Dear Research Colleagues,

A year has passed since the inaugural meeting of the Polio Research Committee (PRC), a year in which we have witnessed a virtual revolution in research activities for polio eradication.

Researchers are evaluating new vaccines and exploring novel uses of existing vaccines. The Global Polio Laboratory Network is implementing faster diagnostic procedures to speed up the rate of detection of poliovirus. Molecular epidemiology and transmission studies help to track virus circulation. Seroprevalence surveys are offering new insight into programme performance and vaccine efficacy. New surveillance strategies are being assessed in key reservoirs. These are just some of the research activities being coordinated by the Global Polio Eradication Initiative (GPEI), under the strategic guidance of the PRC.

To those of us who are members of the Advisory Committee on Poliomyelitis Eradication (ACPE), the global independent advisory body to the GPEI, this research is absolutely vital. It helps make sure we have the sharpest and most up-to-date epidemiological and virological picture, allowing us to determine the most appropriate targeted eradication strategies.

Having this research-enhanced sharp picture is more crucial now than it has ever been in the 20-year history of the GPEI. We can see the finish line, but it has thus far eluded us. This year, however, two ongoing research projects in particular may well revolutionize the way we do business from here on. The first is the much-anticipated evaluation of a bivalent oral polio vaccine (bOPV) containing both type 1 and type 3 serotypes, which could have significant advantages in areas where both remaining wild serotypes co-circulate.

The second is a five-arm clinical trial to assess new vaccine strategies in western Uttar Pradesh, India, arguably the most technically challenging place on earth to eradicate polio and where we have seen the efficacy of OPV compromised time and again. The outcomes of these studies – along with the recommendations of a major independent evaluation into the remaining barriers to polio eradication – will help inform the finalization of a new multi-year GPEI Strategic Plan, expected for publication in January 2010.

Given the critical importance of these and other research projects, this issue of the Polio pipeline provides an overview of the outcomes and conclusions of the most recent PRC, which convened on 2–3 June in Geneva, Switzerland. It is an exciting time to be sure, as the vast research activities give ever-more solid evidence into what works, what doesn’t, and what can and should be done differently. I for one am convinced that it will be research and innovation – perhaps more than anything else – that will lead us in the final steps to a lasting polio-free world.

With best wishes,

Dr Steve Cochi,
Chair of the ACPE

Conflict in Afghanistan and Pakistan has made efforts to immunize children more difficult and perilous for health workers and citizens alike. Although polio workers are not often directly targeted, in areas of active conflict polio eradication partners face immense challenges in extending services without compromising the safety of the immunization workers.

In this type of environment, polio teams have looked to define ways to take advantage of quiet periods when fighting has abated, and to encourage people to be more pro-active in immunizing their children whenever an opportunity exists. One strategy relies on opportunistic immunization that occurs when polio workers see a lull in fighting in an area that was previously inaccessible, and then quickly marshal their forces to immunize children in those communities.

To succeed, it is critical to ensure child caregivers receive information on the need to immunize their children and of immunization services. To help increase this awareness requires local leadership to own and actively support polio eradication efforts. Local leaders can inform polio workers of lulls in conflict, and also use local networks to inform people in communities about available immunization services.

The demand for oral polio vaccine (OPV) is further driven by the deployment of local social mobilizers who work with communities to help them understand the threat of polio and the necessity of immunization, both during supplementary immunization activities (SIAs) and routine immunization.

A key innovative strategy in place to further drive this demand is the ‘courtyard women strategy’. This activity brings trained female health workers into compounds to meet with mothers and other female child caregivers to engage in guided discussions about polio eradication, routine immunization and other basic child survival topics. As mothers are the primary caregivers of young children (the most vulnerable to polio), it is essential to increase an understanding among this target group of the need to immunize and increase empowerment to ensure children receive OPV and other vaccines. In areas where the ‘courtyard women strategy’ has been put in place, there is evidence that routine immunization and coverage during polio SIAs has increased.