1. Global Health Issues; A perspectives from global eradication
of Wild-Polio Virus
Yahaya Oloriegbe H.
School of Health; Comparative Health Studies
ORIGINAL ARTICLE
It is paramount to state that global action towards control of any disease should go beyond funding and
knowledge contribution, rather global health actors need to take more holistic approach by encompassing
diplomacy for the good of all instead of focusing on individual donor countries interest. High-income countries
need to note that other activities such as diplomacy for personal interest during conflict situation deters the
primary aim of health intervention. These interventions are been funded using tax payer money, as such tax-
payers need to seek justification for the way their money are been channelled. Nonetheless, global health is
important for every individual worldwide but the sole purpose of global public good should always be the goal of
global health intervention.
Introduction
The World Health organisation-WHO declared wild Polio
virus prevalence as an “international public health
concern” in 2014 (Global Polio eradication initiative
GPEI, 2014). Apart from the fact that the virus is close to
been eradicated globally, achieving this stride has always
been a global challenge for the past decades (GPEI,
2010). However, with series of global effort; one of which
is the creation of an institution – the global polio
eradication initiative GPEI, It is safe to assume that this
has contributed to the reduction of the polio virus by
almost 99% (Independent monitoring board of GPEI,
2014). The remaining 1% lingers in three countries;
Afghanistan, Pakistan and Nigeria in Southeast Asia and
Sub-Saharan Africa respectively (GPEI, 2010). The
prevalence of the polio virus has been attributed to the
mutating biological characteristics of the wild Polio virus.
Furthermore, analysis has shown that causation factors of
polio virus goes beyond its biological characteristics,
rather series of associated social factor may have also
contributed to the prevalence of the virus. Thus, this essay
will explore the biological and social factors associated
with the prevalence of Polio from a global health
perspective while also understanding efforts that is been
put in place to eradicate the diseases that has lingered for
several decades.
In other to get a clear understanding of the complexity
surrounding the resurgence of polio globally, it is
paramount that this issue is explored from a global health
perspective. Therefore, the next paragraphs will explore
the scopes and perspectives of global health. To further
understand the scopes of global health, a series of the
global health issues will be explored. Focus will then be
drawn towards eradication of Polio virus as a global
health issue.
What is global health and what are the global health
issues?
To understand the term “global health” seems to be a
major debate both in the academic and practice field.
According to Rowson et al. (2012), global health was
described as a field that owes its origin and scope to the
trend in which the global society addresses health issue.
However, it can be argued that Rowson et al. has not
really been able to distinct their view of the term “global
health” from that of public health activities. Rowson et al.
definition of global health imitates the scope of public
health activities where individual countries prevent cross
border infectious diseases by developing policies to
protect their social and economic interest. Interestingly,
Kickbush (1993) argued that global health goes beyond
individual countries interest. He would further go to argue
that global health encompasses the interrelatedness of
globalisation on individual countries health and how this
globalisation affects the distribution of health across
different countries.
Nonetheless, there is a concession in the academic field
reported by Beaglehole and Bonita (2010) that Koplan et
al. definition of global health seems appropriate to
describe the scope and activities of global health. Koplan
et al. (2008) defined global health as ‘an area for study,
research, and practice that places a priority on improving
health and achieving health equity for all people
worldwide’. Beaglehole and Bonita would however depict
Koplan and Kickbush definition to be “too wordy,
uninspiring, broadly focused and has no clear goal.
Instead, Beaglehole and Bonita (2010) defined global
health to be a “collaborative trans-national research and
action for promoting health for all”.
From the analysis above, it can be suggested that defining
the activities, scope and meaning of global health
represent one of the issues in global health itself. More so,
defining what the global health issues are, represents an
additional global health concern. For example, the US
department of health (2014) identified disabilities, global
health security, health diplomacy, LGBT, global water
supply, non-communicable diseases, maternal and child
health as the global health issues. Whereas the World
health organisation, considering burden of disease as

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Global Health and its issues; Polio as a focus www.northampton.ac.uk
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global health concern; listed HIV/Aids, diabetes, Tobacco
use, cardiovascular diseases, disability, child health /
newborn diseases and maternal health issues as the global
health issue. In another description of what the global
health issues are, Ronal and Jerry (2003) categorised
global health into environmental global degradation such
as (green house effect, biodiversity, water shortage and
deforestation); Socio-economic issues (increasing
poverty, financial instability, digital instability and
taxation, etc.); and lastly, cross cutting issues such as
(governance, food security, war and conflict amongst
others). Therefore, it can be concluded that global health
issues cover a wide range of topics and cannot be limited
to a particular theme, as such description of global health
issues depends on the position of the actor engaged with
it.
Thus, description of global health issues could be based
on a developed country seeking to address issues that
poses social and trade threat or low-middle income
countries who tends to reduces burden of diseases from
communicable diseases or researchers and students who
identifies global health issue from a critical point of view.
It is based on these premises that this essay will focus on
polio as a global health issue by exploring the biosocial
association with its global prevalence.
Associated Biological and social factors to prevalence
of Wild polio virus
Polio is an entero-virus infectious disease of three strains
(wild polio virus type1-3) that affects children under the
age of 5years (WHO, 2014). The virus enters the human
system through faecal-oral route, multiplies in the
intestine and enters the blood stream, which may then
invade the central nervous system, and often leads to
paralysis of the lower limbs (WHO, 2000, 2014). In rare
conditions, mortality may arise from the invasion of the
brain stem, which causes breathing difficulty and
eventually death (WHO, 2000; WHO, 2014). One in 200
Polio infections leads to irreversible paralysis with 5-10%
deaths recorded in those paralysed (WHO, 2014).
The virus spreads through agents such as food, water and
sometimes flies when they are contaminated with faeces
of infected children (GPEI, 2010). The long period of
paralysis manifestation in infected children allows the
silent spread of the virus in a community. Therefore, it is
for this reason W.H.O. considers a confirmed single case
of acute flaccid paralysis (AFP), evidence for a polio
epidemic especially in a community with previous low
prevalence of polio cases (GPEI, 2010). The virus
however, doesn’t have a cure but can be eradicated
through the use of vaccines such as oral polio vaccine,
inactivated polio vaccine, monovalent OPV and bivalent
OPV (GPEI, 2010; WHO, 2014). Genetic alteration of the
OPV vaccine through poor handling, storage, and
administration are associated to the incidence and
prevalence of circulating vaccine derived polio vaccine-
CVDPV (GPEI, 2010). In addition, low immunisation
coverage in a community facilitates the spread of this
strain of virus. For example, CVDPV constitutes the
highest percentage of the remaining reported polio cases
globally with more countries suffering polio outbreak
from CVDPV than WPV for the first time in 2012 (WHO,
2013). Therefore, programmatic errors could be said to be
an on-going challenge in the complete eradication of polio
in low-middle income countries.
Nonetheless, Humans are the only susceptible host of the
virus, therefore allowing for easy control of the diseases.
Thus, global focus on polio intensifies day to day due to
its susceptibility to eradication once and for all.
According to Bruce et al., (2014) eradication of the
Poliovirus represents a good example of public good for
health. This is because once an infectious disease such as
polio is controlled or eradicated; every person in receipt
of this protection diminishes the protection enjoyed by
others and therefore provides protection for every
newborn entering the global community (Bruce et al,
2014).
Although polio is deemed to be a high morbidity rate
disease with about 1000 paralysis recorded everyday
globally in 1988; moreover, its detrimental effect on
global economy due to the paralytic effect on mostly
children under 5 makes it a public health concern.
However, the establishment of the global eradication
initiative (GPEI) by the world health assembly in 1988
has led to the reduction poliovirus from 350,000 polio
cases to 406 polio cases in 2012 (GPEI, 2012). As such,
three countries (Nigeria, Pakistan and Afghanistan)
remain endemic, constituting the last 1% of the remaining
poliovirus globally (WHO, 2014). Public-private
partnership activities spearheaded by national
governments, WHO, Rotary international, United States
centre for disease control (CDC), United Nations for
children fund (UNICEF) and other partners such as the
Bill and Melinda gates foundation and Gavi-alliance
enhanced the process of eradicating of polio globally
(WHO, 2014). Their activities since the creation of the
GPEI has majorly been the facilitation of donor
governments, knowledge and technical support amongst
other activities. For example, Rotary international,
through its ‘Polio plus’ initiative and 1.2 million
volunteer worldwide has not only facilitated contribution
from donor governments but also contributed about
US$600million alone by itself in 2005 (). Other
organisations such as the International Red Cross, Red
Crescent Movement, Medicines San Frontiers, Save the
Children, World Vision, CARE, and the U.S. based NGO
umbrella-organization CORE have all contributed both
technical strategies and funding to the eradication of polio
especially in low-middle income countries.
Despite the recorded success, the role of the WHO as a
global health leader has been questioned in different
consensus. It is being argued that the role of WHO has
only been that of a figure head rather than a unilateral
organization such as the Bill and Melinda gates
foundation, Rotary international and Gavi-alliance whom
have all taken leadership roles in not only polio-
eradication but also in changing the trend of
implementing vertical interventions in low-middle income
countries (Cox, 1997; Ruggie 1998; Barnet and
Finnemore 2004). Having said this, it is important to note
that the WHO through the strategic advisory group of
experts on immunisation (SAGE) provides technical
leadership for the eradication of polio through agreement
on strategic planning, policy development, resolution of
technical concerns and priority setting (Bruce et al.,
2014).
Nevertheless, the threat posed by the 3 remaining
endemic countries remains a global health concern. This
is due to the fact that as long as a child is infected,
children across the globe remains at risk of getting
infected. According to WHO (2014), failure to eradicate
the last 1% could led to a prevailing 200,000 new cases of

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Global Health and its issues; Polio as a focus www.northampton.ac.uk
School of Health; Comparative Health studies
polio yearly. Thus, it is important to note that limiting the
causative factor of polio prevalence to its biological
characteristics pose a great risk to the eradication of the
virus. Analysis has shown that social factors play a major
pact in the resurgence of the poliovirus. According to
global polio eradication initiative (2014), conflicts,
political instability, hard-to-reach areas and poor health
infrastructure pose threat to the eradication of the
poliovirus. Other co-founding factors such as the
economy status of a country also plays a role in the
lingering poliovirus globally.
Research and knowledge patency by high-income
countries can be explained to be one of the major factors
affecting the eradication of polio. This is because;
countries especially the low-middle income countries find
it difficult sustaining immunisation programs due to its
related high cost of vaccines purchase (Sidsel et al.,
2013). This suggests that knowledge and research
ownership by developed countries creates barriers for
low-middle income countries to produce and utilize these
necessary vaccines. Nevertheless, the establishment of the
GAVI-alliance, which encompasses a public-private
partnership between developed nations and international
financial firms, research institutes, vaccine manufacturers
and NGOs, through whom funding and technical
knowledge where facilitated for the production and
purchase of vaccines at lower cost for low-middle income
countries (GAVI-alliance, 2013). It can be argued that on
the positive side, GAVI has brought about increased
attention and adequate resources to promoting
immunisation, but the power exerted by global actors
based primarily but not exclusively on their financial
resources, exacerbates the asymmetric relationship
between strong and weak actors, thus threatening the
already limited autonomy-especially the low-middle
income countries (Sidsel et al., 2013). As such, vertical
program is imposed on low-middle countries by donor
countries, which endangers the eradication of diseases as
homogeneous “one size fits all” solution disallow
development of programs based on country/community
needs, therefore reducing the effectiveness of these
interventions.
Most donor countries support to low-middle countries as
regards disease control including polio eradication
includes technical and financial contribution with less
emphasis on good governance, this is despite the agreed
conditions that stipulate this. For example, the term of
reference (TOR) between GAVI and receiving countries
highlights ensuring accountability at all level of
government. Corruption in the health sector and the
governments in low-middle countries prevent the required
downstream approach in eradicating polio globally. For
example, field experience of the author revealed that
funding allocated for the training of health workers at
local government levels are cut and diverted without
getting to the intended recipient (health worker), therefore
little amount of budgeted fees are paid to the staff and as
such, the workers are less motivated to give optimal
performance. Further experience has shown that health
workers prioritise vertical programs such as polio
eradication over other routine health services as the huge
sum of donation from donor countries and organisations
encourages health workers to affiliate more to vertical
programs in other to meet their financial need. As a result
of this, health workers in this category view the
eradication of the poliovirus globally to mean an end
to their source of livelihood. This phenomena thinking
weakens the health system through the neglect of other
areas of the health system.
The eradication of polio from India gives the consensus
amongst stakeholders that polio eradication globally can
be a reality. Eradicating polio from India was thought
impossible at some point due to the demographic
characteristics of the nation; a large population, high
social-economical disparities, difficult geographical
terrain and poor governance amongst others were some of
the threat to polio eradication in India. However,
Initiatives such as advocacy through the use mega
Bollywood faces for polio eradication, intense
supplemental immunisation, and government
accountability amongst other strategies contributed to the
eradication of Polio in India (GPEI, 2014). Global health
actors (WHO, 2014; GPEI, 2014) have suggested that
eradicating the last 1% in the three endemic countries
depends largely on how they can emulate lessons from the
India success story. This author however argues that
eradicating polio in the remaining three countries goes
beyond science and other programmatic approaches used
in India, rather a more holistic view into how global
diplomacy through political activities affects the
eradication needs to be explored.
An analysis of the three endemic countries shows that
they are all affected by civil unrest and political
instability. Resurgence of poliovirus has been recorded in
the past where these conflicts took place. For example, in
Nigeria, the activity of the terrorist group ‘Boko Haram’
hinders health workers from reaching children in the
northern part of Nigeria. Result of this threat is a
reduction in the immunisation coverage rate, which
inherently facilitates the spread of poliovirus not only
within the affected states but also to other neighbouring
communities. Therefore, it is paramount to state that
global action towards eradication of any disease should go
beyond funding and knowledge contribution, rather global
health actors need to take more holistic approach by
encompassing diplomacy for the good of all instead of
focusing on individual donor countries interest. As such,
countries like Syria, Palestine, Russia amongst others
where diplomacy war amongst high-income countries
sustains continuous conflict in this war zone, facilitates
resurgence of not only polio virus but other
communicable diseases due to a weak government and
eventually the health system.
In conclusion, the development of the polio-end game
strategic plan 2013-2018 which aims to eradicate polio by
2018 is a unique plan, in that for the first time, all strains
of the polio virus are targeted simultaneously encouraging
concurrent eradication of both wild polio virus and
vaccine derived polio virus (GPEI, 2014). However, as
argued initially, the success of this plan will depend not
only on the continuous global support of the eradication
but largely on how challenges surrounding polio
eradication can be approached holistically. Therefore,
assumptions such as the “one size fits all” solutions,
concentration on vertical programs, prioritising high
income countries vested interest in global-policy
development should be reviewed towards ensuring global
public good for health. Most importantly, high-income
countries need to note that other activities including
global diplomacy in conflict situation and other situation
deters the effect of any intervention which they invest tax
payer money on, as such it is paramount for tax-payers to

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Global Health and its issues; Polio as a focus www.northampton.ac.uk
School of Health; Comparative Health studies
always seek for justification in the spending of their
money. Nonetheless, global health is important for every
individual worldwide but the sole purpose of global
public good should always be the goal of global actors.
REFERENCES
1. Beaglehole, R. and Bonita, R. (2010) What is global
health? Global Health Actions. 3: 5142-5143.
2. Bloom, D.E., Cafiero, E.T., Jané-Llopis, E.,
Abrahams-Gessel, S., Bloom, L.R., Fathima, S.,
Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A.,
Prettner, K., Rosenberg, L., Seligman, B., Stein,
A.Z., & Weinstein, C. (2011). The Global Economic
Burden of Noncommunicable Diseases. Geneva:
World Economic Forum.
3. Bruce Aylward, Arnab Acharya, Sarah England,
Mary Agocs, Jennifer Linkins (2014) Polio
eradication
http://www.who.int/trade/distance_learning/gpgh/gp
gh2/en/index.html
4. Dara C. (2004) Improving the Health of the World’s
Poorest People. Health Bulletin 1. Washington, DC:
Population Reference Bureau.
5. Global polio eradication Initiative- GPEI (2014)
Polio and Prevention
http://www.polioeradication.org/Polioandprevention.
aspx (accessed 28th, July 2014)
6. Global issues (2011) Global health overview
[online]. Available from:
http://www.globalissues.org/article/588/global-
health-
overview#WTOPatentsIntellectualPropertyEmergenc
yDrugsandDevelopingCountries. [Accessed 8th
Aug.,
2014].
7. Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K.
S., Rodriguez, M. H. and Sewankambo, N. K. (2008)
Towards a common definition of global health.
Lancet. 373: 1993-95.
8. Kickbusch I, Buse K (1993): Global influences and
global responses: international health at the turn of
the twenty-first century. In International Public
Health: Diseases, Programs, Systems, and Policies.
Edited by Merson M, Black R, Mills A.
Gaithersburg, MA: Aspen Publishers Inc;
9. Macfarlane, S. B., Jacobs, M. and Kaaya, E. E.
(2008) In the name of global health: trends in
academic institutions. Journal of Public Health
Policy. 29: 383-401
10. Rowson M., Chris W., Rob H., Arti M., Sophie M.,
Jaime J.M., Vicki P., Abi S., Rae W. and John S
Yudkin (2012) Conceptualising global health:
theoretical issues and their relevance for teaching.
Globalization and Health; 8:36
12. Sidsel R., Desmond M., Stuart b. (2013) Protecting
the World’s children; Immunisation policies and
Practices; Oxford university Press; Oxford.
13. World Health Organization (2012a) Maternal
mortality [online]. Available from:
http://www.who.int/mediaculture/factsheets/fs348/en
/index.html. [Accessed: 8th Aug., 2014]