Political Committment Issues, Polio, and the Measles Initiative

For the most part, political commitment is a counterintuitive term; the majority of government-backed or state-supported endeavors appear to be fraught with inconsistency and lack of funding. In the health sector, the consequences of this manifest in either failure or incomplete results, which typically high-light the stratified populations of people who receive different forms of intervention and health care due to socioeconomic factors.

                In this way, the Measles Initiative is unique; despite its large-scale character, it was able to bypass the shortcomings of public services and inadequate infrastructure in certain countries. This is due to the MI’s complex coordination and planning, especially in regard to awareness campaigns. Learning from previous failures in the 1970s, the kick start of the Measles Initiative in 2001 made strategic outreach a core focus in its roll-out. The visibility of the endeavor-which was achieved by aggressive campaigning and case-based surveillance- made it impossible to ignore. By beginning initial efforts in stable governments and regions, it was able to achieve a reputation of success that would later make it impossible for insecure governments to ignore.

                This is interesting for many reasons; in global health, there seems to be a theme of grand-scale intervention that inevitably leads to failure. Superficially, it appears that lack of funding, cooperation, and technical deficiencies are the villains responsible for wreaking havoc on theoretically sound plans of intervention. For instance, the Polio Eradication Initiative has been successful across the Americas and Europe, yet the disease remains endemic in countries such as Pakistan. Many health officials point to Pakistan’s crumpled infrastructure as a scapegoat, but perhaps it is more helpful to search for reasons as to why the public health systems in certain governments are so dysfunctional. Clearly, lack of funding reflects a lack of support, but what are the reasons behind governmental resistance, and why do certain campaigns win over the hearts of dictators while others do not?

                The book Chasing Polio in Pakistan by Svea Closser begs this very question, and surmises that the Polio Eradication Initiative is failing in Pakistan due to issues of political commitment. Pakistan fails to comply with WHO and UN requests not only because it feels that the PEI is an extension of Western imperialism, but also because it simply does not regard Polio as a top-priority issue. In Pakistan’s agenda, health problems are already of low-importance, and so they are largely shuffled to the bottom of the government’s to-do list. Assuming that this is correct, what then makes an issue a priority?

In many western nations, priority is divided amongst different sectors and government levels. Political commitment is not necessarily a government promise- it is merely associated with a larger force, but implemented by a division of the system that is entirely dedicated to that cause or mission. Thus, the relation of the PEI and the MI is found in each one’s varying levels of political commitment and strategic approach. The PEI began as a top-down measure; the WHO and UN delivered demands, and countries with the capabilities and resources followed dutifully. This is also the case for the MI, but success has been somewhat more attainable due to the Initiative’s early emphasis on reaching out to strong nations in positions to carry out large health interventions. Health endeavors are inherently political, and like anything else in politics, the reputation of a health program is the ultimate determinate of whether or not it will succeed. By starting with wealthy and capable countries, MI was able to convince the most skeptical of leaders and governments that eradication was possible, whereas the PEI went straight to the most affected countries, which were the least-equipped to deal with the issue.

                Ultimately, failure of public health interventions is in its most literal sense a result of inadequate funding, support, and commitment. Symbolically, however, failure is due to an oversight in recognition on the part of these health initiatives. The PEI did not take into account the political environment of the countries where Polio is endemic; the MI-while not perfect- did notice the correlation between measles and political instability. This acknowledgement allowed MI to strategically plan its roll-out, and success has been much more prevalent as a result.