National choices related to inactivated poliovirus vaccine, innovation and the endgame of global polio eradication

Abstract

Achieving the goal of a world free of poliomyelitis still requires significant effort. Although polio immunization represents a mature area, the polio endgame will require new tools and strategies, particularly as national and global health leaders coordinate the cessation of all three serotypes of oral poliovirus vaccine and increasingly adopt inactivated poliovirus vaccine (IPV). Poliovirus epidemiology and the global options for managing polioviruses continue to evolve, along with our understanding and appreciation of the resources needed and the risks that require management. Based on insights from modeling, we offer some perspective on the current status of plans and opportunities to achieve and maintain a world free of wild polioviruses and to successfully implement oral poliovirus vaccine cessation. IPV costs and potential wastage will represent an important consideration for national policy makers. Innovations may reduce future IPV costs, but the world urgently needs lower-cost IPV options.

Keywords::

• cost
• eradication
• inactivated poliovirus vaccine
• oral poliovirus vaccine
• polio

Acknowledgements

The authors wish to thank the stakeholders and anonymous reviewers who provided comments.

Disclaimer

The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the Bill & Melinda Gates Foundation.

Financial & competing interests disclosure

The authors thank the Bill & Melinda Gates Foundation for providing a contract to Kid Risk, Inc. to support the completion of this work under Work Order 4533-23446. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The Global Polio Eradication Initiative continues to make progress toward achieving eradication of all three serotypes of wild polioviruses, which increases the need to prepare for the endgame.

• Introducing a dose of inactivated poliovirus vaccine (IPV) as an additional dose in a three-dose tOPV schedule (i.e., adopting a four-dose schedule) increases individual and population immunity, but substituting one or more IPV doses for one or more tOPV doses in routine immunization may not increase population immunity to poliovirus transmission.

• IPV and administration costs and wastage will determine the cost–effectiveness of IPV, which will ultimately influence decisions made by countries with respect to the role of IPV in their national immunization programs.

• With the apparent disappearance of WPV3, global health leaders may want to consider simultaneous OPV2 and OPV3 cessation, particularly if delays occur with respect to ending cVDPV2 outbreaks.

Notes