20TH Century disease eradication programs & their legacies for health systems

Covid-19 has disrupted health programmes worldwide, strained resources and prompted a reshuffling of priorities. In this context, stakeholders have been revisiting the Global Polio Eradication Initiative strategy, and wrestling with the question of what it means to integrate polio eradication activities into broader health systems. This working paper examines the legacies that six largescale international disease eradication programs (EPs) conducted over the past century have left for health systems. The document analyses how EPs impacted the ‘building blocks’ of health systems (WHO, 2006); the intentions and timing of integration, challenges, and lessons learned. The EPs we analyse include:
- Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (1909–15)
- Continental Plan for the Eradication of the Ae. aegypti (1947–70)
- Global Control of Treponematoses Program (1952–64)
- Global Malaria Eradication Program (1965–70)
- Global Smallpox Eradication Program (1966–80)
- Guinea Worm Disease Eradication Campaign (1991–present)

This research found evidence that EPs left important and useful legacies for the building blocks of health systems (HS). In addition, EPs had impacts beyond national health systems, including in community networks; contributions to gender equity; and intergovernmental and regional collaborations.
Furthermore, all EPs ultimately had to address the question of integration, whether through integration of assets post-eradication or integration into HS in order to continue activities; however integration did not always benefit health systems, nor EPs.