appealed to specialist bodies of Islamic scholars (Ulemas) to support polio vaccination, and provided training on polio and its impact. National Islamic leaders have issued fatwas in support of the vaccine, promoting its safety. Rotary members have then printed these fatwas and distributed them to vaccinators for circulation in communities. Rotary's credibility as a nonpartisan non-governmental organisation (NGO) has aided its advocacy efforts.
Rotary has also conducted special communication programmes to maintain awareness of polio, particularly in countries that no longer suffer from the virus, and to combat any potential mission fatigue. Rotary's "This Close" public awareness campaign enlisted celebrities and other major public figures to promote Rotary's End Polio Now campaign through public service announcements (PSAs) and print advertisements featuring the tagline "We're this close to ending polio". Another strategy has been the illumination of iconic structures across the world, from the United Kingdom's Houses of Parliament to the pyramids of Egypt with the End Polio Now message on the organisation's 108th anniversary in 2013. Rotary also created the "world's biggest commercial" when more than100,000 persons from 171 countries posted selfies in support of End Polio Now (2014) and the world's largest human national flag, composed of 50,000 persons, in Chennai, India.
Rotary is developing a transition plan to ensure that all the resources of polio eradication - both the physical infrastructure and the knowledge acquired - can be transferred to other health priorities. Rotary has transitioned its grants programme to include 6 areas of focus: disease prevention and treatment, water and sanitation, maternal and child health, basic education and literacy, economic and community development, and peace and conflict prevention/resolution. The emphasis is on sustainable investments driven by community-based needs assessments, local advocacy, and community engagement - all lessons learned from the ongoing polio eradication programme.
The Journal of Infectious Diseases, Volume 216, Supplement 1: Pages S355-S361, https://doi.org/10.1093/infdis/jiw556. Image credit: Nancy Barbee