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Economic analysis of the global polio eradication initiative [1]

['World Health Assembly', 'World Health Organization']

Date: 2010-12-16

Following the achievement of smallpox eradication in 1980 [1], and heavily influenced by the substantial progress towards regional polio elimination in the Americas [2], the 41st World Health Assembly (WHA) in 1988 committed to “global eradication of poliomyelitis by the year 2000,” [3] which led to the launch of the Global Polio Eradication Initiative (GPEI) – the single largest, internationally coordinated public health project to date. The WHA resolution focused on “elimination of the indigenous transmission of wild poliomyelitis viruses in ways which strengthen and sustain … national immunization programmes.” The WHA resolution recognized “that achievement of the goal will depend on the political will of countries and on the investment of adequate human and financial resources,” [3] although “some delegates to the assembly in 1988 might not have made a truly informed decision on the launching of the initiative, since there had been no clear statement on resource requirements or strategies” [4, p. 913].

Consistent with the 1988 WHA resolution, we use the term “eradication” to mean contemporaneous interruption of the circulation of wild polioviruses (WPV) everywhere [5]. However we recognize that ending all poliomyelitis disease will ultimately depend on the subsequent successful containment of all live polioviruses, including attenuated OPV viruses, given the potential for vaccine-associated paralysis and the risk of outbreaks of circulating vaccine-derived polioviruses (cVDPVs) [6]. A 2008 WHA resolution recognized this formally by asking the WHO Director-General “to set, if and when appropriate, a date for the eventual cessation of use of oral poliomyelitis vaccine […] in routine immunization programmes.” [7]

With the eradication of type 2 WPV and interruption of types 1 and 3 WPV approaching, this study aims to evaluate the costs and benefits of the GPEI from a societal perspective between 1988 (T WHA ) and 2035 (T end ). The analysis includes prospective considerations because (1) efforts to interrupt the transmission of WPV continue, (2) post-eradication risk management policies will require resources into the future [6], [8], [9], [10], and (3) the achievement of polio eradication will prevent future poliomyelitis cases from WPV and thus accrue long-term benefits.

Although several prior studies provide important economic support for polio eradication efforts [4], [10], [11], [12], [13], [14], none of the existing studies specifically assessed the economics of the GPEI. One evaluation of the US historical and projected polio vaccination programs since 1955 reported $220 billion (2008 US dollars) in net benefits from the US polio vaccination efforts over time due to the prevented treatment costs alone [15], but no comparable analysis of global historical and projected polio vaccination programs exists. This study focuses on quantifying the costs and benefits of the GPEI, reflecting the most up-to-date status of the program and consideration of post-eradication risk management policies [6], [16]. Although this study focuses only on the GPEI and does not quantify the global costs or benefits from all global historical investments in polio control and eradication, it provides important insights about the economics of the GPEI that may inform discussion and debate about future eradication initiatives.

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[1] Url: https://www.sciencedirect.com/science/article/pii/S0264410X10014957?via%3Dihub

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