POST 01293E: MANAGING POLIO VIRUS
23 JULY 2008
Both the contributions have been cross-posted from CSU. A big thank you to Bob Davis and Evelyn Chege.
Meeting in Geneva in May, the governing body of the World Health Organization passed an unusually blunt resolution on "management of potential risks to polio eradication." (The full text of the resolution is attached and can also be accessed at http://www.polioeradication.org
Type 1 wild poliovirus travels very well across international borders, and the huge increases in Type 1 polio seen this year in Nigeria threaten the same kind of expensive, time consuming polio mop-ups in non-endemic countries as were seen when Nigeria last exported polio in the year 2005.
The Nigerian setbacks of this year have distracted the world's attention from the apparently successful efforts of the other three endemic countries, all in South Asia, to stop Type 1 transmission.
The $500 million expended to stop Type 1 transmission exported from Nigeria three years ago is not now available. If Nigeria exports Type 1 polio this year, it is not at all clear that the financial resources needed to mop up in any importation countries would be available.
So the eyes of the world are on one country.
------ The risks, costs, and benefits of possible future global policies for managing polioviruses
Thompson et al. Am J Public Health.2008; 98: 1322-1330
OBJECTIVES: We assessed the costs, risks, and benefits of possible future major policy decisions on vaccination, surveillance, response plans, and containment following global eradication of wild polioviruses. METHODS: We developed a decision analytic model to estimate the incremental cost-effectiveness ratios and net benefits of risk management options for polio for the 20-year period and stratified the world according to income level to capture important variability between nations. RESULTS: For low-, lower-middle-, and upper-middle-income groups currently using oral poliovirus vaccine (OPV), we found that after successful eradication of wild polioviruses, OPV cessation would save both costs and lives when compared with continued use of OPV without supplemental immunization activities. We found cost-effectiveness ratios for switching from OPV to inactivated poliovirus vaccine to be higher (i.e., less desirable) than other health investment opportunities, depending on the actual inactivated poliovirus vaccine costs and assumptions about whether supplemental immunization activities with OPV would continue. CONCLUSIONS: Eradication promises billions of dollars of net benefits, although global health policy leaders face difficult choices about future policies. Until successful eradication and coordination of post-eradication policies, health authorities should continue routine polio vaccination and supplemental immunization activities.
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