eradication will have been accomplished. Here too, the campaign is dependent upon having an effective, readily administered vaccine.

The Institute of Medicine (IOM) has been very much involved in assessing U.S. polio vaccine policy. In fact, the first study done by the IOM dealing with vaccines—or, indeed, preventive medicine—was the 1977 report Evaluation of Poliomyelitis Vaccines. In this report the relative merits of the two polio vaccines, IPV (inactivated polio, or Salk, vaccine) and OPV (oral polio vaccine —live attenuated, or Sabin vaccine), were analyzed and recommendations for national policy made. The Institute recommended that OPV continue to be the vaccine of choice, but that IPV be made more available for special cases such as immunodeficient persons or those with whom they have contact, as well as those who for one reason or another would prefer IPV. In addition, suggestions were made about simplifying and developing more informative consent forms and about developing a compensation program for children injured by vaccines.

A second report on polio vaccine policy was issued in 1988. By this time, circulation in the United States of wild polio virus had almost certainly been interrupted and, although few in number, cases of paralysis due to the poliovirus were almost all attributable to the vaccine virus itself. The recommendations of this report were that the policy continue unchanged except that the standard IPV be replaced by the more potent “enhanced inactivated vaccine” (eIPV). It was also recommended that when a quadrivalent DTP (diphtheria–tetanus–pertussis)-eIPV was licensed in the United States (such a product was already available in some other countries), a schedule of primary immunizations with the quadrivalent product should be considered, to be followed by one or more doses of OPV. Although at the time it was estimated that DTPeIPV would be available within a few years, it is still not licensed in the United States, and no change has been made in U.S. policy.

A third consideration of this topic was conducted in June 1995. This was a workshop to review the situation in the context of the recent declaration that polio has been eradicated from the Americas. No recommendations were made as a result of the workshop, but a summary of the discussion will be made available to the Advisory Committee on Immunization Practices, the body that will recommend changes to U.S. policy. Thus, the IOM has played an important role in determining polio immunization policies in the United States.

In view of the great benefits of vaccines and their cost-effectiveness, one might have expected industry to follow up with tremendous innovation and expanded vaccine development. In the United States, the contrary was true. In the early 1980s there were 14 vaccine manufacturers in the United States. In 1994 there were 4 major vaccine manufacturers and 2 state laboratories



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