Table 2.

Recommended strategies to minimize the risk of an OPV restart and qualitative impacts and resource needs.

Risk management strategy	Impacts	Level of internal (national) resources required	Level of external (GPEI or post-GPE international donors) resources required
Maintain high OPV coverage prior to OPV cessation	++++ serotype-specific population immunity to transmission prior to OPV cessation significantly impacts cVDPV risks and probability of OPV restart	+ for countries that currently conduct OPV SIAs	++ for countries that currently conduct OPV SIAs with external support
Coordinate OPV cessation globally	+++ critical to minimize post-OPV cessation cVDPV risks	+ for countries that currently use OPV	+ for coordination and monitoring
Perform aggressive outbreak response using mOPV in near-term after OPV cessation	+++ essential to stop transmission of live polioviruses post-OPV cessation to prevent OPV restart	++ for countries with post-OPV cessation outbreaks	+ for countries that currently conduct OPV SIAs with external support
Perform aggressive outbreak response using available resources in long-term after OPV cessation	+++ essential to stop transmission of live polioviruses post-OPV cessation to prevent OPV restart	++ for countries with post-OPV cessation outbreaks	+ for countries that currently conduct OPV SIAs with external support
Outbreak response poliovirus vaccine global stockpiles	+++ essential to support outbreak response activities		+ for OPV +++ for IPV long-term
Continue AFP surveillance	+++ essential through OPV-cessation	+ for countries that use AFP	++ for supporting the Global Polio Laboratory Network
Continue or add environmental surveillance (ES)	+ may help with confidence about no live poliovirus transmission, impact depends on design of the system	++ for countries that choose to include ES	++ for coordination and support of countries that require external resources
IPV use after cessation of last OPV serotype	+++ essential in countries that continue to produce poliovirus vaccines, store live polioviruses, and/or sustain potential iVDPVs + provides limited insurance that protects vaccinated individuals	++++ for 2-dose schedule	++++ for countries that require external support
Ensure containment	+++ essential to prevent the reintroduction of live polioviruses after OPV-cessation	+ for most countries +++ for countries that choose to maintain stocks of live polioviruses	++ for global coordination
Development of polio antiviral drugs	? depends on characteristics of products actually developed (e.g. efficacy, cost, ease of delivery, etc.)		++ to finish development
Prevention of iVDPV outbreaks by screening for PIDs	? depends on ability to detect iVDPVs and efficacy of polio antiviral drugs	++ for countries with potential iVDPV excretors	++ for countries that require external support
Develop new OPV and or IPV seed strains	? depends on characteristics of products actually developed		+++ for development