Achieving Polio Eradication: A Need for Innovative Strategies

Objective: The objective of this study was to analyze the current strategies used for eradicating wild polio viruses (WPV) and to propose some innovative strategies that may help to accelerate the progress towards polio eradication. Methods: We assessed the current strategies proposed by the World Health Organization, and the effectiveness of the current trivalent oral polio vaccine types 1, 2 and 3 (tOPV) schedule. Results: With the current schedule, tOPV is given four times to the child during his first year of life. After the four doses, 27%, 10% and 30% of children vaccinated are not immunized against WPV types 1, 2 and 3 respectively. In addition, low access to health care, insufficient funding of the routine immunization activities, and weak health systems hamper the tOPV coverage and the early detection of WPV cases for a rapid outbreak response. All these issues could explain the recurrence of WPV outbreaks, even in countries free of polio for many years. Therefore, we propose for countries of non-polio free regions, a new routine polio vaccination schedule composed of four doses of tOPV, followed by three doses of monovalent OPV type 1, and lastly by three doses of bivalent OPV types 1 and 3. With this schedule, of children fully vaccinated, 100%, 90% and 99% will be immunized against WPV types 1, 2 and 3 respectively. In addition, adequate funding for routine immunization activities and health system strengthening are proposed to accelerate the achievement of the polio eradication goal in a near future. Conclusions: The polio eradication goal is achievable. However, innovative strategies are urgently needed to improve the effectiveness and the efficiency of the routine polio immunization program.