Polio Endgame and Legacy
What Work Needs To Be Done?
There are three principal aspects of the polio “legacy” work:
- Mainstreaming essential polio eradication functions, such as immunization, surveillance, communication, response, and containment, into other ongoing public health programs
- Ensuring that the knowledge generated and lessons learned during 25 years of polio eradication activities are shared with other health initiatives
- Where feasible, desirable, and appropriate, transitioning the capacities, processes and assets that the GPEI has created to support other health priorities
When the spread of wild polio virus (WPV) is stopped, the international partners expect to plan and carry out a series of activities in various stages to certify the eradication of polio and minimize the possibility that the disease will return. High-quality global surveillance must demonstrate the lack of any WPV for at least three years before eradication can be certified. Laboratories will have to ensure the destruction or safe storage of any WPV infectious and potentially infectious materials. Eventually, the use of the Oral Polio Vaccine (OPV) will be stopped. Calculating the annual global cost savings attributed to discontinuing the use of OPV is extremely complicated*, but savings are estimated to be $40 to $50 billion, underlying the critical importance of getting the job done.
The expansion of the national delivery systems that brought polio vaccine to remote and medically underserved populations, paving the way for other preventive health services, will be a lasting legacy of the GPEI. Using the polio networks, other lifesaving vaccines, insecticide-treated bed nets, and other children’s preventive health services are reaching target populations that were previously not served. The polio networks are also used by first responders when disasters strike (e.g., earthquakes, tsunamis, floods).
* For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40–50 billion dollars (2008 US dollars; 1988 net present values). R.J. Duintjer Tebbens et al. / Vaccine 29 (2011) 334–343