Oral Polio Vaccine Is Unsafe for the World and Should Be Replaced with Inactivated Poliovirus Vaccine Globally

The excessive and prolonged reliance on Sabin oral polio vaccine (OPV) for global polio eradication by the World Health Organisation has critically impeded the mission’s success, in part due to persistent safety challenges associated with OPV. For individual children there has always been the risk of vaccine-associated paralytic polio (VAPP). For the community, the increasing risk has been genetic reversal of live vaccine viruses to neuro-virulent ‘vaccine-derived polioviruses’ (VDPVs) which cause polio far more frequently than VAPP and to ‘circulating VDPVs’ (cVDPVs) that are essentially wild polioviruses. As long as OPV is widely used, polio will not be eradicated. The way forward is to introduce the inactivated poliovirus vaccine (IPV) that is completely safe and exquisitely efficacious when given as 3-dose schedule during infancy, plus one or two boosters. Once IPV is made routine, OPV should be withdrawn country by country. Hexavalent combination vaccines including IPV are ideal, as separate injections are avoided. The sooner OPV is globally replaced with IPV, the faster global polio eradication can be achieved.