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Review
. 2019 Jul;18(7):725-736.
doi: 10.1080/14760584.2019.1635463. Epub 2019 Jul 2.

Logistical challenges and assumptions for modeling the failure of global cessation of oral poliovirus vaccine (OPV)

Kimberly M Thompson  1 , Dominika A Kalkowska  1
Affiliations
Review

Logistical challenges and assumptions for modeling the failure of global cessation of oral poliovirus vaccine (OPV)

Kimberly M Thompson et al. Expert Rev Vaccines. 2019 Jul.

Abstract

Introduction: The inability to successfully stop all use of oral poliovirus vaccine (OPV) as part of the polio endgame and/or the possibilities of reintroduction of live polioviruses after successful OPV cessation may imply the need to restart OPV production and use, either temporarily or permanently. Areas covered: Complementing prior work that explored the risks of potential OPV restart, we discuss the logistical challenges and implications of restarting OPV in the future, and we develop appropriate assumptions for modeling the possibility of OPV restart. The complexity of phased cessation of the three OPV serotypes implies different potential combinations of OPV use long term. We explore the complexity of polio vaccine choices and key unresolved policy questions that may impact continuing and future use of OPV and/or inactivated poliovirus vaccine (IPV). We then characterize the assumptions required to quantitatively model OPV restart in prospective global-integrated economic policy models for the polio endgame. Expert commentary: Depending on the timing, restarting production of OPV would imply some likely delays associated with ramp-up, re-licensing, and other logistics that would impact the availability and costs of restarting the use of OPV in national immunization programs after globally coordinated cessation of one or more OPV serotypes.

Keywords: Polio; dynamic modeling; eradication; oral poliovirus vaccine.

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Figures

Figure 1.
Figure 1.
Routine immunization (RI) options for successful-phased OPV cessation.
Figure 2.
Figure 2.
Routine immunization (RI) options with failure of the OPV-cessation strategy (control).
Figure 3.
Figure 3.
Routine immunization (RI) options for IPV/OPV countries with OPV restart and continued phased OPV cessation (starts at bOPV in RI as of mid-2019).
Figure 4.
Figure 4.
Routine immunization (RI) options for OPV+IPV countries with OPV restart and continued phased OPV cessation (starts at bOPV in RI as of mid-2019).
Figure 5.
Figure 5.
Routine immunization (RI) flowchart for blocks in the global model currently using IPV/OPV sequential schedules.
Figure 6.
Figure 6.
Routine immunization (RI) flowchart for blocks in the global model currently use OPV+IPV schedules.
See this image and copyright information in PMC

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This paper was funded by the Bill and Melinda Gates Foundation [OPP1129391].