Publication Date
Publication Date: 
July 1, 2017

"All in all, the work summarized in this supplement demonstrates that, with proper support, country immunization programs have a strong capacity to absorb and adapt to new global health initiatives in immunization, which are ultimately designed to reduce the burden of infectious diseases and provide healthier lives for children worldwide."

This special open-access edition of The Journal of Infectious Diseases focuses on efforts, including communication-centred efforts, by global partners to successfully launch polio endgame activities to permanently secure and sustain the gains of polio eradication. As Manish Patel and Stephen Cochi, both affiliated with one of the Global Polio Eradication Initiative (GPEI) partners, the Centers for Disease Control and Prevention (CDC), indicate, the Global Commission for the Certification of the Eradication of Poliomyelitis certified the eradication of type 2 poliovirus in September 2015, making type 2 poliovirus the first human pathogen to be eradicated since smallpox. The eradication of type 2 poliovirus, the absence of detection of type 3 poliovirus worldwide since November 2012, and cornering type 1 poliovirus to only a few geographic areas of 3 countries (Afghanistan, Pakistan, and Nigeria) has enabled implementation of the endgame of polio eradication. "Polio eradication efforts are resource intensive and cannot go on forever. Once transmission of wild viruses has been interrupted and eradication certified, a narrow window of time exists within which the endgame must be accomplished."

In that context, contributors to the volume explore the operationalisation of efforts to ensure a successful polio endgame, including essential changes in global polio vaccination policy, namely, the beginning of phased withdrawal of oral poliovirus vaccine (OPV) combined with the introduction of inactivated poliovirus vaccine (IPV), as well as the launching of activities to document the transition of polio resources, lessons, and learnings to other priority global health initiatives.

The supplement is not a comprehensive representation of all work in the global arena related to the polio endgame. Rather, it provides a glimpse of key activities within the key domains of the endgame across global, regional, and national levels. For example, several of the articles - linked directly in the table of contents below - have a core focus on the communication elements of the transition. Short excerpts from three of them follow:

  • In "Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support", Lisa Menning et al. examine implementation of IPV introduction and the switch from trivalent OPV (containing types 1, 2, and 3 poliovirus) to bivalent OPV (containing types 1 and 3 poliovirus), noting that it "called for intense global communications and coordination on an unprecedented scale from 2014 to 2016, involving global public health technical agencies and donors, vaccine manufacturers, World Health Organization and United Nations Children’s Fund regional offices, and national governments. At the outset, the new program requirements were perceived as challenging to communicate, difficult to understand, unrealistic in terms of timelines, and potentially infeasible for logistical implementation. In this context, a number of core areas of work for communications were established: (1) generating awareness and political commitment via global communications and advocacy; (2) informing national decision-making, planning, and implementation; and (3) in-country program communications and capacity building, to ensure acceptance of IPV and continued uptake of OPV. Central to the communications function in driving progress for objective 2 was its ability to generate a meaningful policy dialogue about polio vaccines and routine immunization at multiple levels. This included efforts to facilitate stakeholder engagement and ownership, strengthen coordination at all levels, and ensure an iterative process of feedback and learning. This article provides an overview of the global efforts and challenges in successfully implementing the communications activities to support objective 2. Lessons from the achievements by countries and partners will likely be drawn upon when all OPVs are completely withdrawn after polio eradication, but also may offer a useful model for other global health initiatives."
  • In "Legacy of Polio-Use of India's Social Mobilization Network for Strengthening of the Universal Immunization Program in India", Nicole Deutsch et al. explore the Social Mobilization Network (SMNet), which "has been lauded as one of the most successsful community engagement strategies in public health for its role in polio elimination in India. The UNICEF-managed SMNet was created as a strategy to eradicate polio by engaging >7000 frontline social mobilizers to advocate for vaccination in some of the most underserved, marginalized, and at-risk communities in India. This network focused initially on generating demand for polio vaccination but later expanded its messaging to promote routine immunization and other health and sanitation interventions related to maternal and children's health. As an impact of the network's interventions, in collaboration with other eradication efforts, these high-risk pockets witnessed an increase in full routine immunization coverage. The experience of the SMNet offers lessons for health-system strengthening for social mobilization and promoting positive health behaviors for other priority health programs like the Universal Immunization Program."
  • In "Placing Human Behavior at the Center of the Fight to Eradicate Polio: Lessons Learned and Their Application to Other Life-Saving Interventions", Sherine Guirguis et al. articulate "what happened when the GPEI began to pay more attention to the dynamics of human and social behavior change. Three particular lessons for other health and immunization programs can be drawn from the experience of GPEI: change begins from within (ie, success needs institutional recognition of the importance of human behavior), good data are not enough for good decision-making, and health workers are important agents of behavior change. These lessons should be harnessed and put into practice to build demand and trust for the last stages of polio eradication, as well as for other life-saving health interventions."

Table of Contents:
"Addressing the Challenges and Opportunities of the Polio Endgame: Lessons for the Future" [Editor's Note], by Manish Patel and Stephen Cochi

"Polio Endgame: Lessons Learned From the Immunization Systems Management Group", by Simona Zipursky, Jos Vandelaer, Alan Brooks, Vance Dietz, Tasleem Kachra, Margaret Farrell, Ann Ottosen, John L. Sever, and Michel J. Zaffran

Strategy and Coordination

  • "Lessons Learned From Managing the Planning and Implementation of Inactivated Polio Vaccine Introduction in Support of the Polio Endgame", by Simona Zipursky, Manish Patel, Margaret Farrell, Alejandro Ramirez Gonzalez, Tasleem Kachra, Yann Folly, Feyrouz Kurji, Chantal Laroche Veira, Emily Wootton, and Lee M. Hampton
  • "Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support", by Lisa Menning, Gaurav Garg, Deepa Pokharel, Elizabeth Thrush, Margaret Farrell, Frederic Kunjbe Kodio, Chantal Laroche Veira, Sarah Wanyoike, Suleman Malik, Manish Patel, and Oliver Rosenbauer
  • "A Supply and Demand Management Perspective on the Accelerated Global Introductions of Inactivated Poliovirus Vaccine in a Constrained Supply Market", by Ian Lewis, Ann Ottosen, Jennifer Rubin, Diana Chang Blanc, Simona Zipursky, and Emily Wootton
  • "Managing the Planned Cessation of a Global Supply Market: Lessons Learned From the Global Cessation of the Trivalent Oral Poliovirus Vaccine Market", by Jennifer Rubin, Ann Ottosen, Andisheh Ghazieh, Jacqueline Fournier-Caruana, Abraham Kofi Ntow, and Alejandro Ramirez Gonzalez
  • "Regulatory Aspects of Sabin Type 2 Withdrawal From Trivalent Oral Poliovirus Vaccine: Process and Lessons Learned", by Daniela Decina, Jacqueline Fournier-Caruana, Marina Takane, Razieh Ostad Ali Dehaghi, and Roland Sutter
  • "Exceptional Financial Support for Introduction of Inactivated Polio Vaccine in Middle-Income Countries", by Anne-Line Blankenhorn, Tania Cernuschi, and Michel J. Zaffran
  • "Financial Support to Eligible Countries for the Switch From Trivalent to Bivalent Oral Polio Vaccine - Lessons Learned", by Stephanie Shendale, Margaret Farrell, Lee M. Hampton, Jennifer B. Harris, Tasleem Kachra, Feyrouz Kurji, Manish Patel, Alejandro Ramirez Gonzalez, and Simona Zipursky

IPV Introduction and the Switch

  • "Introduction of Inactivated Poliovirus Vaccine and Trivalent Oral Polio Vaccine/Bivalent Oral Polio Vaccine Switch in the African Region", by Carol Tevi-Benissan, Joseph Okeibunor, Gaël Maufras du Châtellier, Afework Assefa, Joseph Nsiari-Muzenyi Biey, Dah Cheikh, Messeret Eshetu, Blanche-Philomene Anya, Halima Dao, Yusuf Nasir, Bartholomew Dicky Akanmori, and Richard Mihigo
  • "Systematization of the Introduction of IPV and Switch from tOPV to bOPV in the Americas", by Cristina Pedreira, Elizabeth Thrush, and Barbara Jauregui
  • "Introduction of Inactivated Polio Vaccine, Withdrawal of Type 2 Oral Polio Vaccine, and Routine Immunization Strengthening in the Eastern Mediterranean Region", by Kamal Fahmy, Lee M. Hampton, Houda Langar, Manish Patel, Tahir Mir, Chandrasegarar Soloman, Andreas Hasman, Nasir Yusuf, and Nadia Teleb
  • "The Switch From Trivalent to Bivalent Oral Poliovirus Vaccine in the South-East Asia Region", by Sunil Bahl, Andreas Hasman, Abu Obeida Eltayeb, Douglas James Noble, and Arun Thapa
  • "Experience With Inactivated Polio Vaccine Introduction and the 'Switch' From Trivalent to Bivalent Oral Polio Vaccine in the World Health Organization's Western Pacific Region", by Santosh Gurung, Jennifer B Harris, Abu Obeida Eltayeb, Lee M Hampton, Sergey Diorditsa, Tigran Avagyan, and W. William Schluter
  • "The Role of National Immunization Technical Advisory Groups (NITAGs) in the Introduction of Inactivated Polio Vaccine: Experience of the Indonesia and Uganda NITAGs", by Antoinette Ba-Nguz, Alex Adjagba, Toto Wisnu Hendrarto, Nelson K. Sewankambo, Celia Nalwadda, and Annette Kisakye
  • "Cold-Chain Adaptability During Introduction of Inactivated Polio Vaccine in Bangladesh, 2015", by Mallick M. Billah, K. Zaman, Concepcion F. Estivariz, Cynthia J. Snider, Abhijeet Anand, Lee M. Hampton, Tajul I. A. Bari, Kevin L. Russell, and Shua J. Chai
  • "Lessons Learned From the Introduction of Inactivated Poliovirus Vaccine in Bangladesh", by Concepcion F. Estivariz, Cynthia J. Snider, Abhijeet Anand, Lee M. Hampton, Tajul I. Bari, Mallick M. Billah, Shua J. Chai, Steven G. Wassilak, James D. Heffelfinger, and K. Zaman
  • "Succeeding in New Vaccine Introduction: Lessons Learned From the Introduction of Inactivated Poliovirus Vaccine in Cameroon, Kenya, and Nigeria", by Soleine Scotney, Sarah Snidal, Yauba Saidu, Abiola Ojumu, Antony Ngatia, Murtala Bagana, Faith Mutuku, Joelle Sobngwi, Oniovo Efe-Aluta, Julia Roper, Yann LeTallec, and Alice Kang'ethe
  • "Assessing Inactivated Polio Vaccine Introduction and Utilization in Kano State, Nigeria, April-November 2015", by Lynda U. Osadebe, Adam MacNeil, Hashim Elmousaad, Lora Davis, Jibrin M. Idris, Suleiman A. Haladu, Olorunsogo B. Adeoye, Patrick Nguku, Uneratu Aliu-Mamudu, Elizabeth Hassan, John Vertefeuille, and Peter Bloland
  • "Acceptance of the Administration of Multiple Injectable Vaccines in a Single Immunization Visit in Albania", by Iria Preza, Saleena Subaiya, Jennifer B. Harris, Daniel C. Ehlman, Kathleen Wannemuehler, Aaron S. Wallace, Shahin Huseynov, Terri B. Hyde, Erida Nelaj, Silvia Bino, and Lee M. Hampton
  • "Administering Multiple Injectable Vaccines During a Single Visit - Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally", by Samantha B. Dolan, Manish Patel, Lee M. Hampton, Eleanor Burnett, Daniel C. Ehlman, Julie Garon, Emily Cloessner, Elizabeth Chmielewski, Terri B. Hyde, Carsten Mantel, and Aaron S. Wallace
  • "Intradermal Administration of Fractional Doses of Inactivated Poliovirus Vaccine: A Dose-Sparing Option for Polio Immunization", by Hiromasa Okayasu, Carolyn Sein, Diana Chang Blanc, Alejandro Ramirez Gonzalez, Darin Zehrung, Courtney Jarrahian, Grace Macklin, and Roland W. Sutter
  • "Lessons From Globally Coordinated Cessation of Serotype 2 Oral Poliovirus Vaccine for the Remaining Serotypes", by Kimberly M. Thompson and Radboud J. Duintjer Tebbens
  • "Lessons From the Polio Endgame: Overcoming the Failure to Vaccinate and the Role of Subpopulations in Maintaining Transmission", by Kimberly M. Thompson and Radboud J. Duintjer Tebbens
  • "Implementing the Synchronized Global Switch from Trivalent to Bivalent Oral Polio Vaccines - Lessons Learned From the Global Perspective", by Alejandro Ramirez Gonzalez, Margaret Farrell, Lisa Menning, Julie Garon, Hans Everts, Lee M. Hampton, Samantha Dolan, Stephanie Shendale, Sarah Wanyoike, Chantal Laroche Veira, Gaël Maufras du Châtellier, Feyrouz Kurji, Jennifer Rubin, Liliane Boualam, Diana Chang Blanc, and Manish Patel
  • "Monitoring and Validation of the Global Replacement of tOPV with bOPV, April-May 2016", by Margaret Farrell, Lee M. Hampton, Stephanie Shendale, Lisa Menning, Alejandro Ramirez Gonzalez, Julie Garon, Samantha Dolan, Gaël Maufras du Châtellier, Sarah Wanyoike, Diana Chang Blanc, and Manish Patel
  • "Disposing of Excess Vaccines After the Withdrawal of Oral Polio Vaccine", by Sarah Wanyoike, Alejandro Ramirez Gonzalez, Samantha Dolan, Julie Garon, Chantal Laroche Veira, Lee M. Hampton, Diana Chang Blanc, and Manish Patel
  • "Resource Needs for the Trivalent Oral Polio to Bivalent Oral Polio Vaccine Switch in Indonesia", by Marionette Holmes, Taiwo Abimbola, Merry Lusiana, Sarah Pallas, Lee M. Hampton, Retno Widyastuti, Idawati Muas, Karlina Karlina, and Soewarta Kosen
  • "Considerations for the Full Global Withdrawal of Oral Polio Vaccine After Eradication of Polio", by Lee M. Hampton, Gaël Maufras du Châtellier, Jacqueline Fournier-Caruana, Ann Ottosen, Jennifer Rubin, Lisa Menning, Margaret Farrell, Stephanie Shendale, and Manish Patel

Strengthening Immunization Services

  • "Monitoring Results in Routine Immunization: Development of Routine Immunization Dashboard in Selected African Countries in the Context of the Polio Eradication Endgame Strategic Plan", by Alain Poy, Maya M. V. X. van den Ent, Stephen Sosler, Alan R. Hinman, Sidney Brown, Samir Sodha, Daniel C. Ehlman, Aaron S. Wallace, and Richard Mihigo
  • "Individually Linked Household and Health Facility Vaccination Survey in 12 At-risk Districts in Kinshasa Province, Democratic Republic of Congo: Methods and Metadata", by Eleanor Burnett, Kathleen Wannemuehler, Guillaume Ngoie Mwamba, Masembe Yolande, Kaya Guylain, Nzazi Nsambu Muriel, Nzuzi Cathy, Tshekoya Patrice, Karen Wilkins, and Norbert Yoloyolo
  • "Contribution of Global Polio Eradication Initiative-Funded Personnel to the Strengthening of Routine Immunization Programs in the 10 Focus Countries of the Polio Eradication and Endgame Strategic Plan", by Maya M. V. X. van den Ent, Rachel D. Swift, Sameer Anaokar, Lea Anne Hegg, Rudolf Eggers, and Stephen L. Cochi
  • "Experiences and Lessons From Polio Eradication Applied to Immunization in 10 Focus Countries of the Polio Endgame Strategic Plan", by Maya M. V. X. van den Ent, Apoorva Mallya, Hardeep Sandhu, Blanche-Philomene Anya, Nasir Yusuf, Marcelline Ntakibirora, Andreas Hasman, Kamal Fahmy, John Agbor, Melissa Corkum, Kyandindi Sumaili, Anisur Rahman Siddique, Jane Bammeke, Fiona Braka, Rija Andriamihantanirina, Antoine-Marie C. Ziao, Clement Djumo, Moise Desire Yapi, Stephen Sosler, and Rudolf Eggers
  • "Legacy of Polio-Use of India's Social Mobilization Network for Strengthening of the Universal Immunization Program in India", by Nicole Deutsch, Prem Singh, Vivek Singh, Rod Curtis, and Anisur Rahman Siddique
  • "Use of Dedicated Mobile Teams and Polio Volunteer Community Mobilizers to Increase Access to Zero-Dose Oral Poliovirus Vaccine and Routine Childhood Immunizations in Settlements at High Risk for Polio Transmission in Northern Nigeria", by Kennedy M. Ongwae, Samuel B. Bawa, Faisal Shuaib, Fiona Braka, Melissa Corkum, and Hammanyero K. Isa
  • "Routine Immunization Service Delivery Through the Basic Package of Health Services Program in Afghanistan: Gaps, Challenges, and Opportunities", by Chukwuma Mbaeyi, Noor Shah Kamawal, Kimberly A. Porter, Adam Khan Azizi, Iftekhar Sadaat, Stephen Hadler, and Derek Ehrhardt
  • "Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal", by Aaron S. Wallace, Rajendra Bohara, Steven Stewart, Giri Subedi, Abhijeet Anand, Eleanor Burnett, Jagat Giri, Jagat Shrestha, Suraj Gurau, Sameer Dixit, Rajesh Rajbhandari, and W. William Schlute

Polio Transition

  • "Transition Planning For After Polio Eradication", by Paul D. Rutter, Alan R. Hinman, Lea Hegg, Dennis King, Stephen Sosler, Virginia Swezy, Ann Lee Hussey, and Stephen L. Cochi
  • "Using Acute Flaccid Paralysis Surveillance as a Platform for Vaccine-Preventable Disease Surveillance", by Steven G. F. Wassilak, Cheryl L. Williams, Christopher S. Murrill, Benjamin A. Dahl, Chima Ohuabunwo, and Rudolf H. Tangermann
  • "The Global Polio Laboratory Network as a Platform for the Viral Vaccine-Preventable and Emerging Diseases Laboratory Networks", by Ousmane M. Diop, Olen M. Kew, Esther M. de Gourville, and Mark A. Pallansch
  • "Transitioning Lessons Learned and Assets of the Global Polio Eradication Initiative to Global and Regional Measles and Rubella Elimination", by Katrina Kretsinger, Peter Strebel, Robert Kezaala, and James L. Goodson
  • "Lessons Learned and Legacy of the Stop Transmission of Polio Program", by Yinka Kerr, Melinda Mailhot, Alford (A. J.) Williams, Virginia Swezy, Linda Quick, Rudolf H. Tangermann, Kirsten Ward, Amalia Benke, Anna Callaghan, Kathleen Clark, Brian Emery, Jessica Nix, Eleanor Aydlotte, Charlotte Newman, and Benjamin Nkowane
  • "Expansion of Surveillance for Vaccine-preventable Diseases: Building on the Global Polio Laboratory Network and the Global Measles and Rubella Laboratory Network Platforms", by Mick N. Mulders, Fatima Serhan, James L. Goodson, Joseph Icenogle, Barbara W. Johnson, and Paul A. Rota
  • "Placing Human Behavior at the Center of the Fight to Eradicate Polio: Lessons Learned and Their Application to Other Life-Saving Interventions", by Sherine Guirguis, Rafael Obregon, Michael Coleman, Benjamin Hickler, and Gillian SteelFisher
  • "Mapping for Health in Cameroon: Polio Legacy and Beyond", by Louie C. Rosencrans, Gerald E. Sume, Jean-Christian Kouontchou, Arend Voorman, Yaw Anokwa, Maurice Fezeu, and Vincent Y. Seaman
  • "The Public Health Legacy of Polio Eradication in Africa", by Allen S. Craig, Rustam Haydarov, Helena O'Malley, Michael Galway, Halima Dao, Ngashi Ngongo, Marie Therese Baranyikwa, Savita Naqvi, Nima S. Abid, Carol Pandak, and Amy Edwards
  • "National, Regional and Global Certification Bodies for Polio Eradication: A Framework for Verifying Measles Elimination", by S. Deblina Datta, Rudolf H. Tangermann, Susan Reef, W. William Schluter, and Anthony Adams
  • "Rotary's PolioPlus Program: Lessons Learned, Transition Planning, and Legacy", by John L. Sever, Michael McGovern, Robert Scott, Carol Pandak, Amy Edwards, and David Goodstone
  • "Using the Stop Transmission of Polio (STOP) Program to Develop a South Sudan Expanded Program on Immunization Workforce", by Dieula D. Tchoualeu, Margaret A. Hercules, William B. Mbabazi, Anthony L. Kirbak, Abdulmumini Usman, Ketema Bizuneh, and Hardeep S. Sandhu
  • "Approaches to Vaccination Among Populations in Areas of Conflict", by Chimeremma Nnadi, Andrew Etsano, Belinda Uba, Chima Ohuabunwo, Musa Melton, Gatei wa Nganda, Lisa Esapa, Omotayo Bolu, Frank Mahoney, John Vertefeuille, Eric Wiesen, and Elias Durry
  • "Polio Legacy in Action: Using the Polio Eradication Infrastructure for Measles Elimination in Nigeria - The National Stop Transmission of Polio Program", by Charles A. Michael, Ndadilnasiya Waziri, Rajni Gunnala, Oladayo Biya, Katrina Kretsinger, Eric Wiesen, James L. Goodson, Lisa Esapa, Saheed Gidado, Belinda Uba, Patrick Nguku, and Stephen Cochi
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The Journal of Infectious Diseases, Volume 216, Supplement 1. Image credit: Chantal Laroche Veira and IMG