Outcomes of the Polio Research Committee (PRC)
The fifth meeting of the Polio Research Committee (PRC) was convened at the World Health Organization (WHO) in Geneva, Switzerland in June 2010, to review current research projects, unmet research needs and evaluate new research proposals.
The PRC reviewed the current status of the global polio eradication programme and ongoing research projects to support the pre-eradication era (eg outbreak investigation, laboratory methods, cost-effectiveness, operational and social research) and post-eradication era (eg antivirals, monoclonal antibody, adjuvant and Sabin IPV development).
The PRC subsequently reviewed more than 20 proposals and endorsed seven new projects (worth a total of US$2.5 million). The new projects include two communication research projects, two seroprevalence studies, a case-control study on mucosal immunity, an alternate seed-strain development project and an intradermal device development project.
Now that many research questions are being addressed by existing projects and the priorities are shifting rapidly as polio epidemiology is evolving, the PRC is in the process of updating a list of resarch priorities, which will be published later in 2010.
Assessing the role of IPV in pre- and post-eradication eras
As progress continues towards the interruption of wild poliovirus transmission globally, a substantial programme of work is ongoing to better understand the role inactivated polio vaccine (IPV) could play in both the pre- and post-eradication eras.
On 4 June 2010, WHO published1 new guidance to Member States on the use of polio vaccines (including IPV) and polio immunization in the pre-eradication era. Developed with guidance from the Strategic Advisory Group of Experts on immunization (SAGE) and the SAGE Working Group on IPV, the new WHO Position Paper assists countries with decision-making on polio vaccination schedules and vaccines, given their risk of poliovirus importations and the probable transmission potential for polioviruses in their country.
A second publication2 summarizes the findings of a study that was commissioned by the Bill and Melinda Gates Foundation in collaboration with WHO to assess the supply landscape and economics of IPV-containing combination vaccines that would be affordable and appropriate for use in low- and low-middle income countries in the post-eradication era. This study, conducted by the international management consulting firm Oliver Wyman, also identifies and explores the range and feasibility of innovations needed to achieve IPV-containing hexavalent products that could approach the break-even price for future pentavalent products and stand-alone IPVs in low-income settings.
A report3 by PATH and Working in Tandem Ltd gives an overview of an economic model, which calculated the costs involved in delivering IPV intradermally (ID), including with new delivery methods such as needle-free jet injection or ID adaptors (to control the depth and angle of the ID injection), at reduced volumes of vaccine per dose; use of adjuvants to allow a reduced antigen content per dose; and, reduced number of doses per IPV immunization schedule. The report suggests such delivery methods could result in per-dose savings of 71-83% compared with the current, standard IPV dose delivered intramuscularly using a needle and syringe. The report concludes that as there are still substantial development risks with each approach, all three strategy options should be pursued given the potential cost savings which could be achieved.
The insights and conclusions from these and other studies and assessments will help further elucidate polio immunization policy. For more information, please see section 6 (Post-wild poliovirus eradication planning) of the new GPEI Strategic Plan 2010-2012.
1Polio vaccines and polio immunization in the pre-eradiation era: WHO position paper. Weekly Epidemiological Record. No. 23, 2010, 85, 213-228.
2The supply landscape and economics of IPV-containing combination vaccines: key findings. Commissioned by the Bill and Melinda Gates Foundation. Prepared by Oliver Wyman, May 2010. Available at www.polioeradication.org.
3Improving the affordability of inactivated poliovirus vaccines (IPV) for use in low- and middle-income countries - an economic analysis of strategies to reduce the cost of routine IPV immunization. PATH and Working in Tandem Ltd. April 2010. Available at www.polioeradication.org.