Eradication versus control for poliomyelitis

Abstract

Kimberly Thompson and Radboud Duintjer Tebbens model the economic and health effects of strategies for poliomyelitis eradication and control. They conclude that eradication (defined as the interruption of wild polio virus transmission globally) is less costly and more effective than control. Thompson and Radboud previously estimated a 50-100% chance of a poliomyelitis outbreak within 20 years of eradication and oral polio vaccine cessation. Sustained eradication is not achievable without continued vaccination. As Paul Fine and Ulla Griffiths correctly note in their accompanying Comment use of live vaccine to control future outbreaks is fighting fire with fire. To leave future birth cohorts unprotected would be irresponsible given the acknowledged chance for future infections possibly at older ages when there is an increased rate of paralytic poliomyelitis per infection. Any discussion of the economic cost of polio eradication should include a transparent and pragmatic assessment of the posteradication options from the outset. A realistic estimate of the cost of sustainable poliomyelitis eradication must include the cost of continued vaccination-about US$3-6 billion every 20 years for low-income countries only in line with other estimates of $20-24 billion for the entire world. Claimed funding shortfalls for the Global Polio Eradication Initiative (GPEI) of $575 million are therefore illusory. Semantic redefinitions of polio eradication might serve political goals and promises but should not come at the jeopardy of poor countries that look for public-health guidance. GPEI can celebrate the striking reductions in poliomyelitis. Failure to ensure long-term protection by not accounting for the continued need for vaccination would risk greater incidence and be negligent. (full text)