Polio and the politics of policy diffusion in Latin America

The world's health ministers convened in Geneva for the World Health Assembly from May 21-26, 2012, and declared a global public health emergency, appealing to the countries of the world to respond to the threat of resurgent polio. Coincidentally, this historic declaration came fifty years to the day after the last case of polio was reported in Cuba on May 26, 1962, making Cuba only the second country in the world and the first in the Americas to successfully eradicate the dreaded disease. The Cuban strategy in 1962 was to mobilize volunteer armies to give the live oral polio vaccine (OPV) to children throughout the entire country twice a year on national immunization days (NIDs). Over the course of the next thirty years every country in Latin America adopted and implemented some variation of the original Cuban policy model, and in 1994 the Americas became the first region in the world to completely eliminate polio. The highly successful experience in Latin America was used as evidence to rally support for the Global Polio Eradication Initiative (GPEI) launched by the World Health Organization in 1988. The Americas seemed to have provided a simple blueprint for polio eradication that the rest of the world had only to follow in order to achieve the same dramatic results. However, as evidenced by the recent World Health Assembly declaration, the policy innovations that were adopted and implemented so successfully in the Region of the Americas have been far less effective when simply exported to other countries and other regions of the world. The persistent failure of both domestic governments and the GPEI itself has highlighted longstanding problems linked to the dissemination and diffusion of evidence and new public health innovations, and the "translation gaps" that prevent existing evidence-based interventions from being effectively implemented in different countries and sustained over time.;This dissertation, Polio and the Politics of Policy Diffusion in Latin America, contributes to global health policy scholarship by providing the first comprehensive history of the domestic Latin American initiatives that preceded the regional polio eradication campaign in the Americas, after which both regional and global campaigns were modeled. In addition, my dissertation contributes to policy diffusion and implementation research. At its core, the history of polio eradication in the Americas is a history of how new ideas and innovations linked to polio and immunization strategies were circulated among actors in different countries, and what different actors did with new information and innovations once they became available. This history provides an opportunity to examine why new innovations and ideas were more effectively implemented in some countries than others and how interactions between domestic and external factors made it possible to overcome "translations gaps" hindering effective policy implementation at different points in time.