October 21, 2016 | The Editors

The multidimensional fight against polio

Our elimination strategy involves an arsenal of innovative solutions and inviting the world to roll up its sleeves.
Two health workers administer an oral vaccine to an infant being cradled in a woman's lap.
Two health workers administer a vaccine to a newborn. Photo: PATH/Umit Kartoglu.

“The end of polio in sight”

“What if we fail to eradicate polio?”

“WHO concerned about Nigeria polio outbreak”

The headlines covering polio are inspiring and troubling at the same time. Are we really close to eliminating this paralytic disease from the face of the earth, or aren’t we?

Here’s the answer: There is great hope that this disease is nearing an end, but the gains we have made are fragile. Global eradication will require a complex and multilayered approach involving tools, surveillance, vaccines, and connecting the world through a shared vision.

PATH has been involved in the global fight against polio for some time.

We’re advancing tools to find the poliovirus in the environment before outbreaks occur. We’re also developing new, safer transmission-blocking vaccines that protect people—especially children. And we’re hard at work to expand vaccine access to reach the people most in danger of contracting the disease.

Detecting polio before it can harm

A surveillance worker collects samples of water.
Environmental surveillance is an essential activity in the global effort to eradicate polio. It alerts us if the poliovirus is present and if a vaccination campaign is needed. Surveillance also serves to report back after a campaign, and tell us if we were successful. Photo: PATH/S. Khan.

PATH and the University of Washington have developed two tools for improved surveillance of poliovirus to help ensure detection methods are low-cost and available in low-resource countries and hard-to-reach areas.

The bag-mediated filtration system (BMFS) is a highly sensitive tool that was designed to detect the poliovirus in challenging environments, such as remote and mountainous regions. In Pakistan, validation studies of the BMFS show improved sensitivity (detection) of the polioviruses.

We are also focused on a rapid, sensitive, and simple poliovirus diagnostic test that can be used to screen people who are showing signs of polio. This portable test benefits health care systems in areas challenged by security or logistics conditions.

Why we need new vaccines

A health worker administers an oral vaccine to a newborn who is being held by a woman.
PATH accelerates the development, delivery, and introduction of vaccines that protect children and communities from disease. Photo: PATH/Gabe Bienczycki.

Vaccines are the best and only way we can protect ourselves against polio. Yet even after eradication, these vaccines will be needed for years.

We work with developing-country vaccine manufacturers to bolster the global vaccine supply and drive down costs particularly for the inactivated polio vaccines (IPVs), making these interventions affordable to those who need them most.

It’s also crucial that we continue to invest in new vaccines to ensure long-term protection against potential outbreaks. We’re developing a new oral polio vaccine (OPV), called nOPV2, that protects against the type 2 polio strain. OPV is an inexpensive yet powerful tool that can halt wild polio transmission in high-risk settings. What’s novel about this one is that it should have the positive benefits of a replicating live viral vaccine with less risk of mutating into vaccine-derived polio.

Our goal is for the vaccine to supply the international emergency stockpile for use in potential outbreaks.

Improving how vaccines are administered

As more and more countries introduce IPV into routine immunization schedules, we need to anticipate both increases in demand and potential supply shortages. One approach recently recommended by the World Health Organization (WHO) is the use of a fractional dose of IPV—essentially one-fifth of a full dose—that is delivered into the upper layers of the skin (intradermally).

PATH has a long history of collaborating with vaccine product developers, device manufacturers, and country ministries of health to design, develop, and assess technologies. Recently, with WHO’s Global Polio Eradication Initiative (GPEI), we helped inform and build the evidence base for two fractional dose IPV-capable delivery technologies.

A jet-injector is held by a gloved hand.
The PharmaJet Tropis® disposable-syringe jet injector uses a sterile single-dose syringe and a pressurized liquid stream rather than a needle to administer a fractional dose of inactivated poliovirus vaccine to patients. Photo: PATH.
Injection tech device and a disposable vial being held in two hands.
PATH helped develop the West Pharmaceutical Services ID Adapter, which fits over a traditional needle and syringe like a sleeve, standardizing the injection depth and angle so health care workers can more easily and precisely deliver an intradermal injection. Photo: PATH.

The GPEI plans to introduce both technologies into country programs by early 2017 to help ensure supply shortages neither threaten the protection of children and families nor disrupt progress in the global fight against polio.

Envisioning a world free from disease

Making sure we sustain high-immunization coverage is critical to eliminating polio and ultimately global eradication. The recent cases of polio in Nigeria show us these gains are fragile, and that it is imperative policymakers stay focused on finishing the job to ensure polio is eradicated and that there is no risk of resurgence.

For a review of our work in polio, please read “Beyond Eradication: The United States’ Role in Sustaining Public Health Gains Achieved Through Polio Programs

And yet, our work doesn’t stop with the eradication of any one disease. Current polio programs have contributed significantly to broader public health outcomes, including strengthening systems for routine immunization and global health security. Polio-specific efforts and their associated systems are part of a greater architecture that we need to keep intact to protect the gains we have made in global health.

We are advocating to protect the scaffolding we’ve built to fight polio, so it does not disappear along with the disease.

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