CIDID Polio Modelers at The University of Michigan Epidemiology: Jim Koopman, Marisa Eisenberg, Joe Eisenberg, Christopher Henry, Xinyu Zhang Statistics: Edward Ionides, JoonHa Park HMP: David Hutton

Important Endgame Modeling Issues Insure there is no silent circulation when OPV is stopped –Persistent cVDPV2, WPV1, WPV3 1.Model reinfection transmission dynamics accurately enough to insure endgame policies don’t permit silent circulation Infer whether vaccinating adults is needed to insure silent circulation ends before global OPV cessation Modern complex system analyses of data covering last 15 years 2.Investigate re-emergence of transmission after OPV is stopped with intensive asymptomatic infection detection, sequencing, and serology across all age groups Infer whether “whack-a-mole” policy will work or if booster IPV or OPV vaccinations are needed in specific age groups

What needs to change Better complex system science that elucidates how program decisions are affected by –waning immunity dynamics, –dose response effects on transmission, –transmission routes (direct, fomite, water) More effective interaction between modeling groups –Building a common understanding of what needs to be done More scientists involved in modeling complex systems! More accessible data over longer times from more areas –AFP surveillance, Environmental surveillance, Virus sequences, Vaccination administration, Demographic data