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ADITI RAO: Hello, everyone.

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My name is Aditi Rao.

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I'm a research associate at the
Johns Hopkins Bloomberg School

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of Public Health.

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Welcome to the
lecture on eradication

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and the challenge of
reaching the last 1%.

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We know polio has existed
for thousands of years,

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causing illness
and, in some cases,

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permanent disability and death.

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However, today, we stand at
the very brink of eradication

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due to the dedicated efforts
of very many organizations

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across the globe since 1988.

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The road to eradication has been
longer and harder than anyone

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expected, and tackling
the last 1% of polio cases

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remains a challenge today.

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The final pockets
of disease remain

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among hard-to-reach
populations, including

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those residing in
environmentally

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and geographically
challenging areas,

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socially excluded and
vulnerable populations,

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and those in high-risk,
conflict-ridden areas.

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Each of these groups continue
to receive inequitable access

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to resources and
health services.

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Addressing these challenges
and finding new ways

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to reach children in
high-risk, hard-to-reach areas

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is essential to achieve
eradication and importantly

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to achieve health equity
and social justice.

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Proponents of
disease eradication

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have argued that it
provides the ultimate

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in health equity
and social justice,

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bringing identical
and universal benefits

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to every person globally.

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But reaching the world's hardest
to reach with an education

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program may distort
systems, even

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as it delivers an intervention
to populations who do not often

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receive quality health
services, often diverting

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limited resources from
integrated programs

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for a focused, vertical effort.

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This lecture draws on the
polio eradication experience

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to explore how and why
political, social, and

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technological forces
function differently

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in the last 1% of
eradication programs

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and to consider the consequences
for the least developed

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and poorest communities.

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As we attempt to unpack this
very interesting and complex

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challenge, I'd like each of us
to consider some key questions.

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What are the underlying
factors which

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have led the last 1% of
children with polio cases

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to be consistently underserved?

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And how did eradication
activities confront and address

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these forces?

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What are long-term effects
of eradication programs

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in communities as well
as health systems'

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performance and equity?

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And, finally, can tools
developed for eradication

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be transformed for health
systems strengthening, or are

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new approaches required?

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To begin with, let's
look at an example.

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This map is of Pakistan and
Afghanistan from October 2019.

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Pakistan and Afghanistan
are the only countries

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in the world where the
Global Polio Eradication

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Initiative has failed
to ever eliminate polio.

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The two countries
are often taken

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as one epidemiological block.

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The red dots on the map
indicate polio cases,

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and the blue dots are places
where environmental samples

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tested positive for polio.

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For a moment, think about
what this map tells us

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about how polio's distributed
in these two countries,

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particularly in areas
along the border.

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As we move through the lecture,
Pakistan and Afghanistan

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will be our key examples.

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