Research underpins new roadmap to a polio-free world

In 2008, alarmed that polio remained entrenched in the four countries which had never stopped transmission of wild poliovirus, the World Health Assembly (WHA) called for the development of a new strategy to complete polio eradication. Since then, the Global Polio Eradication Initiative (GPEI) introduced a major programme of work to help develop new approaches to interrupt the remaining chains of wild poliovirus transmission. Underpinning the finalization of this new Strategic Plan has been an accelerated research agenda to develop and evaluate new tools and approaches that directly tackle the remaining barriers to eradication in the lingering polio endemic areas, that facilitate a swifter, more thorough outbreak response, and that limits renewed international spread of polio.

The accelerated research agenda has focused on a vast array of cross-cutting and country-specific studies. The game-changing bivalent oral polio vaccine (OPV) was evaluated and developed in record time; the Short Interval Additional Dose (SIAD) strategy was introduced in conflict-affected and outbreak settings; social research was conducted to tailor social mobilization strategies in India, Nigeria and Pakistan; trials were held to more clearly assess vaccine efficacy in multiple settings; seroconversion studies focused on validating supplementary immunization activity (SIA) performance in key reservoir areas; and, mathematical modelling and case-control studies were employed to more clearly highlight areas at particular risk of outbreaks following re-infection. New methods to monitor SIA operations were pioneered to help guide mid-course corrections and new strategies were examined to further boost the efficacy of OPVs and close susceptibility gaps in targeted communities. Finally, supplemental surveillance strategies - including expanding environmental surveillance to key urban reservoir areas - were explored.

All of these new approaches, the implementation of which has already had a significant epidemiological impact, particularly in the traditional reservoir areas of northern India and northern Nigeria, have now been institutionalized in the published GPEI Strategic Plan 2010-2012, which was endorsed by the WHA in May. Mr Bill Gates, co-chair of the Bill and Melinda Gates Foundation, told the United States Congress in March 2010 that this new Plan will "strike at the final reservoirs of polio and consign this terrible virus to history".

There has never been a better opportunity to achieve a polio-free world, as the GPEI is now armed with the required insight and knowledge to tackle the remaining challenges. Due to the fact research will play a key role in both monitoring the implementation of the new strategy and in further sensitizing the approaches, this issue of Polio Pipeline examines in greater depth the role research has played in developing this new strategy, and how it will contribute to its implementation.