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Since the 1988 resolution of the World Health Assembly of the World Health Organization to eradicate polio globally by 2000, the incidence of polio has declined more than 98%. Wild poliovirus type 2 has been eradicated and the eradication has been certified globally; more than 3 years have passed since the last wild poliovirus 3 was isolated in Nigeria. There are now three remaining reservoirs for wild poliovirus transmission—Nigeria, Afghanistan, and Pakistan. This is no time to celebrate. The world is 19 years past the original target. The year 2019 in particular has not been kind to theGlobal Polio Eradication Initiative. During the first 6months of 2019, the number of reported polio cases in Pakistan exceeded the number reported in 2018 over the same time period, and at present, the numbers are rising monthly. Parts of Afghanistan under Taliban control have stopped vaccination. Some communities in both Pakistan and Afghanistan actually refuse polio vaccination because of mistrust of the polio initiative, fueled by social media. Now, more than ever, community engagement and community ownership of the initiative, supported by civil society organizations in remaining areas at risk, must reverse the tide of public distrust and re-invigorate community ownership of efforts to fully vaccinate all children and ultimately reach the goal of the eradication of all polioviruses. Accordingly, the experience highlighted in the series of articles published in this supplement is incredibly timely. In the lead article, Losey et al. describe the model for community engagement for polio eradication supported by grants to the CORE Group (an association of U.S.-based non-governmental organizations (NGOs) working in community health) from the United States Agency for International Development (USAID) beginning in 1999 and later from the Bill & Melinda Gates Foundation. The CORE Group Polio Project (CGPP) worked with international and national NGOs to implement this program. Losey et al. state that such support has contributed to improvements in routine immunization programs, polio campaign quality, and surveillance for acute flaccid paralysis in many areas challenged by geography (being in isolated, dispersed, or remote areas), by the social characteristicsof thepopulation (beingnomadicor transient),orby resistance to polio immunization (being resentful of the attention given to polio immunization while other basic health needs are being neglected, suspicious of the underlying motivation for immunization, or fearful of side effects falsely promoted for political purposes). Specifically, the authors describe how the CGPP developed innovative strategies to detect cases using communitybased surveillance, promoted independent campaignmonitoring, established cross-border initiatives, and developed a strong and creative cadre of Community Mobilizers (CMs) to track missed children, engage families in discussions aboutwhy immunizations are important, and link families to accessible vaccination sites. Many strategies are required to reverse the tide of mistrust. Perhaps most important is listening to communities who doubt the benefit of polio eradication. As described by Solomon, this is exactly what was done in India. She relates how CGPP/India listened to the families and communities who refused to participate in the polio eradication program and then strategically addressed their concerns. This strategic approach, however, must also be well coordinated among the partners. Awale et al. discuss the various processes and techniques adopted in India to build strong partnerships and coordination mechanisms among stakeholdersbyoptimizing their strengthsandusingopportunities that lead toward the eradication of polio. They go on to cite that such lessons indeveloping,managing, andnurturingpartnerships can be adapted and replicated for elimination or controlling other diseases. Linked to this, data and mechanisms for sharing data are fundamental. Choudhary et al. describe how the communitybased management information system (CB-MIS) has helped to make it possible for community-based health workers to understand barriers to immunization that families face and how to overcome them. The CB-MIS also provides a robust platform for community-based health workers to register vital events. Any strategy is only as good as the quality of the staff at the point of implementation and the engagement of the community in the form of volunteers mobilized for support. Three articles from Ethiopia illustrate this point. Asegedew et al. describe the CGPP/Ethiopia, which began in 2001 to support polio eradication initiatives in hard-to-reach pastoralist and semipastoralist high-risk border areas of Ethiopia by training and supporting community volunteers (CVs) for immunization promotion and community-based surveillance activities. Their assessment of the program highlights the desire expressed by CVs to receive more training, suggesting a highly committed cadre of implementers. The authors note as a consequence the CVs have made notable contributions to polio eradication efforts in high-risk areas of Ethiopia, as well as to immunization promotion anddisease control there. Using the trained network of volunteers, Tassema et al. also describe the Ethiopian experience. Their article suggests that the CGPP/Ethiopia was able to achieve increasing levels of polio immunization coverage in the hardest-to-reach areas of these states, with the achievement of levels actually higher than those achieved in the rest of Ethiopia. A third article, by Stamidis et al. report that CVs secured the buy-in of community members through open and fair eligibility and selection processes, which in turn ensured representation of community needs and perspectives. In this same article, the authors further describe how communitydriven participation in Ethiopia consisted of identifying and choosing credible, trusted individuals who were willing to actively engage as caretakers of the community. Community volunteers then received specialized training and supportive * Address correspondence to Jon K. Andrus, CU Anschutz Medical Campus,Mail StopA090, 13199E.MontviewBlvd., Suite 310, Aurora, CO 80045. E-mail: andrusjonkim@yahoo.com

Community Engagement, Ownership, and Civil Society Organizations in Polio Eradication