Global Polio Eradication Initiative (GPEI): Future Perspectives and Need for a New Generation of Inactivated Poliovirus Vaccine

Abstract

More than two decade-old Global Polio Eradication Initiative (GPEI) has finally tasted success and wild poliovirus is now on the verge of eradication. The pre-eradication era was full of challenges and a great learning experience for all those involved with this tedious process. Many new phenomena emerged and new information about poliovirus learned during this campaign. Many new developments such as vaccine-derived polioviruses (VDPVs) were not anticipated and resulted in serious thinking regarding post-eradication vaccine policy. As a result, the post-eradication era is going to be even more complex, more uncertain and complicated than the pre-eradication era. There are many issues that warrant urgent attention not only by the perpetrators of GPEI but by the individual member country. There is almost unanimity that continuous post-eradication use of oral polio vaccine (OPV) is incompatible with the eradication, hence, OPV will need to be discontinued. However, there is utter confusion on the face of future polio immunization after eradication. Few of the most contentious issues of immediate post-eradication era are how to safely stop and withdraw OPV usage world-wide and whether universal inactivated poliovirus vaccine (IPV) be used or not, especially in developing countries. Although both OPV and IPV have proven highly effective in the past, neither the live nor the current IPV are optimal for use in the post-eradication setting. Therefore, rigorous efforts are urgently needed to develop a new generation of inactivated vaccine that is risk-free and affordable and can be produced even in developing country setup. This review provides an insight to the all the issues related to post-eradication era and also discusses briefly the need of having a third generation IPV.