Since the inception of the Global Polio Eradication Initiative, the number of annual polio cases has dropped dramatically – from 350,000 in 1998 to 223 cases, in 2012. That’s nearly a 100% reduction. However, polio remains active in a few countries, primarily among the most disadvantaged, remote and conflict-affected populations, for whom its continued existence remains a dangerous threat.
Concluding 24 months of work with manufacturers and partners, last Thursday UNICEF announced the lowest prices ever for inactivated polio vaccine (IPV): ~$1.00 per dose for a 10-dose vial and $1.90 per dose for a 5-dose vial, down from $3.30 per dose for a 1-dose vial. Over the coming five years (2014–2018), the new prices will result in about $800 million of reduced costs for the Global Polio Eradication Initiative and countries.
In addition, UNICEF has negotiated tiered-prices for middle-income countries that, in most cases, will save them more than half of what they would have otherwise paid. Full pricing details can be found in this document. Large volumes, multi-year awards, and elimination of risks (such as exchange rates, for one supplier) are all elements that have contributed to the new pricing.
One hundred twenty-six low- and middle Income countries will start to use IPV, which is injected, in a single dose, in addition to the oral polio vaccine (OPV). OPV will gradually be phased out, based on certain epidemiologic triggers.
The previous price was a major barrier to making this shift. The shift is needed because, for eradication to occur, the polio virus needs to be gone from people, labs, sewage, etc. – i.e. the places in which vaccine-derived polio virus can survive, mutate and cause disease. IPV is ‘inactivated’, and does not carry risk of polio infection to people who are not vaccinated.
The plan for 126 countries to introduce IPV in the coming two years is the most aggressive vaccine introduction plan in history. The work required at country level is immense; many countries are introducing rotavirus and pneumococcal vaccine and scaling up maternal and child health programmes. If the gains on pricing are applauded, the real work and applause go to governments, health workers, NGOs, UNICEF and WHO locally, faith-based leaders and parents who get kids immunized. The immunization schedule is a single dose given as soon as possible after 14 weeks of age.
Polio has existed as long as human society, but became a public health issue in the 1800’s and 1900’s, with major epidemics in Europe and the U.S. The virus causes spinal and respiratory paralysis, can kill and remains incurable, but vaccines have assisted in its almost total eradication, today. With IPV as an additional tool, it is the hope that this decade will be the last to witness children crippled by polio.
It is hard to understand why health workers would need armed protection to reach kids with vaccine that prevents this horrible disease. But, the world is complicated. Saturday’s news of polio vaccinators and their guards being bombed in Pakistan shows the risks that these brave, caring, selfless, people take on behalf of kids. But not even this will deter them. True heroes.
Shanelle Hall is the Director of UNICEF Supply Division, the organization’s procurement and logistics headquarters in Copenhagen. She focuses on both the global availability and local delivery of essential supplies for children in more than 100 countries