Polio switch strategy: An obituary in the making?

Abstract

India was certified free of polio in 2014. Until now, the oral polio vaccine (OPV) was being used in India. As the OPV is a live vaccine, vaccine-associated paralytic poliomyelitis may occur after its use. The aim is to replace the OPV with injectable polio vaccine. The Polio Eradication and Endgame Strategic Plan 2013–2018 has been made to eradicate polio. A switch from the trivalent OPV (tOPV) to bivalent OPV (bOPV) has been undertaken in all countries since April 2016. tOPV vials have been withdrawn and replaced by bOPV. In addition, the inactivated polio vaccine (IPV) has been introduced. The next step would be to remove the type 3 virus component followed by complete cessation of the OPV and a final switch to the IPV. The timeline has been fixed as 2018–2019. Replacement of a vaccine may raise fears in the community that need to be addressed. Re-emergence of circulating vaccine-derived poliovirus after withdrawal of the tOPV may occur. Proper disposal of vaccine vials needs to be ensured. Proper training of vaccinators is important. All stakeholders need to be incorporated, and focus should be more on deprived populations. The switch marks a significant step towards the final goal of polio eradication. Finally, the importance of community participation cannot be overemphasized. Sustained surveillance is the key to prevent occurrence of cases in polio-free countries through importation.