Chapter 8: The Rotary crusade

In 1985, when Rotary International launched its 20-year crusade to help immunize every child against polio, the public health community doubted Rotary's long-term commitment as well as its ability to do the job. At the time, this private sector service organization had scant experience of operating within the public health sector. Most projects were community-based and organized by individual Rotary clubs. Apart from youth exchanges and educational programmes, Rotary had never orchestrated anything on a global scale.

Today, Rotary has confounded the early sceptics and enhanced its international reputation as a private sector service organization. It enjoys consultative status with the World Health Organization and in 1993 was awarded WHO's prestigious "Health for All" Gold Medal. In December 1996, Rotary was the first to receive the Children's Vaccine Initiative (CVI) Jenner Award for recent outstanding contributions to immunization. The CVI award was in recognition of the fact that Rotary has not only provided major funding for the polio eradication initiative, but also mobilized millions of volunteers to help carry out mass immunization campaigns.

For over a decade, Rotary International has funded the purchase of massive quantities of polio vaccine for both routine immunization and national immunization days, carried out social mobilization campaigns at community level and provided critically needed organizational skills for immunization campaigns. Rotary volunteers have also helped equip and maintain a refrigerated cold chain for vaccine transport and storage for national immunization days and mobilized millions of volunteers to man immunization posts and even administer polio drops to children. Today Rotarians are increasingly involved in advocacy work and in the development of effective surveillance systems.

During India's first ever national immunization days in December 1995 and January 1996, Rotary contributed US$ 5 million for vaccine costs and mobilized 100 000 of the two million volunteers who helped operate 500 000 immunization posts throughout India over the two days. As many as 87 million and 93 million children were immunized on the two days. In Peru, a decade earlier, 11 000 volunteers offered their services as home visitors, vaccinators, drivers, cooks, data analysts, and publicists. Rotarians also estimated that they secured US$ 440 000 worth of free advertising, transport, and supplies for national immunization days in Peru. Elsewhere, in China, where there are no Rotary clubs, the organization gave a US$ 15 million grant for the construction of a factory for the local manufacture of polio vaccine. More recently, Rotary has provided funds for the global polio laboratory network - supplying equipment and training laboratory workers.

Over the past decade, over a billion children have been immunized against polio ...

Over the past decade, Rotary International has worked with WHO, the US Centers for Disease Control and Prevention (CDC), UNICEF, and other partners in helping immunize over a billion children against polio. As a result, an estimated 2-3 million children who would otherwise have been disabled by polio are now able to run, walk, and play normally.

Rotary's involvement began in the late 1970s with a five-year commitment to immunize six million children in the Philippines. The campaign was the first project under Rotary's newly launched Health, Hunger, and Humanity Programme (the 3-H programme) and paid for out of a US$ 7.5 million 75th Anniversary Fund. The 3-H programme was designed to meet the growing need for humanitarian assistance throughout the world, on a scale that individual Rotary clubs or even districts could not undertake. In the Philippines, Rotary International proved - not just to its own membership but to the international community as well - that it could successfully work with a national Ministry of Health to immunize children. Within four years, additional polio projects had been approved in Haiti, Bolivia, Morocco, Sierra Leone, and the Gambia. Each was a five-year project - providing protection against polio for a total of seven million children.

From then on there was no looking back. In 1982, Rotary International began planning its most ambitious programme ever - to immunize all the world's children against polio by the year 2005, the organization's 100th anniversary year. Rotary had no illusions that it could do the job single-handedly. The idea was to work in collaboration with international, national, and local health agencies to promote this global immunization effort and help carry it out.

Rotary International was well placed to launch its ambitious plan. Founded in the United States in 1905, its 1.2 million members are business and professional men and women with a commitment to volunteer service. With a global network of over 28 000 Rotary clubs in 155 countries, it has the capacity to mobilize both funds and volunteers and to galvanize public opinion behind efforts to eradicate polio. Over the years it has exercised these skills to the full.

... As a result, an estimated 2-3 million children who would otherwise have been disabled by polio are now able to run, walk, and play normally.

With advice and support from the late Dr Albert Sabin, Rotary International established its new programme - PolioPlus - in 1985. A US$ 120 million fund-raising effort was launched to fund the purchase of vaccine for a five-year immunization campaign. Nothing was left to chance. A firm of fund-raising consultants was engaged, over 40 fund-raising committees established, and almost 4000 Rotary volunteers mobilized to brief other Rotarians on the need to raise funds for polio eradication. For the first time ever, Rotarians looked beyond their own membership circle to raise funds. And even they were astounded at how successful they were. Within two years they had raised more than twice the original target - US$ 247 million.

In the meantime, Rotarians continued to help immunize children against polio. Rotary International established a five-member Immunization Task Force which worked with professional staff to create immunization manuals that could be used by community volunteers throughout the world. To convince WHO that it could be an effective partner in immunization, Rotary organized NIDs in Paraguay - a small country with about 100 cases of polio a year. Within five years Paraguay was polio-free. Next, Rotary set out to prove that it could repeat this success on a much bigger scale. In Mexico in 1987, more than 200 000 volunteers were mobilized by Rotary International to help with a national immunization day which succeeded in reaching 13 million children. Within four years polio had been eradicated in Mexico. In 1988, as global immunization coverage increased and the strategy of polio eradication was shown to be working in the Americas, 166 nations committed themselves at the World Health Assembly to the goal of polio eradication by the year 2000.

Rotary International has helped organize mass immunization campaigns against polio.

Photo: Rotary International

Between 1988 and 1990, Rotary worked closely with the Pan American Health Organization (PAHO) in supporting national immunization campaigns in 27 countries in South and Central America and the Caribbean. In Colombia in 1989, Rotarians launched a social mobilization campaign, working with UNICEF and the Pan American Health Organization, to inform local government officials of the crucial importance of polio immunization campaigns. And a year later Rotarians in Ecuador negotiated with local health workers to avert a threatened strike that would have prevented national immunization days.

Because of its non-governmental status, Rotary has played a key role in cross-border immunization efforts (Colombia-Venezuela and Ecuador-Peru) and in the delivery of vaccine in no-go areas during conflicts in El Salvador, Nicaragua, and Peru. Elsewhere, in both Bulgaria and Romania, Rotary volunteers succeeded in convincing minority ethnic groups to participate in national immunization days - despite these groups' deep-seated distrust of government programmes.

Meanwhile Rotary volunteers from one country have made themselves available to provide advice as well as practical assistance to Rotarians elsewhere. In 1985, Paraguayan Rotarians with experience of door-to-door ("mopping up") immunization campaigns in their own country taught these skills to Rotarians in Brazil.

More recently, in 1995, Rotary provided most of the vaccine needed for the first year of Operation Mecacar - a 3-year campaign to immunize 58 million children in 19 adjacent countries in the Middle East, Caucasus, and Central Asian Republics.

However, over the past two years, Rotary's support for polio eradication has focused less on vaccine supply (although it continues to provide large quantities of vaccine for NIDs) and more on advocacy work, social mobilization, and surveillance. The change of emphasis is a pragmatic one - based on a need to make the best use of available funds. In 1995, WHO estimated that an additional US$ 120 million a year would be needed over the next five years - over and above the existing contributions of governments and donors - in order to eradicate polio by the year 2000. Almost 70% of this money was earmarked for vaccine purchase. With Rotary committed to providing US$ 20 million a year out of its remaining PolioPlus funds, that left a gaping hole of US$ 500 million. To make matters worse, the money was needed urgently to buy vaccine for imminent NIDs.

By the time polio is eradicated, Rotary estimates that it will have spent US$ 400 million on the campaign.

Rotary's response was to establish an eight-member high-level Task Force on International Advocacy. Its role is to encourage governments to increase their commitment to polio eradication and raise the level of funding. Its initial success was in the United States, where in 1995 and 1996, Rotarians testified before the US Congress and were influential in securing substantial increases in government allocations for polio eradication. The 1995 budget request of US$ 11.3 million for polio eradication was boosted in 1996 to US$ 47.1 million (US$ 27.1 million channelled through the Centers for Disease Control and Prevention and US$ 20 million through the US Agency for International Development (USAID) - mainly for vaccine purchase and delivery). A year later, the US Congress agreed to an even larger increase - a total of US$ 72 million.

Over the next 18 months, the Task Force is now holding talks with representatives of the European Union in Brussels and with almost 40 potential donor governments. Not all of them are rich industrialized countries. They also include some of the countries in Latin America, for example, where polio has been eradicated. The Rotary Task Force is also approaching vaccine manufacturers to encourage donations of oral polio vaccine for NIDs in polio-endemic countries.

Another change is Rotary's increasing emphasis on support for laboratories and surveillance systems - a shift prompted by an increase in the number of alternative donors willing to provide vaccine. Most donors prefer to support vaccine purchase because it has a tangible, visible outcome - readily measured by a head-count of children immunized. But donors are reluctant to pay for less attractive programme areas such as surveillance, where funds are now critically needed. Unless national surveillance systems are improved, recently endemic countries will be unable to pinpoint the final chains of transmission of poliovirus and target door-to-door ("mopping up") immunization. And countries that are polio-free will be unable to prove that circulation of wild poliovirus has stopped - making it impossible to certify that polio has been eradicated globally.

Because Rotary is less constrained than other donors in the way it channels the remaining US$ 100 million of its PolioPlus funds, it is willing to use them to plug these and other gaps identified by WHO.

Rotary funds surveillance systems, pays doctors' salaries, and meets the cost of training laboratory technicians. Meanwhile individual Rotary clubs have launched smaller-scale projects in individual countries - under Rotary's PolioPlus Partners scheme - providing funds to equip laboratories and to assist medical officers in the field by providing computers, software, motorcycles, and other equipment. During 1995 PolioPlus Partners - designed to foster partnerships between polio-free and polio-endemic countries - raised an additional US$ 1 million for polio eradication.

Rotary continues to play a crucial role in social mobilization for immunization - preparing publicity and promotional material for NIDs, and providing transport to ensure that children in remote areas have access to immunization posts.

The PolioPlus programme has highlighted the potential impact of applying private sector skills and know-how to social needs. By the time polio is eradicated, Rotary estimates that it will have spent a total of US$ 400 million on the campaign - most of it from the investment of the original US$ 247 million. But no one will ever be able to put an exact figure on the hundreds of thousands of hours of volunteer service put in by Rotarians throughout the world in their attempt to turn the dream of polio eradication into reality.

Polio paralysis can create lifelong dependency and loss of productivity among survivors.

Photo: WHO/Thierry Geenan