Your search found 82 Results

  1. 1
    Peer Reviewed

    Documentation of polio eradication initiative best practices: Experience from WHO African Region.

    Okeibunor J; Nshimirimana D; Nsubuga P; Mutabaruka E; Tapsoba L; Ghali E; Kabir SH; Gassasira A; Mihigo R; Mkanda P

    Vaccine. 2016 Oct 10; 34(43):5144-5149.

    BACKGROUND: The African Region is set to achieving polio eradication. During the years of operations, the Polio Eradication Initiative [PEI] in the Region mobilized and trained tremendous amount of manpower with specializations in surveillance, social mobilization, supplementary immunization activities [SIAs], data management and laboratory staff. Systems were put in place to accelerate the eradication of polio in the Region. Standardized, real-time surveillance and response capacity were established. Many innovations were developed and applied to reaching people in difficult and security challenged terrains. All of these resulted in accumulation of lessons and best practices, which can be used in other priority public health intervention if documented. METHODS: The World Health Organization Regional Office for Africa [WHO/AFRO] developed a process for the documentation of these best practices, which was pretested in Uganda. The process entailed assessment of three critical elements [effectiveness, efficiency and relevance] five aspects [ethical soundness, sustainability, involvement of partners, community involvement, and political commitment] of best practices. A scored card which graded the elements and aspects on a scale of 0-10 was developed and a true best practice should score >50 points. Independent public health experts documented polio best practices in eight countries in the Region, using this process. The documentation adopted the cross-sectional design in the generation of data, which combined three analytical designs, namely surveys, qualitative inquiry and case studies. For the selection of countries, country responses to earlier questionnaire on best practices were screened for potential best practices. Another criterion used was the level of PEI investment in the countries. RESULTS: A total of 82 best practices grouped into ten thematic areas were documented. There was a correlation between the health system performances with DPT3 as proxy, level of PEI investment in countries with number of best practice. The application of the process for the documentation of polio best practices in the African Region brought out a number of advantages. The triangulation of data collected using multiple methods and the collection of data from all levels of the programme proved useful as it provided opportunity for data verification and corroboration. It also helped to overcome some of the data challenge. Copyright (c) 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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  2. 2

    Introducing an accountability framework for polio eradication in Ethiopia: results from the first year of implementation 2014-2015.

    Kassahun A; Braka F; Gallagher K; Gebriel AW; Nsubuga P; M'pele-Kilebou P

    Pan African Medical Journal. 2017; 27(Suppl 2):12.

    INTRODUCTION: the World Health Organization (WHO), Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in 2014 with the aim of improving the program's performance. Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework. METHODS: the impact of the WHO accountability framework was reviewed after its first year of implementation from June 2014 to June 2015. We analyzed selected program and staff performance indicators associated with acute flaccid paralysis (AFP) surveillance from a database available at WHO. Data on managerial actions taken were also reviewed. Performance of a total of 38 staff was evaluated during our review. RESULTS: our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts. CONCLUSION: the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance.
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  3. 3

    [Poliomyelitis--Challenges for the Last Mile of the Eradication Programme] Poliomyelitis--Herausforderungen in der Endphase des globalen Eradikationsprogramms.

    Muller O; Jahn A; Razum O

    Gesundheitswesen). 2016 Apr; 78(4):227-9.

    The World Health Organisation initiated the Global Polio Eradication Initiative in the year 1988. With the large-scale application of routine and mass vaccinations in children under the age of 5 years, polio disease has become restricted to only 3 endemic countries (Afghanistan, Pakistan and Nigeria) by today. However, since the beginning of the 21st century, increasing numbers of secondary polio epidemics have been observed which were triggered through migration, political turmoil and weak health systems. In addition, there emerged serious technical (e. g., back-mutations of oral vaccine virus to wild virus) and socio-political (refusal of vaccinations in Muslim populations of Nigeria and Pakistan) problems with the vaccination in the remaining endemic countries. It thus appears questionable if the current eradiation initiative will reach its goal in the foreseeable future. (c) Georg Thieme Verlag KG Stuttgart . New York.
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  4. 4

    Progress towards poliomyelitis eradication: Afghanistan and Pakistan, January 2013-August 2014.

    Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):493-9.

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  5. 5

    Polio-free certification of the WHO South-East Asia Region, March 2014.

    Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):500-4.

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  6. 6
    Peer Reviewed

    Routine vaccination coverage in low- and middle-income countries: further arguments for accelerating support to child vaccination services.

    Tao W; Petzold M; Forsberg BC

    Global Health Action. 2013; 6:20343.

    BACKGROUND AND OBJECTIVE: The Expanded Programme on Immunization was introduced by the World Health Organization (WHO) in all countries during the 1970s. Currently, this effective public health intervention is still not accessible to all. This study evaluates the change in routine vaccination coverage over time based on survey data and compares it to estimations by the WHO and United Nations Children's Fund (UNICEF). DESIGN: Data of vaccination coverage of children less than 5 years of age was extracted from Demographic and Health Surveys (DHS) conducted in 71 low- and middle-income countries during 1986-2009. Overall trends for vaccination coverage of tuberculosis, diphtheria, tetanus, pertussis, polio and measles were analysed and compared to WHO and UNICEF estimates. RESULTS: From 1986 to 2009, the annual average increase in vaccination coverage of the studied diseases ranged between 1.53 and 1.96% units according to DHS data. Vaccination coverage of diphtheria, tetanus, pertussis, polio and measles was all under 80% in 2009. Non-significant differences in coverage were found between DHS data and WHO and UNICEF estimates. CONCLUSIONS: The coverage of routine vaccinations in low- and middle-income countries may be lower than that previously reported. Hence, it is important to maintain and increase current vaccination levels.
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  7. 7

    Outbreak news. Poliomyelitis, Somalia and Kenya.

    Releve Epidemiologique Hebdomadaire. 2013 Jun 14; 88(24):241-2.

    In May 2013, eight total cases of wild poliovirus type 1 (WPV1) were isolated in Mogadishu and Bay Region, becoming the first polio cases reported in Somalia since March 2007. That same month, the Kenyan Ministry of Public Health and Sanitation confirmed a WPV1 case in an infant girl from the Dadaab refugee camps near the Somalia border. Genetic sequence analysis of WPV1 from both countries shows that they are closely related, with evidence of the virus’ single introduction into the region and subsequent local transmission. In Somalia and Kenya, rapid response polio supplementary immunization activities (SIA) were conducted. Preventive SIAs are being conducted in areas of Ethiopia and Yemen, and surveillance for acute flaccid paralysis (AFP) is being strengthened in all countries in the Horn of Africa.
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  8. 8

    Meeting of the Strategic Advisory Group of Experts on immunization, April 2013 - conclusions and recommendations.

    Releve Epidemiologique Hebdomadaire. 2013 May 17; 88(20):201-6.

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  9. 9

    Poliomyelitis: intensification of the global eradication initiative. Report by the Secretariat.

    World Health Organization [WHO]

    [Geneva, Switzerland], WHO, 2013 Mar 28. [5] p. (A66/18)

    The Executive Board at its 132nd session noted a previous version of this report. The Board provided additional guidance on addressing the short- and long-term risks to attaining the milestones of the new polio eradication and endgame strategic plan 2013-2018, particularly in the areas of: vaccination of travellers; fast-tracking access to affordable inactivated poliovirus vaccination options for all countries; strengthening routine immunization; and legacy planning, including that for the human resource infrastructure currently funded by the Global Polio Eradication Initiative. This guidance has been incorporated into the final plan, which is due to be shared with Member States in April 2013, in advance of the planned roll-out of the new plan at a Global Vaccine Summit scheduled to be held in Abu Dhabi (24 and 25 April 2013). In addition, data have been updated in this version of the report. In May 2014, the Secretariat will report to the Sixty-seventh World Health Assembly on progress in implementing and financing the strategic plan; outcomes of the consultative process on the legacy planning; and action required by the Health Assembly in advance of initiating the phased removal of the type 2 component of the oral poliovirus vaccine from all routine use globally. (Excerpt)
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  10. 10
    Peer Reviewed

    Successful polio eradication in Uttar Pradesh, India: the pivotal contribution of the Social Mobilization Network, an NGO / UNICEF collaboration.

    Coates EA; Waisbord S; Awale J; Solomon R; Dey R

    Global Health: Science and Practice. 2013 Mar; 1(1):68-83.

    In Uttar Pradesh, India, in response to low routine immunization coverage and ongoing poliovirus circulation, a network of U.S.-based CORE Group member and local nongovernmental organizations partnered with UNICEF, creating the Social Mobilization Network (SMNet). The SMNet’s goal was to improve access and reduce family and community resistance to vaccination. The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children’s immunization history and encourage vaccination of children missing scheduled vaccinations, and mobilize local opinion leaders. Creative behavior change activities and materials promoted vaccination awareness and safety, household hygiene, sanitation, home diarrheal-disease control, and breastfeeding. Program decision-makers at all levels used household-level data that were aggregated at community and district levels, and senior staff provided rapid feedback and regular capacity-building supervision to field staff. Use of routine project data and targeted research findings offered insights into and informed innovative approaches to overcoming community concerns impacting immunization coverage. While the SMNet worked in the highest-risk, poorly served communities, data suggest that the immunization coverage in SMNet communities was often higher than overall coverage in the district. The partners’ organizational and resource differences and complementary technical strengths posed both opportunities and challenges; overcoming them enhanced the partnership’s success and contributions.
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  11. 11
    Peer Reviewed

    Global lessons from India's poliomyelitis elimination campaign.

    Arora NK; Chaturvedi S; Dasgupta R

    Bulletin of the World Health Organization. 2010 Mar; 88(3):232-4.

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  12. 12

    Report on country experience: A multi-sectoral response to combat polio outbreak in Namibia. Draft background paper.

    Namibia. Ministry of Health and Social Services

    [Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011. [20] p. (WCSDH/BCKGRT/19/2011; Draft Background Paper 19)

    Namibia witnessed an outbreak of Wild Polio Type 1 virus in 2006. A total of 323 suspected cases of Acute Flaccid Paralysis were reported, of which 19 were confirmed as Wild Polio Virus Type 1. The outbreak affected mostly the older population and thirty-two of the suspected cases died. The country mounted an immediate response that enabled the whole population to be vaccinated against polio virus. The outbreak of the epidemic witnessed an unprecedented response with the country coming together in the spirit of one Nation facing a common enemy. The reported deaths in some communities engendered fear among the populace and motivated the people to seek early treatment and prevention from further spread of the outbreak. The key to the successful response to the outbreak included: Political commitment; Resource mobilization and availability; Support of international community; Good community mobilization and cooperation from the communities; Commitment and dedication from the Health Care Providers and the volunteers; Team work and delegation; Good communication and support from the media. (Excerpt)
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  13. 13
    Peer Reviewed

    Interrupting wild poliovirus transmission using oral poliovirus vaccine: environmental surveillance in high-risks area of India.

    Chowdhary R; Dhole TN

    Journal of Medical Virology. 2008 Aug; 80(8):1477-88.

    Global eradication of poliomyelitis has reached critical stage. Sabin Oral Poliovirus Vaccine (OPV) has been successful in three major regions of the world. In India eradication of poliomyelitis from states of Uttar Pradesh (UP) and Bihar has been difficult due to high population and low-socioeconomic standards of living. Acute flaccid paralysis (AFP) surveillance and intensive OPV rounds continues with the World Health Organization (WHO) operational strategies. Yet apparent lack of progress in reducing the number of wild cases has resulted in occasional impatience and frustration, even leading to questions about ultimate feasibility of global eradication using OPV. Lucknow in UP is in geographical area endemic for poliomyelitis and is surrounded by high-risk areas yet maintains a polio-free status since 2002. Environmental surveillance study was conducted (2004-2006) to authenticate the decline in the wild poliovirus (PV) cases in Lucknow. Sewage sample analyses were compared with stools of AFP patients and healthy children from same geographical area. Study reveals useful information on OPV circulation and proves important epidemiological tool to trust WHO's OPV immunization program. Genetic sequencing had detected silent wild PV-1 circulation of RCP1PGI (EU049849), RCP2PGI (EU049850), RCP3PGI (EU049851), and RCP4PGI (EU049852) in sewage waters. Properties of isolates from sewage reflected those of viruses excreted from human. This study provides valuable information and encouragement to AFP surveillance to maintain high levels of OPV immunization campaigns in the most difficult endemic region of India to interrupt the wild PV transmission.
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  14. 14
    Peer Reviewed

    Vaccine-derived poliomyelitis in Nigeria.

    Lancet. 2007 Oct 20; 370(9596):1394.

    Eradicating poliomyelitis presents many challenges. Financing essential activities can be difficult when donors fail to meet funding targets (a US$60 million funding gap currently exists for the fourth quarter of 2007). Security issues in two of the four polio-endemic countries-Afghanistan and Pakistan-make access to children difficult for immunisation teams. And in Nigeria, low vaccine coverage and an outbreak of disease from vaccine-derived poliovirus (VDPV) could set back global eradication efforts. Over the past 10 years there have been nine outbreaks of poliomyelitis derived from the oral vaccine in nine countries. Nigeria has seen the largest outbreak; 69 children have been paralysed this year. VDPVs are rare but occur when the live virus in an oral polio vaccine mutates and reverts to neurovirulence. This loss of attenuation does not matter so much in populations who are fully immunised with oral vaccine, since they will be protected from wild and vaccine-derived poliovirus, but in Nigeria,where vaccine coverage is 39% (and even lower in some northern states), it is a problem. (excerpt)
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  15. 15
    Peer Reviewed

    An evaluation of infant immunization in Africa: Is a transformation in progress?

    Arevshatian L; Clements CJ; Lwanga SK; Misore AO; Ndumbe P

    Bulletin of the World Health Organization. 2007 Jun; 85(6):449-457.

    The objective was to assess the progress made towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunization between 2001 and 2005. We reviewed data from national infant immunization programmes in the 46 countries of WHO's African Region, reviewed the literature and analysed existing data sources. We carried out face-to-face and telephone interviews with relevant staff members at regional and subregional levels. The African Region fell short of the target for 80% of countries to achieve at least 80% immunization coverage by 2005. However, diphtheria-tetanus-pertussis-3 coverage increased by 15%, from 54% in 2000 to 69% in 2004. As a result, we estimate that the number of nonimmunized children declined from 1.4 million in 2002 to 900 000 in 2004. In 2004, four of seven countries with endemic or re-established wild polio virus had coverage of 50% or less, and some neighbouring countries at high risk of importation did not meet the 80% vaccination target. Reported measles cases dropped from 520 000 in 2000 to 316 000 in 2005, and mortality was reduced by approximately 60% when compared to 1999 baseline levels. A network of measles and yellow fever laboratories had been established in 29 countries by July 2005. Rates of immunization coverage are improving dramatically in the WHO African Region. The huge increases in spending on immunization and the related improvements in programme performance are linked predominantly to increases in donor funding. (author's)
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  16. 16

    Current issues in global immunizations.

    Keegan R; Bilous J

    Seminars in Pediatric Infectious Diseases. 2004 Jul; 15(3):130-136.

    Since Edward Jenner's discovery of the smallpox vaccine 200 years ago, vaccines have been one of the most lifesaving health interventions for humankind and, conversely, one of the most underused health interventions in developing countries. The implementation of childhood vaccines in the United States and other industrialized countries led to a rapid and large decrease in morbidity and mortality from common childhood diseases. The smallpox eradication program, led by the World Health Organization (WHO) from 1967 to 1977, ended deaths from smallpox, a disease that once killed millions of children and adults each year. Beginning in the early 1980s, the development of routine immunization programs by WHO and UNICEF for children in developing countries led to a sustained program of administration of lifesaving vaccinations as part of primary healthcare systems. Since the launch of these routine immunization programs in most countries, more than 20 million deaths have been prevented from vaccine-preventable diseases (Fig 1). Ongoing initiatives to eradicate polio, reduce measles mortality rates, eliminate measles from discrete regions of the world, and introduce additional vaccines have been remarkably successful. However, more than 1.4 million children died from vaccine-preventable diseases in 2002, 610,000 from measles alone, suggesting that great challenges still exist to fully utilize the potential of lifesaving vaccines (WHO, unpublished data). This article reviews the status of current immunization initiatives, summarizes lessons learned, and makes recommendations for a healthier world through the use of vaccines. (excerpt)
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  17. 17

    Respect for AIDS victims rights, wars against polio, smoking asked - World Health Assembly - includes related article.

    UN Chronicle. 1988 Sep; 25(3):[3] p..

    Respect for the human rights of victims of acquired immune deficiency syndrome (AIDS) and campaigns against polio and smoking have been called for by the 41st World Health Assembly. The 166-member body which guides the work of the World Health Organization (WHO), also urged that "unprecedented measures" be taken to help the least developed countries improve the health of their people. Governments were also called on to increase their primary health care efforts in order to attain the WHO goal of "Health for All by the Year 2000" so that all the peoples of the world could lead socially and economically productive lives. At a solemn ceremony on 4 May to celebrate the 40th anniversary of WHO, outgoing Director-General Dr Halfdan Mahler said the organization had made "a unique contribution to the restoration of social justice in health matters by demonstrating how health can be achieved by all and not just by the privileged few". (excerpt)
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  18. 18

    Impact of the Polio Eradication Initiative on donor contributions to routine immunization.

    Levin A; Jorissen J; Linkins J; McArthur C

    Bethesda, Maryland, Abt Associates, Partnerships for Health Reform, 2001 Mar. [26] p. (Special Initiatives Report No. 36; USAID Contract No. HRN-C-00-95-00024)

    While the polio eradication initiative has been highly successful in lowering the number of polio cases worldwide, questions have arisen about the impact of the initiative on the functioning and financing of health systems as a whole and routine immunization more specifically. While some studies have investigated the impact of polio eradication on the functioning of health systems, few have been able to examine the impact on financing. This study is the second conducted by the United States Agency for International Development’s Partnerships for Health Reform Project on the impact of the polio eradication initiative on the financing of routine immunization activities. The first study examined funding trends for polio eradication and routine immunization in three countries: Bangladesh, Côte d’Ivoire, and Morocco. This study looks at funding trends among international organizations and donors, and the impact that their funding of polio eradication activities has had on their funding of routine immunization activities. The study findings indicate that while some short-term decreases in donor funding for routine immunization appear to have taken place as polio eradication initiative activities were introduced and accelerated, on the whole, donor funding for routine immunization support does not appear to have decreased. (author's)
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  19. 19
    Peer Reviewed

    Global efforts to eradicate polio.

    Krym VF; MacDonald RD

    CMAJ: Canadian Medical Association Journal. 2004 Jan 20; 170(2):189-190.

    As of Oct. 29, 2003, Nigeria gained the dubious honour of having the highest number of reported cases of polio (217 new cases) in the world, surpassing the previous leader, India. The resurgence of poliomyelitis in northern Nigeria poses a threat to neighbouring countries and further postpones the goal of the World Health Organization (WHO) to eradicate the disease globally. This is by no means an impossible goal: humans are the only natural reservoir, an inexpensive and effective vaccine is available, immunity is life-long, and the virus can survive for only a very short time outside the human host. (excerpt)
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  20. 20
    Peer Reviewed

    Vaccine rumors, funding shortfall threaten to derail global polio eradication efforts.

    Mitka M

    JAMA. 2004 Apr 28; 291(16):1947-1948.

    Politics and rumors in Nigeria are threatening to derail efforts to finally eradicate poliomyelitis around the world. Smallpox is the only disease that has been completely banished from nature, and the goal of repeating such success with polio is tantalizingly close. In the past, polio paralyzed more than 350000 children in more than 125 countries annually. Last year, the disease was limited to just six countries-Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan-and affected only 758 individuals. But cases are now being reported in countries surrounding Nigeria that were previously free of the disease. The World Health Organization (WHO) blamed the spread of the infection on suspension of immunization campaigns last year in Nigeria's northern states. These areas are largely Islamic and, as reported by the British Broadcasting Channel and other media, some Muslim leaders suggested the vaccine was contaminated and would cause AIDS and infertility in women. Other published reports noted some Muslim leaders in northern Nigeria also believed that these vaccines were contaminated in an effort by the United States to decimate the Muslim population. (excerpt)
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  21. 21
    Peer Reviewed

    Polio eradication-rethinking the endpoint of the end game.

    Khuri-Bulos N

    Lancet. 2004 May; 4(5):262-263.

    In May 1988, the WHO decided to embark on the eradication of poliomyelitis by the year 2000. Due to changing epidemiology, polio was causing large outbreaks in many developing countries such as Jordan, and the infectious agent causing the disease fulfilled the criteria for an eradicable agent. Polio was believed to be eradicable because the poliovirus infects only human beings in nature causing a recognisable, although not diagnostic, clinical entity—namely acute flaccid paralysis (AFP)—it does not lead to a chronic carrier state, it is readily identifiable as a causative agent of the disease by simple laboratory tests, and, most importantly, it is easily controlled in endemic and epidemic situations by a widely available and affordable vaccine that leads to lifelong immunity. (excerpt)
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  22. 22

    Chronicling the end of polio.

    Andaló P

    Perspectives in Health. 2003; 8(3):10-17.

    In its 3,500-year known history, polio has robbed millions of boys and girls, men and women of their freedom to move at will. Vaccines developed in the 1950s began to rein in the virus, dramatically reducing the disease's incidence through massive immunization campaigns. The Americas region was the first to eradicate the wild strain of the virus and was declared polio-free in 1994. Luis Fermín, a 3-year-old Peruvian, was the hemisphere's last registered case. Western Europe was declared polio-free in 2002. But other regions have been less fortunate. Polio remains endemic in seven countries: Afghanistan, Egypt, India, Niger, Nigeria, Pakistan and Somalia. Twenty million people today are paralyzed as a result of the disease. (author's)
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  23. 23
    Peer Reviewed

    Polio-endemic countries pledge to boost eradication efforts in 2004.

    Zarocostas J

    Lancet. 2004 Jan 17; 363(9404):215.

    Health ministers from the world’s six remaining polio-endemic countries— Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan —pledged in a declaration signed in Geneva on Jan 15 to boost their polio-eradication activities in a bid to wipe out the disease. The commitment came amid growing fears that the ongoing outbreak in west Africa—centred in Nigeria and Niger—and the importation of cases to neighbouring countries could derail the 15-year global effort to eradicate the disease. (excerpt)
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  24. 24
    Peer Reviewed

    Polio eradication: 7 countries and US$ 210 million to go.

    Fleck F

    Bulletin of the World Health Organization. 2003 Sep; 81(9):696-697.

    The World Health Organization launched a final push on 29 July to eradicate polio by 2005 with a call to donors for an additional US$ 210 million to finally stamp out the incurable laming disease that mainly affects under-five-year-olds. WHO’s Director- General Jong-Wook Lee has appointed David Heymann as his representative on polio eradication following the infectious diseases expert’s success heading a WHO team that helped stop the spread of SARS earlier this year. (excerpt)
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  25. 25
    Peer Reviewed

    Global health goals: lessons from the worldwide effort to eradicate poliomyelitis.

    Aylward RB; Acharya A; England S; Agocs M; Links J

    Lancet. 2003 Sep 13; 362(9387):909-914.

    The Global Polio Eradication Initiative was launched in 1988. Assessment of the politics, production, financing, and economics of this international effort has suggested six lessons that might be pertinent to the pursuit of other global health goals. First, such goals should be based on technically sound strategies with proven operational feasibility in a large geographical area. Second, before launching an initiative, an informed collective decision must be negotiated and agreed in an appropriate international forum to keep to a minimum long-term risks in financing and implementation. Third, if substantial community engagement is envisaged, efficient deployment of sufficient resources at that level necessitates a defined, time-limited input by the community within a properly managed partnership. Fourth, although the so-called fair-share concept is arguably the best way to finance such goals, its limitations must be recognised early and alternative strategies developed for settings where it does not work. Fifth, international health goals must be designed and pursued within existing health systems if they are to secure and sustain broad support. Finally, countries, regions, or populations most likely to delay the achievement of a global health goal should be identified at the outset to ensure provision of sufficient resources and attention. The greatest threats to poliomyelitis eradication are a financing gap of US$210 million and difficulties in strategy implementation in at most five countries. (author's)
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