Policy Decision Options During the first Five Years Following Certification of Polio Eradication
by Nalinee Sangrujee, Radboud J. Duintjer Tebbens, Victor M. Cáceres, and Kimberly M. Thompson, Medscape General Medicine 5(4) (December 19, 2003). Available at: http://www.medscape.com/viewarticle/464841 PDF

Abstract

Policy makers face a number of difficult choices as they develop policies to ensure maintenance of a polio-free world following global eradication and certification. These policy decisions include choices about immunization, outbreak response (including whether to create a vaccine stockpile), surveillance, containment, management of chronic excretors, and investment in future research. This paper focuses on identifying the categories of decisions and characterizing the actual factors that country-level policy makers must weigh to manage polio risks during the first 5 years after certification. Building on a comprehensive literature review, we report the results of the first qualitative analysis to: (1) systematically characterize each type of decision and the relevant options during the first 5 years after certification, (2) clearly identify critical factors that influence the choices, and (3) specifically demonstrate the interdependence among the decisions to produce a reduced set of decision options. This paper explicitly focuses on the different perspectives of developed and developing countries in characterizing the options. While the management of polio risk in the postcertification period presents important challenges, this comprehensive approach helps simplify the process by focusing on critical decisions.

Answers to frequently asked questions

What are the study’s main findings?
What are the study’s main recommendations?
Background on polio

What are the study’s main findings?

  • The decision options for the first 5 years following certification of the world as free of wild poliovirus that countries will face include multiple categories and multiple choices within those categories. The paper identified seven major categories of decisions including: routine immunization, Supplemental Immunization Activities (SIAs), outbreak response, stockpile, surveillance, containment, and management of chronic excretors, and summarized these using a decision tree:
  • The leaders of countries of different income levels may essentially view different sets of options based on their future vaccine preference, their willingness to pay the costs of health interventions, and their perceptions about the various risks of reintroduction. (See how the set of relevant decision options varies for countries choosing routine IPV vaccination, routine OPV vaccination, or stopping routine vaccination by selecting the appropriate button to the right of the figure above.)
  • Global discussions and negotiations should anticipate different perspectives, and recognize the interdependence of policy decisions.
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What are the study’s main recommendations?
  • Coordinating national implementation of policy changes globally represents a critical issue for consideration and discussion. This paper encourages discussions among countries regarding their collective policy choices an additional efforts to help decision makers better understand the trade-offs associated with their choices.
  • The paper also suggests that the framework offered for managing disease at a national level could extend broadly (i.e., beyond polio). For example, people working on water management or bioterrorism risk management might find the decision tree structure in the paper helpful in showing the interactions between the complex choices related to managing disease threats.
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