WEBVTT

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[MUSIC PLAYING]

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SVEA CLOSSER: Now let's talk
about where the polio program

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is today or at least when this
lecture was recorded in 2020.

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First, between the
years 2000 and 2010,

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there were major increases in
routine immunization coverage

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across the world, a result
of renewed attention

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to routine immunization through
initiatives such as Gavi.

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Still, routine immunization
was not high everywhere,

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particularly in polio endemic
areas of Afghanistan, Pakistan,

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and Nigeria.

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Routine immunization
coverage was low.

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So what this map
shows is there's still

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some pockets in South Asia and
sub-Saharan Africa in 2010 that

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have less than 60% reaching
immunization coverage.

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The same regions in South
Asia and sub-Saharan Africa

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still stubbornly
had polio cases.

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In 2010, there were still
polio in Nigeria, Afghanistan,

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Pakistan, and India.

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It's those same regions
that, while they

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had made big improvements
in routine immunization,

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still didn't have full coverage.

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In part in recognition of this,
Gavi or the vaccine alliance,

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which is responsible for
routine immunization,

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was added as a partner to
polio eradication in 2019.

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This was a big, big move
for polio eradication

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because, in practice,
despite stated commitments,

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polio eradicators and
those championing routine

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immunization, although one would
think that their goals were

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quite similar, have actually
sometimes been at odds.

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In the 1990s, for example,
part of the reason

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that polio eradication got
off to a very slow start

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was because many in the
World Health Organization

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were still skeptical of
eradication as a strategy

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and of polio eradication
in particular.

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On the other side, polio
eradication officials

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have sometimes seen support
for broader health goals,

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even the relatively
narrow goal of promoting

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more routine immunization
as a distraction

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from the single-minded focus
needed to eradicate a disease.

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In the early 2000s,
for example, many,

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though certainly not all
polio eradication officials,

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were wary of Gavi.

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They viewed Gavi as a
potential threat, a competitor

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for attention and funding.

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A global level
policymakers said,

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quote, "The Independent
Monitoring Board

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made a recommendation
back, and I

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believe it was 2014,
that Gavi should

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be made a sixth spearheading
partner of GPEI.

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And at that point in
time, they decided

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not to invite Gavi to be a
member of polio eradication,

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but there have been increasing
calls for this to happen",

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end quote.

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And it was shortly
after this interview

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that Gavi was
added as a partner.

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Given the different mandates
of Gavi and the Global Polio

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Eradication Initiative-- one
aims to eradicate a disease,

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the other aims to increase
routine immunization--

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it's not yet clear how
the addition of Gavi

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will affect the
shared decision making

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within polio eradication.

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So this map shows
one way of thinking

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about the situation of the Polio
Eradication Initiative in 2020.

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This is the optimistic view.

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It shows you that there's only
two countries in the world that

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still have wild polio cases--

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Pakistan and Afghanistan.

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This map shows a different
and less optimistic

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version of the story.

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There's a new problem--

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big outbreaks of
vaccine-derived polio,

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the orange dots on this map.

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As you can see, countries across
sub-Saharan Africa, South Asia,

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and even East Asia
have been infected

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with vaccine-derived polio.

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We'll dig into that in
more detail elsewhere

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in this course.

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But the short version is that
vaccine-derived polio functions

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almost exactly the
same way as wild polio.

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It's preventable with
adequate vaccination,

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and you need more vaccination
campaigns in order to stop it.

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In addition, there's
an emerging problem

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in that COVID put
vaccination campaigns on hold

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across much of the world.

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As this lecture is being
recorded in August 2020,

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polio cases has risen
across the world.

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So it's been a very long road
since that last case of polio

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was found in the
Americas in 1991.

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It's been much more
difficult and much more

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expensive than anyone dreamed.

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But along the way, a new
model for collaboration

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in public health was born.

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This model now seems common.

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These sorts of partnerships
all built on the polio model

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are everywhere.

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But polio was the first.

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And its trajectory
gives us some idea

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both of the promise and the
challenges of this model.

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