Exploring the Role of Antiviral Drugs in the Eradication of Polio Workshop Report (2006) / Chapter Skim
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. This tremendous public health achievement -- accomplished through the cooperation of international organizations, individual governments, private organizations and hundreds of thousands of volunteers -- has vastly reduced the public health burden once imposed by paralytic polio.
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At the request of the Centers for Disease Control and Prevention and the World Health Organization, a committee was established by the National Research Council to organize a workshop to evaluate whether an antiviral drug against poliovirus would be helpful in the final stages of the global polio eradication campaign. The committee was not asked to evaluate the plan to discontinue universal vaccination with oral polio vaccine or other aspects of the post-eradication plans developed by the agencies.
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Using inactivated polio vaccines may be preferred, but may not be sufficient. The immunity provided by the inactivated vaccine prevents paralytic disease by blocking spread of the virus from the intestinal tract to the central nervous system, but does not protect against intestinal poliovirus infection and, ergo, viral replication.
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The development of one or more antiviral drugs against poliovirus, although expensive, serves as an insurance policy that provides an additional means of reacting to repeated outbreaks due to continued circulation of vaccine-derived strains, should they occur. Furthermore, the existence of such antiviral drugs, in combination with stockpiled vaccine, would provide the ability to respond to a future accidental or intentional reintroduction of poliovirus.The consequences of a laboratory accident or a bioterrorist attack with poliovirus will grow increasingly severe after universal vaccination has ceased.
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However, the public health burden of paralytic polio that has been lifted as a result of the eradication effort is enormous and the recommended investment in drug development can be seen as the capstone to past investments in polio eradication. The committee concludes that it is important to ensure that past investment in the eradication effort be protected and therefore that it would be prudent to develop at least one, but preferably two, polio antiviral drugs as a supplement to the tools currently available for the control of poliomyelitis outbreaks in the posteradication era.
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