Implementing the Synchronized Global Switch from Trivalent to Bivalent OralPolio Vaccines—Lessons Learned From the Global Perspective

摘要

In 2015, the Global Commission for the Certification of Polio Eradication certified the eradication of type 2 wild poliovirus, 1 of 3 wild poliovirus serotypes causing paralytic polio since the beginning of recorded history. This milestone was one of the key criteria prompting the Global Polio Eradication Initiative to begin withdrawal of oral polio vaccines (OPV), beginning with the type 2 component (OPV2), through a globally synchronized initiative in April and May 2016 that called for all OPV using countries and territories to simultaneously switch from use of trivalent OPV (tOPV; containing types 1, 2, and 3 poliovirus) to bivalent OPV (bOPV; containing types 1 and 3 poliovirus), thus withdrawing OPV2. Before the switch, immunization programs globally had been using approximately 2 billion tOPV doses per year to immunize hundreds of millions of children. Thus, the globally synchronized withdrawal of tOPV was an unprecedented achievement in immunization and was part of a crucial strategy for containment of polioviruses. Successful implementation of the switch called for intense global coordination during 2015–2016 on an unprecedented scale among global public health technical agencies and donors, vaccine manufacturers, regulatory agencies, World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) regional offices, and national governments. Priority activities included cessation of tOPV production and shipment, nationalinventories of tOPV, detailed forecasting of tOPV needs, bOPV licensing, scaling up ofbOPV production and procurement, developing national operational switch plans, securingfunding, establishing oversight and implementation committees and teams, traininglogisticians and health workers, fostering advocacy and communications, establishingmonitoring and validation structures, and implementing waste management strategies. TheWHO received confirmation that, by mid May 2016, all 155 countries and territories thathad used OPV in 2015 had successfully withdrawn OPV2 by ceasing use of tOPV in theirnational immunization programs. This article provides an overview of the global effortsand challenges in successfully implementing this unprecedented global initiative,including (1) coordination and tracking of key global planning milestones, (2) guidancefacilitating development of country specific plans, (3) challenges for planning andimplementing the switch at the global level, and (4) best practices and lessons learned inmeeting aggressive switch timelines. Lessons from this monumental public healthachievement by countries and partners will likely be drawn upon when bOPV is withdrawnafter polio eradication but also could be relevant for other global health initiativeswith similarly complex mandates and accelerated timelines.