PMC:7497282 / 31614-35488
Annnotations
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High-level policy discussions related to control vs. eradication in late 2006 motivated KRI to apply the post-eradication model to estimate the economics of eradication (followed by several different post-WPV eradication immunization policies) compared to a wide range of control options [19]. This analysis demonstrated that eradication (if technically and operationally feasible in a reasonable time) represented a better health and economic option than control with OPV in OPV-using countries [19]. Some discussions at the time included significant pessimism about the ability to stop poliovirus transmission in India and the other remaining endemic countries [191]. KRI modeling suggested that elimination could occur in India with sufficient immunization intensity [19] and demonstrated that achieving eradication is a choice (i.e. the actions that countries and the GPEI take matter with respect to outcomes, and neither failure nor success could be taken as a given). KRI also demonstrated the economic inefficiency of a wavering global commitment to eradication [19]. The economic analysis of post-WPV eradication immunization policies showed that either stopping OPV altogether or switching to IPV dominated the continued OPV use (i.e. control) after successful eradication of WPVs [18]. However, using IPV after WPV eradication represented the option with the highest expected costs and the lowest expected cases, while stopping poliovirus immunization represented an option with lower expected costs and some additional expected cases, which led KRI to recommend research and investment into strategies to reduce IPV costs [18]. KRI performed extensive uncertainty and sensitivity analyses [20]. Recognizing the importance of OPV cessation as an option, KRI demonstrated the need for globally coordinated coordination of OPV cessation due to game-theoretic considerations associated with cVDPV risks that could occur with uncoordinated OPV cessation [21]. This analysis also highlighted the importance of creating a stockpile for post-WPV eradication outbreak response [21]. Due to the complexity and scale of the GPEI, KRI recognized the importance of managing the GPEI as a major project and ensuring sufficient resources for polio eradication to succeed [22]. KRI discussions about this work with GPEI partners highlighted the importance of the GPEI taking the long view and asking for the funds that it needed to succeed with a long-term budget and plan, instead of what it thought it could raise in annual budgeting cycles. Although not specific to polio, by extending a simple integrated theoretical model [192], KRI discussed uncertainty and sensitivity analyses for integrated models [193] and explored the dynamics of priority shifting for eradicable diseases [194], the latter of which also built on prior KRI analysis of a wavering commitment to eradication [19]. Recognizing the importance of a stockpile of OPV for post-WPV eradication outbreak response [21], KRI developed a framework for optimal stockpile design [23]. Although KRI primarily used DEB models, KRI developed an IB polio dynamic disease transmission model that showed the significance of different assumptions about mixing networks, which remain highly uncertain and difficult to model at the global level 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