title: An economic analysis of poliovirus risk management policy options for 2013-2052.
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.
authors.affiliation: Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, 32832, USA. rdt@kidrisk.org.
authors.forename: Radboud J
authors.initials: RJ
authors.lastname: Duintjer Tebbens
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. map1@cdc.gov.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pallansch
authors.affiliation: Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. slc1@cdc.gov.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Cochi
authors.affiliation: Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. sgw1@cdc.gov.
authors.forename: Steven G F
authors.initials: SG
authors.lastname: Wassilak
authors.affiliation: Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, 32832, USA. kimt@kidrisk.org.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Thompson
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D004196:Disease Outbreaks; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000473:pathology; D011051:Poliomyelitis / Q000191:economics / Q000517:prevention & control* / Q000635:transmission; D017955:Poliovirus / Q000276:immunology; D011054:Poliovirus Vaccine, Inactivated / Q000191:economics / Q000627:therapeutic use; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage / Q000191:economics; D011446:Prospective Studies; D011634:Public Health / Q000191:economics; D012308:Risk Management / Q000191:economics*; D065288:Serogroup; D014611:Vaccination / Q000191:economics
chemical_list: D000998:Antiviral Agents; D011054:Poliovirus Vaccine, Inactivated; D011055:Poliovirus Vaccine, Oral