Polio Eradication: the final challenge within and outside the health sector. Only the highest-level political leadership has the neces sary authority to ensure this accountability, particularly in the non-health ministries whose personnel and resources are so important in ensuring that all children are reached with OPV. Such high-level engagement of political leaders has brought additional, often extraordinary, benefits. Recognizing that poliovirus knew no borders, in April 1995 leaders of 18 countries of Asia, Europe and the Eastern Mediterranean began coordinating the OPv immunization of 56 million children Similar activities followed in Africa. where the conflict-affected coun tries of Angola, the Democratic Republic of the Congo, Gabon, and the Republic of the Congo synchronized three rounds of NiDs from July 2001, reaching 15 million children. Through out the past 15 years, in countries such as Afghanistan, Angola, Sierra Leone and Sri Lanka, warring parties have laid down their weapons to participate in"days of tranquility"so that their children might be immunized against polio(7). Progress towards eradication in coun- tries of the Eastern Mediterranean and South-East Asia Regions is detailed in Boxes 4. 1 and 4.2 Finding the funds Sabin s vision of a world without polio required reaching all children with multiple doses of OPV, which in turn required substantial financial resources and in-kind contributions from national and international sources To mobilize and manage resources on this scale, the polio partnership established a mix of strategies and mechanisms. The success of this approach is reflected in the mobilization of more than USS 5 billion in funding and in-kind contribu- tions for polio eradication activities, over a 20-year period (8). While the majority of these funds went to time-limited eradication activities, a substantial proportion was directed to the strengthening of routine immunization and surveillance services In any given country, the proportion of costs covered by national and international sources has correlated most closely with income level and health system capacity. China, for example, has estimated that over 95% of its costs were borne by the country itself. Even in the poorest countries with virtually non-existent formal health services, such as Somalia, the community absorbs 25-50% of the real costs of implementing polio NIDs through in-kind contribu- tions. Because of the diversity of the communities, governments and partners that have Box 4.2 Responding to the challenge of polio eradication in South-East Asia In 2002, the global goal of polio eradication was jeopardized as India This progress is the result of a regionally coordinated, data-driven pro- suffered the largest outbreak in recent history: 1600 cases were reported gramme that began in the early 1990s and through which National Im that year, a fivefold increase over 2001. As the epidemic spread into munization Days have reached over 200 million children, often Indian states which had finally become polio-free in recent years, the synchronized across Member States and supported by regional bodies number of infected districts more than doubled from 63 in 2001 to 159. such as the South Asian Association for Regional Cooperation. Strong Because of India's long borders with Bangladesh and Nepal, the epi- polio surveillance and a regional network of 17 high-quality laborato demic also threatened these polio-free countries. By the end of 2002, ries have guided the effort and confirmed these achievements. he South-East Asia Region accounted for 84% of the global polio bur. Investigations into the 2002 epidemic demonstrated that a com den. Since then, however, a massive national and international response bination of low routine immunization coverage and an insufficient scale, has again brought polio to the brink of elimination in the most popu- number and quality of polio campaigns had led to a rapid accumulation lous WHO region. of susceptible children, especially in the state of Uttar Pradesh. In re- By the end of 2000, 9 of the 10 WHO Member States in the South. sponse, political oversight of the programme was markedly inceased, East Asia Region and 35 of Indias 37 states had interrupted wild polio the number of polio campaigns was raised to six per year, and addi- virus transmission as part of the global eradication effort. In addition to tional efforts were made to reach children in minority populations. Con- Bangladesh and Nepal, Myanmar has been polio-free since 2000; Bhu. sequently, by the end of September 2003, polio was at its lowest level in tan, the Democratic People's Republic of Korea, Indonesia, Maldives, Sri history(132 cases)and there was again the real possibility of forever anka and Thailand all stopped indigenous transmission prior to 1999. eliminating this devastating disease from South-East Asia by 2005Polio Eradication: the final challenge 63 within and outside the health sector. Only the highest-level political leadership has the neces￾sary authority to ensure this accountability, particularly in the non-health ministries whose personnel and resources are so important in ensuring that all children are reached with OPV. Such high-level engagement of political leaders has brought additional, often extraordinary, benefits. Recognizing that poliovirus knew no borders, in April 1995 leaders of 18 countries of Asia, Europe and the Eastern Mediterranean began coordinating the OPV immunization of 56 million children. Similar activities followed in Africa, where the conflict-affected coun￾tries of Angola, the Democratic Republic of the Congo, Gabon, and the Republic of the Congo synchronized three rounds of NIDs from July 2001, reaching 15 million children. Through￾out the past 15 years, in countries such as Afghanistan, Angola, Sierra Leone and Sri Lanka, warring parties have laid down their weapons to participate in “days of tranquility” so that their children might be immunized against polio (7). Progress towards eradication in coun￾tries of the Eastern Mediterranean and South-East Asia Regions is detailed in Boxes 4.1 and 4.2. Finding the funds Sabin’s vision of a world without polio required reaching all children with multiple doses of OPV, which in turn required substantial financial resources and in-kind contributions from national and international sources. To mobilize and manage resources on this scale, the polio partnership established a mix of strategies and mechanisms. The success of this approach is reflected in the mobilization of more than US$ 5 billion in funding and in-kind contribu￾tions for polio eradication activities, over a 20-year period (8). While the majority of these funds went to time-limited eradication activities, a substantial proportion was directed to the strengthening of routine immunization and surveillance services. In any given country, the proportion of costs covered by national and international sources has correlated most closely with income level and health system capacity. China, for example, has estimated that over 95% of its costs were borne by the country itself. Even in the poorest countries with virtually non-existent formal health services, such as Somalia, the community absorbs 25–50% of the real costs of implementing polio NIDs through in-kind contribu￾tions. Because of the diversity of the communities, governments and partners that have Box 4.2 Responding to the challenge of polio eradication in South-East Asia In 2002, the global goal of polio eradication was jeopardized as India suffered the largest outbreak in recent history: 1600 cases were reported that year, a fivefold increase over 2001. As the epidemic spread into Indian states which had finally become polio-free in recent years, the number of infected districts more than doubled from 63 in 2001 to 159. Because of India’s long borders with Bangladesh and Nepal, the epi￾demic also threatened these polio-free countries. By the end of 2002, the South-East Asia Region accounted for 84% of the global polio bur￾den. Since then, however, a massive national and international response has again brought polio to the brink of elimination in the most popu￾lous WHO region. By the end of 2000, 9 of the 10 WHO Member States in the South￾East Asia Region and 35 of India’s 37 states had interrupted wild polio￾virus transmission as part of the global eradication effort. In addition to Bangladesh and Nepal, Myanmar has been polio-free since 2000; Bhu￾tan, the Democratic People’s Republic of Korea, Indonesia, Maldives, Sri Lanka and Thailand all stopped indigenous transmission prior to 1999. This progress is the result of a regionally coordinated, data-driven pro￾gramme that began in the early 1990s and through which National Im￾munization Days have reached over 200 million children, often synchronized across Member States and supported by regional bodies such as the South Asian Association for Regional Cooperation. Strong polio surveillance and a regional network of 17 high-quality laborato￾ries have guided the effort and confirmed these achievements. Investigations into the 2002 epidemic demonstrated that a com￾bination of low routine immunization coverage and an insufficient scale, number and quality of polio campaigns had led to a rapid accumulation of susceptible children, especially in the state of Uttar Pradesh. In re￾sponse, political oversight of the programme was markedly increased, the number of polio campaigns was raised to six per year, and addi￾tional efforts were made to reach children in minority populations. Con￾sequently, by the end of September 2003, polio was at its lowest level in history (132 cases) and there was again the real possibility of forever eliminating this devastating disease from South-East Asia by 2005