1. بسم الله الرحمن الرحيم

2. IRAN Vaccination policy for post eradication phase Presented by : A. R.ESTEGHAMATI, MD IRAN EPI Manager

3. Suggested vaccination policies for post eradication era Discontinue all polio vaccination Continue with current immunization policies, including OPV Discontinue OPV, with universal IPV use Discontinue OPV, with some countries electing to use IPV

4. Discontinue all polio vaccination (first strategy ) Advantages 1.It is consistent with the traditional interpretation of eradication 2.It has maximum cost saving and the budget can be shift to the other health priority 3.Health workers find out the success of polio eradication project 4.Policy makers may accept other WHO project easier 5.It doesn't need to train health workers for new vaccine usage

5. Discontinue all polio vaccination (first strategy ) Disadvantages : 1-Dual policy (regardless of global policy some industrialized country may continue with IPV because of the perceived threat of bioterrorism this dose not affect other countries,but: It is an obvious discrimination against countries which is not consistent with moral humanities of WHO

6. Discontinue all polio vaccination (first strategy ) Disadvantages : 2-Increasing susceptible persons that may support major outbreak this is a major treat and a potential danger for bioterrorism and advertent or inadvertent polio virus escape from labs We suggest a concurrent NID for all polio users with low vaccine coverage to decrease susceptible persons before OPV discontinuation.

7. Discontinue all polio vaccination (first strategy ) Disadvantages : 3-Use of OPV for outbreak control may lead to re-establishment of endemic or epidemic polio This can be prevented by developing new vaccine for outbreak control or increasing the community immunity by concurrent OPV use

8. Discontinue all polio vaccination (first strategy ) Disadvantages : 4-This require coordination and collaboration among region and countries Regional coordination and strengthening surveillance is easily achievable.

9. Continue with current immunization policies, including OPV (second strategy) Disadvantages Because OPV would be used it is likely that at any time and anywhere cVDVP outbreak occur this strategy is inconsistent with polio eradication A continuing VAPP burden would occur in the absence of naturally occurring disease So in our opinions it is not a suitable strategy

10. Discontinue OPV, with universal IPV use (third strategy ) It would be inconsistent with the definition of eradication and if the disease had been eradicated, all type of vaccination including IPV should be stopped advantages of IPV usage instead of OPV would be : It is not associated with VAPP or the threat of cVDPV unlike OPV It can maintain a high population immunity

11. Discontinue OPV, with universal IPV use (third strategy ) Disadvantages : The cost would be much higher than the two previous strategy Although the price of IPV vaccine will be reduced due to increasing IPV production it can be an advantage for the country who were IPV users. on the contrary, it can be a disadvantages for some country like IRAN who were previous OPV user Iran has been producing OPV vaccine locally with low price for the past four decades.

12. In Islamic republic of IRAN It is cost benefit to spend the health budget for other priorities, to control disease like HIV,STD, MDR TB, MALARIA,…. we think this is necessary for the middle or low income countries even though they receive funds from other sources

13. The production of IPV in IRAN was reviewed and the results were: 1.IPV production technology is not accessible and should be transferred 2.It needs BSL4 which may not be available 3.Since IPV will be used for limited time after eradication, local production needs to spent much money so is not cost benefit 4.Procurement of IPV needs spending much money for a great population and we have other priority

14. IPV purchase Because of : 1.Limited GNP 2.High target population 3.Limited annual budget IPV vaccine procurement is not our health priority

15. disadvantages There is limitation of universal IPV vaccine production at present very few manufacturers produce IPV and the production capacity is only 100 million doses /year So the universal IPV usage deems not possible

16. Disadvantages : It could be difficult to convince the public on the continuation of immunization against polio even with IPV. Use of a new vaccine (IPV) needs training of health facility staff and community education It may not have any political support

17. Discontinue OPV, with some countries electing to use IPV (forth strategy ) Continuation with IPV by some of the countries would be inconsistent with the principles of polio eradication Cost saving from discontinuation of all polio vaccine in developing country enable to shift funds to other health priority

18. Disadvantage Usage of vaccine in some countries is an obvious discrimination Dual vaccination policy since the usage of live attenuated polio vaccine is advised for outbreak control,also IPV usage in routine immunization can not induce intestinal immunity therefore OPV usage may lead to re-establishment of virus circulation

19. Use of IPV by some of the countries will save their population against reintroduction of polio virus through bioterrorism or its escape from the laboratory, where as accidental release of wild polio virus would be a real treat for the countries being unable to use IPV.

20. IN CONCLUTION The national certification committee advised the EPI department of MOHME to discontinue the immunization with OPV as soon as global polio eradication is certified (first strategy )