Inactivated polio vaccine support

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The IPV programme is being implemented at record speed

10 million children immunised with Gavi support by the end of 2015

First child in Nepal to be immunized with IPV since its introduction into the routine immunization schedule.

In September 2014, Nepal became the first country to introduce inactivated polio vaccine into the routine immunisation schedule with Gavi support.
Credit: UNICEF Nepal/2014.

The Vaccine Alliance supports one of the fastest roll-outs in the history of vaccination: the introduction of at least one dose of inactivated polio vaccine (IPV) into the routine immunisation schedules of all Gavi countries.

Nepal became the first Gavi-supported country to introduce the vaccine in September 2014, just 10 months after the programme was initiated. By the end of 2015, all 71 eligible countries had been approved for IPV support and 38 had successfully completed their introductions.

The sheer pace and scale of IPV introductions, coupled with the technical difficulties of increasing production and the increased use of the vaccine for campaigns, has, however, led to severe supply constraints. This has pushed the global IPV roll-out off schedule, with at least 40 countries delaying their scheduled IPV introductions due to supply shortages.

To eliminate the risk of vaccine-derived polio cases, the Polio Eradication and Endgame Strategic Plan calls for the phased removal of oral polio vaccines (OPV) – a critical step towards polio eradication. The process started in April 2016 with the replacement of trivalent OPV, containing type 2 virus, by bivalent OPV, comprising poliovirus types 1 and 3 only.

To minimise the risks associated with the switch, WHO recommended that all countries introduce at least one dose of IPV into their routine immunisation schedule before the transition. IPV provides protection against all three poliovirus types. Because of supply constraints, however, 21 countries – all at low risk of polio outbreaks – did not introduce IPV until after the switch.

With supply constraints expected to remain until at least 2018, the Immunisation Systems Management Group, responsible for managing and coordinating partners’ activities to achieve objective 2 of the Polio Endgame (the introduction of at least one dose of IPV into routine immunisation schedules), is prioritising countries most at risk of type 2 polio outbreaks.

One way to mitigate the supply shortage, currently pursued by India and Sri Lanka, is to twice administer a fraction (one-fifth) of the full dose of IPV. While complex to implement, studies show that it provides at least as much protection as one full dose of IPV.

Following a 2014 tender for IPV, the vaccine is available to Gavi-supported countries from as little as €0.75 per dose. Middle-income countries are able to buy the vaccine through UNICEF for between €1.49 and €2.40 per dose.

Three countries are still polio-endemic

There is no cure for polio but it can be prevented with a vaccine

Crippling, potentially fatal

Polio is a highly contagious viral infection, mainly affecting children under the age of five, which can lead to paralysis or even death.

Many infected people have no symptoms but they still excrete the virus, transmitting infection to others. In areas with poor sanitation, the virus easily spreads through contaminated water or food.

One in 200 infections leads to irreversible paralysis, usually in the legs. Among those paralysed, 5–10% die when their breathing muscles become immobilised.

Global polio eradication efforts

Polio can only be prevented with a vaccine, as there is no cure. Multiple doses are required, usually providing life-long protection.

When the Global Polio Eradication Initiative (GPEI) was launched in 1988, polio was endemic in 125 countries and paralysed about 1,000 children per day. Thanks to global efforts and vaccination, polio cases have fallen by 99% since then, from an estimated 350,000 cases a year to 74 reported cases in 2015.

Today, more than 15 million people are walking who would otherwise have been paralysed by the poliovirus. India, once the world’s epicentre of polio, has been polio-free since January 2011. Only parts of three countries – Afghanistan, Nigeria and Pakistan – remain polio-endemic.

POLIO’S FINAL MILE

As long as a child anywhere remains infected with polio, children in all countries are at risk. Half of the polio cases in the 2009–2011 period resulted largely from weak immunisation and health systems, accessibility and security issues.1 In the past decade, polio has spread to over 20 polio-free countries from endemic areas.

Today, Pakistan and Afghanistan carry the burden of wild polio cases, but as outbreaks in Ukraine and Mali have shown, a weakened health system and persistent low immunisation coverage rates can quickly reverse the gains.

In May 2013, the World Health Assembly endorsed the new Polio Eradication & Endgame Strategic Plan 2013–2018, calling on countries to introduce at least one dose of the inactivated polio vaccine (IPV) and begin the phased removal of oral polio vaccines (OPV).

All countries successfully switched from the trivalent OPV to the bivalent OPV in April 2016 – removing the type 2 component of the vaccine as type 2 wild poliovirus has already been eradicated. This, in turn, will lead to the complete removal of the live-attenuated oral vaccine, which is necessary to eliminate the risk of vaccine-associated polio outbreaks.

The introduction of IPV is a critical step to manage potential risks associated with this phased removal. Adding IPV to routine immunisation programmes will improve immunity and help to prevent further OPV-associated outbreaks from emerging.

Overcoming the final 1% of polio cases is similar to completing a marathon – the final stretch is often the most difficult to complete, takes the most focused effort and yet can be the most rewarding.

A 2010 study2 estimates that polio eradication could provide at least US$ 40–50 billion in net benefits for the world’s poorest countries, primarily from avoided treatment costs and productivity gains.

The wild poliovirus remains endemic in Afghanistan, Nigeria and Pakistan. The Global Polio Eradication Initiative has thus extended its deadline for eradicating polio from 2018 to 2019.

The Global Polio Eradication Initiative (GPEI) is a public-private partnership led by national governments and spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), and UNICEF. Its goal is to eradicate polio worldwide.


1 GPEI Polio Eradication & Endgame Strategic Plan 2013 -2018, p9

2 Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Linkins J, Sutter RW, Aylward RB, Thompson KM. Economic analysis of the Global Polio Eradication Initiative. Vaccine 2011;29(2):334-343.

Gavi supports the Polio Endgame through the introduction of inactivated polio vaccine into routine immunisation programmes

Supporting the Polio Endgame

To complement the efforts of the Global Polio Eradication Initiative (GPEI), Gavi is using its experience in supporting new vaccine introductions to facilitate the rapid roll-out of inactivated polio vaccine (IPV). This will help meet the unprecedented timelines of the Polio Eradication and Endgame Strategic Plan.

Gavi supports the introduction of IPV with funding from GPEI in eligible countries and helps to strengthen routine immunisation programmes.

IPV introduction

The Vaccine Alliance continues to support one of the fastest roll-outs in the history of vaccination: the introduction of at least one dose of IPV into the routine immunisation schedules of Gavi-supported countries.

Countries introducing IPV receive a one-time cash grant from Gavi, funded by GPEI, to support some of the additional activity costs related to introducing the new vaccine. These activities may include health worker training, social mobilisation, micro-planning, expansion or rehabilitation of cold chain equipment, printing of materials (such as immunisation cards), technical assistance and modifications to the surveillance systems.

STRENGTHENING ROUTINE IMMUNISATION

Routine immunisation is the sustainable, reliable and timely interaction between the vaccine, those who deliver it and those who receive it to ensure every person is fully immunised against vaccine-preventable diseases.

Strengthening routine immunisation is a pillar of the polio eradication strategy. High coverage provides a strong base for population immunity to prevent polio outbreaks and builds a sustainable platform for the introduction of IPV and other life-saving vaccines.

In polio-endemic countries, the virus persists in marginalised populations where health and immunisation services are largely non-existent, and where oversight and management of primary health care systems are weak.

However, the poliovirus cannot survive for long periods outside the human body. Without an unvaccinated person to infect, the polio virus will die out. As a result, strengthening routine immunisation is a critical factor in successfully interrupting all poliovirus transmission.

Polio endgameGavi is working with GPEI and other key partners to strengthen routine immunisation in 10 focus countries targeted by the Polio Endgame Strategy. The countries (Afghanistan, Angola, Chad, DR Congo, Ethiopia, India, Nigeria, Pakistan, Somalia, South Sudan) all have significant numbers of partially and non-vaccinated children. 

These efforts benefit from the expertise developed by GPEI since 1988 to support and strengthen broader immunisation activities.

Maximise, manage, mobilise, monitor

Strengthening routine immunisation involves:

  • maximising the reach of vaccines through a well-functioning supply and cold chain system, detecting unreached groups, efficient service delivery and the capacity building of vaccinators and supervisors;
  • managing programmes with strong political and management support, effective planning, as well as policy and strategy development;
  • mobilising people to generate demand through community and caretaker engagement; and
  • monitoring programme performance with rigorous disease surveillance, data analysis and evaluation.

Together, routine immunisation and polio assets amplify each other’s impact towards a polio-free world, and towards improving health overall.

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