CSU 31/2008: FUTURE GLOBAL POLICIES FOR MANAGING POLIOVIRUSES
This article, also available at http://www.ajph.org/cgi/reprint/98/7/1322
reviews the options before governments and international agencies
confronted with the risks and benefits of different polio vaccination
The authors do not support the expensive switch from OPV to IPV, more and
more accepted in the industrialized world, as a global policy.
Authors' summary is below' full text on the Internet.
The Risks, Costs, and Benefits of Possible Future Global Policies for
Kimberly M. Thompson, ScD, Radboud J. Duintjer Tebbens, PhD, Mark A.
Pallansch, PhD, Olen M. Kew, PhD, Roland W. Sutter, MD, MPH, R. Bruce
Aylward, MD, MPH, Margaret Watkins, MPH, BSN, Howard E. Gary, Jr, PhD,
James Alexander, MD, MEd, Hamid Jafari, MD and Stephen L. Cochi, MD, MPH
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 posteradication
policies, health authorities should continue routine polio vaccination and
supplemental immunization activities.
July 2008, Vol 98, No. 7 | American Journal of Public Health 1322-1330
© 2008 American Public Health Association