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

Abstract

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, national inventories of tOPV, detailed forecasting of tOPV needs, bOPV licensing, scaling up of bOPV production and procurement, developing national operational switch plans, securing funding, establishing oversight and implementation committees and teams, training logisticians and health workers, fostering advocacy and communications, establishing monitoring and validation structures, and implementing waste management strategies. The WHO received confirmation that, by mid May 2016, all 155 countries and territories that had used OPV in 2015 had successfully withdrawn OPV2 by ceasing use of tOPV in their national immunization programs. This article provides an overview of the global efforts and challenges in successfully implementing this unprecedented global initiative, including (1) coordination and tracking of key global planning milestones, (2) guidance facilitating development of country specific plans, (3) challenges for planning and implementing the switch at the global level, and (4) best practices and lessons learned in meeting aggressive switch timelines. Lessons from this monumental public health achievement by countries and partners will likely be drawn upon when bOPV is withdrawn after polio eradication but also could be relevant for other global health initiatives with similarly complex mandates and accelerated timelines.

Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support

“…Specifically concerning the OPV switch [ 5 ] in 155 countries and territories in a 2-week period in April 2106, the unprecedented nature of this initiative represented a significant challenge for communications and advocacy efforts. The CWG started early in 2015 and proceeded methodically, developing a comprehensive plan and then a package of initial materials, including a high-level briefing note, an introductory PowerPoint presentation [ 6 ] to introduce the technical rationale and early considerations for national planning, and a frequently asked questions document.…”

Considerations for the Full Global Withdrawal of Oral Polio Vaccine After Eradication of Polio

“…Training of immunization and logistics staff at the global, regional, national, and local levels was essential to the success of the switch [ 8 ] and will also be needed for OPV withdrawal. Experience with the switch suggests that trainings that can disseminate guidance and build technical assistance capacity regarding OPV withdrawal should ideally begin at the global level at least a year prior to OPV withdrawal ( Table 2 ).…”

Cold chain and virus‐free oral polio booster vaccine made in lettuce chloroplasts confers protection against all three poliovirus serotypes

“…Continued use of serotype 2 in oral polio vaccine (OPV) led to 683 cases of polio caused by circulation of vaccine-derived poliovirus type 2 (cVDPV2) between 2000and 2014(McCarthy et al, 2017. Therefore, WHO Global Polio Eradication Initiative recommended withdrawal of the type 2 component (OPV2) in April 2016 and replacing bivalent OPV (bOPV) in all 155 countries and territories that had used OPV in 2015 (Holmes et al, 2017;Ramirez Gonzalez et al, 2017). The Strategic Advisory Group of Experts (SAGE) proposed that during the transition, a single dose of inactivated poliovirus vaccine (IPV) may be adequate to prime global population due to the high cost and inadequate supply of IPV.…”