Kimberly M. Thompson ^1*, Radboud J. Duintjer Tebbens ¹, Mark A. Pallansch ², Olen M. Kew ², Roland W. Sutter ³, R. Bruce Aylward ³, Margaret Watkins ², Howard E. Gary Jr ², James Alexander ², Hamid Jafari ², Stephen L. Cochi ²

¹ Kids Risk Project, Harvard School of Public Health
² Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease
³ Health Organization, Polio Eradication Initiative

^* To whom correspondence should be addressed. E-mail: kimt{at}hsph.harvard.edu.

	Abstract

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.

Key Words: Child and Adolescent Health, Global Health, Health Policy, Infections, Statistics/Evaluation/Research