In 1988 during the 41st World Health Assembly a resolution known as WHA 41.28 was passed which directed WHO for polio eradication by the year 2000, by exclusive use of oral polio vaccine (OPV). Polio was not eradicated in 2000, any suggestions to review or re-evaluate the strategy were not acceptable(1), even the complementary use of IPV(2) or stoppage of OPV(3).

The global agencies for polio eradication are having second thought on continuation of OPV. These agencies are now seriously considering stoppage of OPV(4). This change in strategy is not because current OPV has caused high incidence of VAPP and failed to protect many children in developing countries. If current trivatent oral polio vaccine (tOPV) or monovalent oral polio vaccine (mOPV) are continued to be administered in the developing countries, there is a potential risk that circulating mutant vaccine derived polio-viruses (cVDPV) may reach polio free countries and cause polio there.

WHO consultation group concluded that the continued occurrence of 250-500 VAPP cases each year, along with infrequent cases of VDPV, would be unacceptable for most, if not all countries, and that the scientific evidence points to the need for eventual, simultaneous OPV cessation, thus ensuring that no country is at risk of importing VDPV from a country that continues the use of OPV(6). But, wild poliovirus circulation will not stop in near future. So some other reason for cessation of OPV even before interruption of wild poliovirus circulation will be presented to thwart the perceived threat from cVDPV to the developed countries.

Can these developing countries afford IPV exclusively for polio eradication? Huge amounts of money and manpower have been spent during these eleven years (1995-2005) of pulse polio immunization, still India has not become polio free. Had this amount and manpower been spent on improving the sanitation facilities it would have drastically brought down the incidences of polio, typhoid and hepatitis A and hepatitis E infections along with many other gastrointestinal diseases.

Thus, OPV may be withdrawn in future not because it had been causing VAPP in the developing countries, but, because of a perceived threat of VAPP in the developed countries.

Yash Paul,
A-D-7, Devi Marg,
Bani Park,
Jaipur 302 016,
India.
Email: [email protected] 

1. Paul Y. Polio eradication strategy: need for re-appraisal. Indian Pediatr 2000; 37: 913-916.

2. Paul Y. Polio Eradication in India. Indian Pediatr 2003: 40: 1100-1101.

3. Paul Y. Polio Eradication: Let us Face the Facts and Accept the Reality. Indian Pediatr 2005; 42: 728-729.

4. Heyman DL, Sutter RW, Aylward RB. Polio eradication: interrupting transmission, towards a polio-free world. Future Virol 2006; 1: 181-188.

5. WHO: Introduction of inactivated poliovirus vaccine into oral poliovirus vaccine using countries. WHO position paper. Wkly Epidomiol Rec 2003; 78: 241 - 250.