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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2015

Open Access 01-12-2015 | Research article

An economic analysis of poliovirus risk management policy options for 2013–2052

Authors: Radboud J. Duintjer Tebbens, Mark A. Pallansch, Stephen L. Cochi, Steven G.F. Wassilak, Kimberly M. Thompson

Published in: BMC Infectious Diseases | Issue 1/2015

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Abstract

Background

The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) after interrupting all wild poliovirus (WPV) transmission, but many questions remain related to long-term poliovirus risk management policies.

Methods

We used an integrated dynamic poliovirus transmission and stochastic risk model to simulate possible futures and estimate the health and economic outcomes of maintaining the 2013 status quo of continued OPV use in most developing countries compared with OPV cessation policies with various assumptions about global inactivated poliovirus vaccine (IPV) adoption.

Results

Continued OPV use after global WPV eradication leads to continued high costs and/or high cases. Global OPV cessation comes with a high probability of at least one outbreak, which aggressive outbreak response can successfully control in most instances. A low but non-zero probability exists of uncontrolled outbreaks following a poliovirus reintroduction long after OPV cessation in a population in which IPV-alone cannot prevent poliovirus transmission. We estimate global incremental net benefits during 2013–2052 of approximately $16 billion (US$2013) for OPV cessation with at least one IPV routine immunization dose in all countries until 2024 compared to continued OPV use, although significant uncertainty remains associated with the frequency of exportations between populations and the implementation of long term risk management policies.

Conclusions

Global OPV cessation offers the possibility of large future health and economic benefits compared to continued OPV use. Long-term poliovirus risk management interventions matter (e.g., IPV use duration, outbreak response, containment, continued surveillance, stockpile size and contents, vaccine production site requirements, potential antiviral drugs, and potential safer vaccines) and require careful consideration. Risk management activities can help to ensure a low risk of uncontrolled outbreaks and preserve or further increase the positive net benefits of OPV cessation. Important uncertainties will require more research, including characterizing immunodeficient long-term poliovirus excretor risks, containment risks, and the kinetics of outbreaks and response in an unprecedented world without widespread live poliovirus exposure.
Appendix
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Literature
1.
2.
World Health Organization. Transmission of wild poliovirus type 2 - Apparent global interruption. Wkly Epidemiol Rec. 2001;76:95–7.
3.
Kew OM, Cochi SL, Jafari HS, Wassilak SG, Mast EE, Diop OM, et al. Centers for Disease Control and Prevention (CDC): Possible eradication of wild poliovirus type 3--worldwide, 2012. MMWR Morb Mortal Wkly Rep. 2014;63(45):1031–3.PubMed
4.
Thompson KM, Pallansch MA, Duintjer Tebbens RJ, Wassilak SG, Kim J-H, Cochi SL. Pre-eradication vaccine policy options for poliovirus infection and disease control. Risk Anal. 2013;33(4):516–43.CrossRefPubMed
5.
Thompson KM, Pallansch MA, Duintjer Tebbens RJ, Wassilak SGF, Cochi SL. Modeling population immunity to support efforts to end the transmission of live polioviruses. Risk Anal. 2013;33(4):647–63.CrossRefPubMed
6.
Thompson KM, Kalkowska DA, Duintjer Tebbens RJ. Managing population immunity to reduce or eliminate the risks of circulation following the importation of live polioviruses. Vaccine. 2015;33(3):1568–77.CrossRefPubMed
7.
Sutter RW, Kew OM, Cochi SL, Aylward RB. Poliovirus vaccine -- Live. In: Plotkin SA, Orenstein WA, Offit PA, Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. Sixthth ed. Philadelphia: Saunders Elsevier; 2013. p. 598–645.CrossRef
8.
Duintjer Tebbens RJ, Pallansch MA, Kew OM, Cáceres VM, Jafari H, Cochi SL, et al. Risks of paralytic disease due to wild or vaccine-derived poliovirus after eradication. Risk Anal. 2006;26(6):1471–505.CrossRef
9.
World Health Organization: Polio Eradication Initiative. Cessation of Routine Oral Polio Vaccine (OPV) use after Global Polio Eradication. Framework for National Policy Makers in OPV-using Countries. Geneva, 2005; Report No.: WHO/POL/05.02.
10.
Duintjer Tebbens RJ, Pallansch MA, Kim J-H, Burns CC, Kew OM, Oberste MS, et al. Review: Oral poliovirus vaccine evolution and insights relevant to modeling the risks of circulating vaccine-derived polioviruses (cVDPVs). Risk Anal. 2013;23(4):680–702.CrossRef
11.
Kew O, Morris-Glasgow V, Landaverde M, Burns C, Shaw J, Garib Z, et al. Outbreak of poliomyelitis in Hispaniola associated with circulating type 1 vaccine-derived poliovirus. Science. 2002;296(5566):356–9.CrossRefPubMed
12.
Kew OM, Sutter RW, de Gourville EM, Dowdle WR, Pallansch MA. Vaccine-derived polioviruses and the endgame strategy for global polio eradication. Annu Rev Microbiol. 2005;59:587–635.CrossRefPubMed
13.
Wassilak SGF, Pate MA, Wannemuehler K, Jenks J, Burns C, Chenoweth P, et al. Outbreak of type 2 vaccine-derived poliovirus in Nigeria: emergence and widespread circulation in an underimmunized population. J Infect Dis. 2011;203(7):898–909.CrossRefPubMedPubMedCentral
14.
Burns C, Diop O, Sutter RW, Kew OM. Vaccine-derived polioviruses. J Infect Dis. 2014;210 Suppl 1:S283–93.CrossRefPubMed
15.
Thompson KM, Duintjer Tebbens RJ. The case for cooperation in managing and maintaining the end of poliomyelitis: Stockpile needs and coordinated OPV cessation. Medscape J Med. 2008;10(8):190.PubMedPubMedCentral
16.
17.
Vidor E, Plotkin SA. Poliovirus vaccine -- Inactivated. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. Sixthth ed. Philadelphia: Saunders Elsevier; 2013. p. 573–97.CrossRef
18.
Thompson KM, Duintjer Tebbens RJ. National choices related to inactivated poliovirus vaccine, innovation, and the end game of global polio eradication. Exp Rev Vaccines. 2014;13(2):221–34.CrossRef
19.
World Health Organization: Global Polio Eradication Initiative: Polio Eradication and Endgame Strategic Plan (2013–2018). Geneva, 2013; Report No.: WHO/POLIO/13.02.
20.
Duintjer Tebbens RJ, Pallansch MA, Chumakov KM, Halsey NA, Hovi T, Minor PD, et al. Expert review on poliovirus immunity and transmission. Risk Anal. 2013;33(4):544–605.CrossRefPubMed
21.
Duintjer Tebbens RJ, Pallansch MA, Chumakov KM, Halsey NA, Hovi T, Minor PD, et al. Review and assessment of poliovirus immunity and transmission: Synthesis of knowledge gaps and identification of research needs. Risk Anal. 2013;33(4):606–46.CrossRefPubMed
22.
Anis E, Kopel E, Singer S, Kaliner E, Moerman L, Moran-Gilad J, et al. Insidious reintroduction of wild poliovirus into Israel, 2013. Euro Surveill. 2013;18(38):pii=20586.CrossRef
23.
Kalkowska DA, Duintjer Tebbens RJ, Grotto I, Shulman LM, Anis E, Wassilak SGF, et al. Modeling options to manage type 1 wild poliovirus imported into Israel in 2013. J Infect Dis. 2015;211(11):1800–12.CrossRefPubMed
24.
Duintjer Tebbens RJ, Thompson KM. Modeling the potential role of inactivated poliovirus vaccine to manage the risks of oral poliovirus vaccine cessation. J Infect Dis. 2014;210 Suppl 1:S485–97.CrossRefPubMed
25.
Wahjuhono G, Revolusiana, Widhiastuti D, Sundoro J, Mardani T, Ratih WU, et al. Switch from oral to inactivated poliovirus vaccine in Yogyakarta Province, Indonesia: summary of coverage, immunity, and environmental surveillance. J Infect Dis. 2014;210 Suppl 1:S347–52.CrossRefPubMed
26.
Thompson KM, Duintjer Tebbens RJ, Pallansch MA, Kew OM, Sutter RW, Aylward RB, et al. The risks, costs, and benefits of possible future global policies for managing polioviruses. Am J Public Health. 2008;98(7):1322–30.CrossRefPubMedPubMedCentral
27.
Duintjer Tebbens RJ, Pallansch MA, Kew OM, Sutter RW, Aylward RB, Watkins M, et al. Uncertainty and sensitivity analyses of a decision analytic model for post-eradication polio risk management. Risk Anal. 2008;28(4):855–76.PubMed
28.
Duintjer Tebbens RJ, Pallansch MA, Kew OM, Cáceres VM, Sutter RW, Thompson KM. A dynamic model of poliomyelitis outbreaks: Learning from the past to help inform the future. Am J Epidemiol. 2005;162(4):358–72.CrossRefPubMed
29.
Grassly NC, Wenger J, Durrani S, Bahl S, Deshpande JM, Sutter RW, et al. Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case–control study. Lancet. 2007;369(9570):1356–62.CrossRefPubMed
30.
31.
Thompson KM, Duintjer Tebbens RJ. Current polio global eradication and control policy options: Perspectives from modeling and prerequisites for OPV cessation. Expert Reviews of Vaccines. 2012;11(4):449–59.CrossRef
32.
Thompson KM, Duintjer Tebbens RJ: Health and economic consequences of different options for timing the coordinated global cessation of the three oral poliovirus vaccine serotypes. doi:10.​1186/​s12879-015-1113-7.
33.
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat; World Population Prospects: The 2012 revision. Volume I: Comprehensive tables. New York, 2013; Report No.: ST/ESA/SER.A/336.
34.
35.
Gold MR, Siegel JE, Russel LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
36.
World Health Organization: WHO guide for standardization of economic evaluations of immunization programmes. Geneva: Initiative for Vaccine Research, Department of Immunization, Vaccine, and Biologicals, 2008; Report No.: WHO/IVB/0814.
37.
38.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Oxford, United Kingdom: Oxford University Press; 2006.CrossRef
39.
Duintjer Tebbens RJ, Thompson KM, Hunink M, Mazzuchi TM, Lewandowski D, Kurowicka D, et al. Uncertainty and sensitivity analyses of a dynamic economic evaluation model for vaccination programs. Med Dec Making. 2008;28(2):182–200.CrossRef
40.
Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Linkins J, Sutter RW, et al. Economic analysis of the Global Polio Eradication Initiative. Vaccine. 2011;29(2):334–43.CrossRef
41.
World Health Organization: Global Polio Eradication Initiative - Financial resource requirements 2013–2018 as of 1 June 2013. Geneva, 2013; Report No.: WHO/POLIO/13.01.
42.
Duintjer Tebbens RJ, Sangrujee N, Thompson KM. The costs of polio risk management policies after eradication. Risk Anal. 2006;26(6):1507–31.CrossRef
43.
Aylward RB, Acharya A, England S, Agocs M, Linkins J. Global health goals: lessons from the worldwide effort to eradicate poliomyelitis. Lancet. 2003;362(9387):909–14.CrossRefPubMed
44.
45.
Hutubessy R, Chisholm D, Edejer TT-T, WHO-CHOICE. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8.CrossRefPubMedPubMedCentral
46.
47.
Duintjer Tebbens RJ, Pallansch MA, Kalkowska DA, Wassilak SG, Cochi SL, Thompson KM. Characterizing poliovirus transmission and evolution: Insights from modeling experiences with wild and vaccine-related polioviruses. Risk Anal. 2013;23(4):703–49.CrossRef
48.
Duintjer Tebbens RJ, Kalkowska DA, Wassilak SGF, Pallansch MA, Cochi SL, Thompson KM. The potential impact of expanding target age groups for polio immunization campaigns. BMC Infect Dis. 2014;14:45.CrossRefPubMedPubMedCentral
49.
Kisjes KH, Duintjer Tebbens RJ, Wallace GS, Pallansch MA, Cochi SL, Wassilak SGF, et al. Individual-based modeling of potential poliovirus transmission in connected religious communities in North America with low uptake of vaccination. J Infect Dis. 2014;210(Supplement 1):S424–33.CrossRefPubMed
50.
Kalkowska DA, Duintjer Tebbens RJ, Thompson KM. Modeling strategies to increase population immunity and prevent poliovirus transmission in the high-risk area of northwest Nigeria. J Infect Dis. 2014;210 Suppl 1:S412–23.CrossRefPubMed
51.
Rahmandad H, Sterman J. Heterogeneity and network structure in the dynamics of diffusion: Comparing agent-based and differential equation models. Manage Sci. 2008;54(5):998–1014.CrossRef
52.
Thompson KM, Duintjer Tebbens RJ. Modeling the dynamics of oral poliovirus vaccine cessation. J Infect Dis. 2014;210 Suppl 1:S475–84.CrossRefPubMed
53.
Dunn G, Klapsa D, Wilton T, Stone L, Minor PD, Martin J. Twenty-eight years of poliovirus replication in an immunodeficient individual: Impact on the Global Polio Eradication Initiative. PLoS Pathog. 2015;11(8):e1005114.CrossRefPubMedPubMedCentral
54.
Duintjer Tebbens RJ, Pallansch MA, Thompson KM: Modeling the prevalence of immunodeficiency-associated long-term vaccine-derived poliovirus excretors and the potential benefits of antiviral drugs. doi:10.​1186/​s12879-015-1115-5
55.
Mulders MN, Reimerink JH, Koopmans MP, van Loon AM, van der Avoort HGAM. Genetic analysis of wild-type poliovirus importation into The Netherlands (1979–1995). J Infect Dis. 1997;176(3):617–24.CrossRefPubMed
56.
57.
Alexander L, Birkhead G, Guerra F, Helms C, Hinman A, Katz S, et al. Ensuring preparedness for potential poliomyelitis outbreaks: Recommendations for the US poliovirus vaccine stockpile from the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP). Archives of Pediatrics and Adolescent Med. 2004;158(12):1106–12.CrossRef
58.
Thompson KM, Wallace GS, Duintjer Tebbens RJ, Smith PH, Barskey AE, Pallansch MA, et al. Trends in the risk of U.S. polio outbreaks and poliovirus vaccine availability for response. Public Health Rep. 2012;127(1):23–37.PubMedPubMedCentral
59.
Oostvogel P, van Wijngaarden J, van der Avoort HG, Mulders MN, Conyn-van Spaendonck MA, Rümke H, et al. Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992–3. Lancet. 1994;344(8923):665–70.CrossRefPubMed
60.
Miller MA, Sutter RW, Strebel PM, Hadler SC. Cost-effectiveness of incorporating inactivated poliovirus vaccine into the routine childhood immunization schedule. JAMA. 1996;276(12):967–71.CrossRefPubMed
61.
Thompson KM, Duintjer Tebbens RJ. Eradication versus control for poliomyelitis: An economic analysis. Lancet. 2007;369(9570):1363–71.CrossRefPubMed
62.
Musgrove P. Is polio eradication in the Americas economically justified? Bull Pan Am Health Organ. 1988;22(1):1–16.PubMed
63.
Bart K, Foulds J, Patriarca P. Global eradication of poliomyelitis: benefit-cost analysis. Bull World Health Organ. 1996;74:35–45.PubMedPubMedCentral
64.
Kahn MM, Ehreth J. Costs and benefits of polio eradication: a long-run global perspective. Vaccine. 2003;21:702–5.CrossRef
65.
Aylward RB, Acharya AK, England S, Agocs M, Linkins J: Polio eradication. In: Global public goods for health: Health economic and public health perspectives. edn. Edited by Smith R, Beaglehole R, Woodward D, Drager N: Oxford University Press; 2003: 33–53.
66.
Griffiths U, Botham L, Schoub BD. The cost-effectiveness of alternative polio immunization policies in South Africa. Vaccine. 2006;24:5670–8.CrossRefPubMed
67.
Tucker AW, Isaacs D, Burgess M. Cost-effectiveness of changing from live oral poliovirus vaccine to inactivated poliovirus vaccine in Australia. Aust N Z J Public Health. 2001;25(5):411–6.CrossRefPubMed
68.
Alvis N, De la Hoz F, Narvaez J. Economic impact of introducing the injectable inactivated polio vaccine in Colombia. Rev Panam Salud Publica. 2010;27(5):352–9.CrossRefPubMed
69.
Duintjer Tebbens RJ, Pallansch MA, Alexander Jr JP, Thompson KM. Optimal vaccine stockpile design for an eradicated disease: Application to polio. Vaccine. 2010;28(26):4312–27.CrossRef
70.
Kalkowska DA, Duintjer Tebbens RJ, Thompson KM. Modeling strategies to increase population immunity and prevent poliovirus transmission in two high-risk areas in northern India. J Infect Dis. 2014;210 Suppl 1:S398–411.CrossRefPubMed
71.
Kalkowska DA, Duintjer Tebbens RJ, Thompson KM. The probability of undetected wild poliovirus circulation after apparent global interruption of transmission. Am J Epidemiol. 2012;175(9):936–49.CrossRefPubMed
72.
Duintjer Tebbens RJ, Pallansch MA, Wassilak SGF, Cochi SL, Thompson KM. Combinations of quality and frequency of immunization activities to stop and prevent poliovirus transmission in the high-risk area of northwest Nigeria. PLoS One. 2015;10(6):e0130123.CrossRefPubMedPubMedCentral
73.
74.
World Health Organization: WHO policy statement: Multi-dose vial policy (MDVP) - Revision 2014. Geneva, 2014; Report No.:WHO/IVB/14.07.
Metadata
Title
An economic analysis of poliovirus risk management policy options for 2013–2052
Authors
Radboud J. Duintjer Tebbens
Mark A. Pallansch
Stephen L. Cochi
Steven G.F. Wassilak
Kimberly M. Thompson
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2015
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-015-1112-8

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