Political Engagement: A Key Pillar in Revitalisation of Polio and Routine Immunisation Programmes in the Democratic Republic of the Congo

"The Forums in DRC succeeded in increasing focus, ownership and participation in immunisation activities at the highest levels of national and provincial government...This type of high-level commitment could serve as a template for other countries struggling to have high engagement as targets for polio eradication and strengthened routine immunisation are set for 2025-2030."

In 2019, the Democratic Republic of the Congo (DRC)'s newly elected president began setting the political groundwork in support of the improvement of immunisation and polio eradication by organising the National Forum in Support of Vaccination and the Eradication of Polio (the Presidential Forum). With an eye to exploring the power of political engagement and advocacy to effect change, this article highlights the key outcomes of the Forum, such as the signing of the Kinshasa Declaration, which formally set targets and specified national, provincial, and community-level commitments to vaccination and polio eradication.

As detailed here, the first Presidential Forum was held in Kinshasa on July 22-23 2019 with support from immunisation partners and technical assistance partners. To publicly communicate the presidential commitment to the international community, a multinational, representative cohort, as well as ambassadors from donor countries, were invited to participate. Delegations from all 26 provinces included the governor, the president of the provincial assembly, as well as provincial ministers of health and chiefs of health. In addition to various speeches, the 2-day Forum featured participation by the President in high-level roundtable discussions with the leads of international agencies to discuss common goals for improving routine immunisation, polio, and the role of the government. At the conclusion of these meetings, the president, ministers, governors of each province, and presidents of provincial assemblies signed the Declaration of Kinshasa on Routine Immunisation and Polio Eradication. A publicly available website in both French and English was created to track adherence to the main commitments of the declaration. The government and partners also agreed to a scorecard mechanism to monitor adherence to the main commitments of the declaration.

The second Presidential Forum was held in Kinshasa on October 21 2021. The second Forum presented results that indicated immediate improvements in vaccination rates. The third Presidential Forum was held in Kinshasa June 27-28 2023. Beyond the establishment of the Presidential Forum as a regular biannual event, one notable element of this gathering was the provision by the minister of health of prizes to the best performing and most improved provinces. The secretary general of health also held a panel with governors of the best and lowest-performing provinces, based on the results of the coverage surveys. Several governors committed to reinvigorating their immunisation programmes and monitoring progress more regularly.

The Presidential Forums' goal was also to increase focus on polio eradication efforts. Following the subnational commitments at the first Forum, cases of confirmed vaccine-derived poliovirus type 2 (VDPV2) decreased in the provinces of Haut Lomami and Tanganyika. However, as of 2022, there was a surge in VDPV2 cases as well as identification of VDPV1 cases in several provinces. Following the spike in cases observed in 2022, the national government announced an increased focus on outbreak response activities. At the provincial level, the President demanded during the Forums that governors make polio outbreak response a priority.

According to the analysis presented here, "These Forums directly promoted high-level commitment to vaccination and played a role in changing the processes and increasing domestic sources from which routine immunisation programmes are funded in the DRC....At the highest level of DRC governance, these Presidential Forums were instrumental in encouraging provincial buy-in and participation in the routine immunisation programmes of a decentralised state.... By focusing on high-level financial and vaccine coverage targets, the declaration and subsequent monitoring mechanisms focused the attention of leaders on critical activities. With the increased oversight of the President and national attention, another positive outcome of this political advocacy was the improvement in disbursement for vaccines, with the country fulfilling its financial obligations 4 years in a row - the first time in its history." 

In conclusion: "Presidential Forums serve as an example of how high-level political support at both the national and subnational levels associated with a measurable accountability framework can improve public health programme outcomes. However, they should not be seen as the only way LICs [low-income countries] can achieve high vaccination coverage, instead, they should be seen as an opportunity for countries to engage high-level political leaders with the task in mind to increase political visibility and political support. With this in mind, biannual Forums were a key tool to support routine immunisation and polio eradication in DRC. This approach to complement programmatic support could be replicated in other settings as an additional mechanism for public health advocacy."

Full list of authors, with institutional affiliations: Roger Kamba, Ministry of Health, DRC; Amine El Mourid, Bill & Melinda Gates Foundation; Raoul Mpoyi Ngambwa, McKing Consulting; Donat Chungu Salumu, Expanded Programme for Immunization; Jean-Bernard Le Gargasson, GAVI the Vaccine Alliance; Daniel Nacoulma, United Nations Children's Fund (UNICEF); Marcellin Nimpa Mengouo, World Health Organization (WHO); Nolan Meyer, PATH; Christophe Luhata, Expanded Programme for Immunization; Nicole A Hoff, University of California Los Angeles Jonathan and Karin Fielding School of Public Health; Hadia Samaha, World Bank; Collard Madika, McKing Consulting; Christelle Mputu, Development Catalyst; Sylvia Tangney, University of California Los Angeles Jonathan and Karin Fielding School of Public Health; Cyril Nogier, GAVI the Vaccine Alliance; Chris Diomi, Ministry of Finance, DRC; Sydney Merritt, University of California Los Angeles Jonathan and Karin Fielding School of Public Health; Emma Din, United States Agency for International Development (USAID); Polydor Kabila, Ministry of Health, DRC; Annabelle Burgett, Bill & Melinda Gates Foundation; Didier Nyombo, McKing Consulting; Emmanuelle Assy, UNICEF; Dalau Mukadi Nkamba, Universite de Kinshasa; Lora Bertin, Expanded Programme for Immunization; Trad Hatton, PATH; Didine Kaba, Universite de Kinshasa; Anne W Rimoin, University of California Los Angeles Jonathan and Karin Fielding School of Public Health; Elisabeth Mukamba Musenga, Expanded Programme for Immunization; Aimé Cikomola, Expanded Programme for Immunization; Guillaume Ngoie Mwamba, VillageReach; Sylvain Yuman Ramazani, Ministry of Health, DRC; Kamel Senouci, University of Geneva; Magdalena Robert, Bill & Melinda Gates Foundation