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Evaluation of Proactive and Reactive Strategies for Polio Eradication Activities in Pakistan and Afghanistan

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  • Radboud J. Duintjer Tebbens
  • Kimberly M. Thompson

Abstract

Only Pakistan and Afghanistan reported any polio cases caused by serotype 1 wild polioviruses (WPV1s) in 2017. With the dwindling cases in both countries and pressure to finish eradication with the least possible resources, a danger exists of inappropriate prioritization of efforts between the two countries and insufficient investment in the two countries to finish the job. We used an existing differential‐equation‐based poliovirus transmission and oral poliovirus (OPV) evolution model to simulate a proactive strategy to stop transmission, and different hypothetical reactive strategies that adapt the quality of supplemental immunization activities (SIAs) in response to observed polio cases in Pakistan and Afghanistan. To account for the delay in perception and adaptation, we related the coverage of the SIAs in high‐risk, undervaccinated subpopulations to the perceived (i.e., smoothed) polio incidence. Continuation of the current frequency and quality of SIAs remains insufficient to eradicate WPV1 in Pakistan and Afghanistan. Proactive strategies that significantly improve and sustain SIA quality lead to WPV1 eradication and the prevention of circulating vaccine‐derived poliovirus (cVDPV) outbreaks. Reactive vaccination efforts that adapt moderately quickly and independently to changes in polio incidence in each country may succeed in WPV1 interruption after several cycles of outbreaks, or may interrupt WPV1 transmission in one country but subsequently import WPV1 from the other country or enable the emergence of cVDPV outbreaks. Reactive vaccination efforts that adapt independently and either more rapidly or more slowly to changes in polio incidence in each country may similarly fail to interrupt WPV1 transmission and result in oscillations of the incidence. Reactive strategies that divert resources to the country of highest priority may lead to alternating large outbreaks. Achieving WPV1 eradication and subsequent successful OPV cessation in Pakistan and Afghanistan requires proactive and sustained efforts to improve vaccination intensity in under‐vaccinated subpopulations while maintaining high population immunity elsewhere.

Suggested Citation

  • Radboud J. Duintjer Tebbens & Kimberly M. Thompson, 2019. "Evaluation of Proactive and Reactive Strategies for Polio Eradication Activities in Pakistan and Afghanistan," Risk Analysis, John Wiley & Sons, vol. 39(2), pages 389-401, February.
    • Handle: RePEc:wly:riskan:v:39:y:2019:i:2:p:389-401
    DOI: 10.1111/risa.13194
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    1. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Dominika A. Kalkowska & Steven G. F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2013. "Characterizing Poliovirus Transmission and Evolution: Insights from Modeling Experiences with Wild and Vaccine‐Related Polioviruses," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 703-749, April.
    2. Kimberly M. Thompson & Mark A. Pallansch & Radboud J. Duintjer Tebbens & Steve G. Wassilak & Jong‐Hoon Kim & Stephen L. Cochi, 2013. "Preeradication Vaccine Policy Options for Poliovirus Infection and Disease Control," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 516-543, April.
    3. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Jong‐Hoon Kim & Cara C. Burns & Olen M. Kew & M. Steven Oberste & Ousmane M. Diop & Steven G.F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2013. "Oral Poliovirus Vaccine Evolution and Insights Relevant to Modeling the Risks of Circulating Vaccine‐Derived Polioviruses (cVDPVs)," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 680-702, April.
    4. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Stephen L. Cochi & Derek T. Ehrhardt & Noha H. Farag & Stephen C. Hadler & Lee M. Hampton & Maureen Martinez & Steve G.F. Wassilak & Kimberly M. Thomp, 2018. "Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations," Risk Analysis, John Wiley & Sons, vol. 38(8), pages 1701-1717, August.
    5. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Konstantin M. Chumakov & Neal A. Halsey & Tapani Hovi & Philip D. Minor & John F. Modlin & Peter A. Patriarca & Roland W. Sutter & Peter F. Wright & S, 2013. "Review and Assessment of Poliovirus Immunity and Transmission: Synthesis of Knowledge Gaps and Identification of Research Needs," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 606-646, April.
    6. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Konstantin M. Chumakov & Neal A. Halsey & Tapani Hovi & Philip D. Minor & John F. Modlin & Peter A. Patriarca & Roland W. Sutter & Peter F. Wright & S, 2013. "Expert Review on Poliovirus Immunity and Transmission," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 544-605, April.
    7. Radboud J. Duintjer Tebbens & Kimberly M. Thompson, 2009. "Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases," Management Science, INFORMS, vol. 55(4), pages 650-663, April.
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    1. Kimberly M. Thompson & Dominika A. Kalkowska, 2021. "An Updated Economic Analysis of the Global Polio Eradication Initiative," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 393-406, February.
    2. Dominika A. Kalkowska & Kimberly M. Thompson, 2021. "Insights From Modeling Preventive Supplemental Immunization Activities as a Strategy to Eliminate Wild Poliovirus Transmission in Pakistan and Afghanistan," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 266-272, February.
    3. Kimberly M. Thompson & Dominika A. Kalkowska, 2021. "Reflections on Modeling Poliovirus Transmission and the Polio Eradication Endgame," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 229-247, February.
    4. Kim E. Van Oorschot & Luk N. Van Wassenhove & Marianne Jahre, 2023. "Collaboration–competition dilemma in flattening the COVID‐19 curve," Production and Operations Management, Production and Operations Management Society, vol. 32(5), pages 1345-1361, May.
    5. Kimberly M. Thompson, 2021. "Modeling and Managing Poliovirus Risks: We are Where we are…," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 223-228, February.

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