Launched in 1988, the Global Polio Eradication Initiative (GPEI) has been the largest international public health effort ever undertaken, involving billions of US dollars donated through GPEI partners, the dedicated efforts of governments at all levels, countless hours of volunteer services, and the immunization of billions of children with oral polio vaccine (OPV). The Polio Eradication & Endgame Strategic Plan 2013-2018 (the Endgame Strategy) (3) set the goal of a polio-free world by 2018. Achieving this goal requires: (i) completion of eradication to eliminate the risk of wild poliovirus (WPV) transmission; (ii) cessation of the use of OPV to eliminate the risks of vaccine-associated paralytic poliomyelitis (VAPP), chronic immunodeficiency-associated vaccine-derived poliovirus (iVDPV) and outbreaks of circulating vaccine-derived poliovirus (cVDPV)

(4; 5); and (iii) implementation of poliovirus safe-handling and containment measures to minimize the risks of a facility-associated reintroduction of virus into the polio-free community. The first step towards cessation of trivalent OPV (tOPV) use will be the withdrawal of OPV type 2 (OPV2), which has caused over 90% of cVDPV cases since the eradication of WPV2 in 1999. The resulting bivalent OPV (bOPV, types 1 and 3) will replace tOPV in global immunization programmes, facilitated by the introduction of at least one dose of inactivated poliovirus vaccine (IPV), composed of all three virus types. Providing adequate IPV doses for all OPV-using countries will require both volume purchasing of existing IPV products and developing alternative low-cost IPV options (e.g. Sabin-IPV) for developing countries to meet programmatic needs. Until cessation of OPV use, bOPV will be the vaccine of choice to respond to any

WPV type 1 (WPV1) and WPV type 3 (WPV3) outbreaks, while monovalent OPV

type 2 (mOPV2) will be the choice for responding to type 2 outbreaks. After OPV

cessation, a combination of type-specific mOPV and IPV will be used to respond to any WPV or vaccine-derived poliovirus (VDPV) outbreak. Global consensus to stop bOPV will require international assurance that the transmission of wild and vaccine-derived poliovirus has been interrupted; affordable, safe and effective IPVs are available; potential outbreaks from undetected or newly emerged cVDPV can be controlled; and the risk from facility-associated reintroduction of wild or OPV/Sabin polioviruses can be minimized. This third edition of the Global Action Plan (GAPIII) aligns the safe handling and containment of poliovirus infectious and potentially infectious materials with the WHO Endgame Strategy and replaces both the 2009 draft version of the third edition posted on the GPEI website and the second edition of the WHO Global Action Plan for laboratory containment of wild polioviruses (6).