Thompson Kimberly M, Duintjer Tebbens Radboud J
Kids Risk Project, Harvard School of Public Health, Boston, Massachusetts, USA.
Medscape J Med. 2008;10(8):190. Epub 2008 Aug 13.
Achieving successful eradication of a disease requires global cooperation to obtain a shared goal. Coordination of the endgame may seem an obvious requirement for success, but that does not ensure that cooperation will occur.
To analytically explore the need for cooperation to maintain global polio eradication specifically related to creation of a global polio vaccine stockpile and coordination of oral poliovirus vaccine (OPV) cessation.
Using risk and decision analysis and game theoretical concepts, we modeled the importance of global cooperation in managing the risks associated with polioviruses for a time horizon of 20 years after successful global disruption of circulation of wild polioviruses.
Countries may wish to avoid the financial costs of vaccination and risks for vaccine-associated paralytic polio following eradication of wild polioviruses, which may lead them to reduce their use of OPV. However, reducing or stopping vaccination too soon and without coordination poses serious risks, including the possibility of reimportation of wild polioviruses and the possibility of vaccine-derived polioviruses. Analysis of the risks for potential outbreaks suggests the need for creation and maintenance of a global stockpile of vaccine for outbreak response. Game theoretical considerations show that coordination of OPV cessation optimizes expected costs and risks globally, despite the potential perceived incentives for countries to stop OPV earlier or later than other countries, or to continue OPV use indefinitely.
This article makes the strong case for global cooperation on risk management and suggests that even though individual countries may perceive their own risks as small, risks at the global level warrant cooperative action and coordination of OPV cessation.
成功根除一种疾病需要全球合作以实现共同目标。终局协调看似是成功的一项明显要求，但这并不能确保合作会发生。
分析探讨维持全球脊髓灰质炎根除工作所需的合作，具体涉及创建全球脊髓灰质炎疫苗储备以及协调口服脊髓灰质炎病毒疫苗（OPV）停用事宜。
运用风险与决策分析以及博弈论概念，我们模拟了在全球成功阻断野生脊髓灰质炎病毒传播后的20年时间范围内，全球合作在管理与脊髓灰质炎病毒相关风险方面的重要性。
在野生脊髓灰质炎病毒被根除后，各国可能希望避免疫苗接种的财务成本以及疫苗相关麻痹型脊髓灰质炎的风险，这可能导致它们减少OPV的使用。然而，过早且无协调地减少或停止疫苗接种会带来严重风险，包括野生脊髓灰质炎病毒重新输入的可能性以及疫苗衍生脊髓灰质炎病毒的可能性。对潜在疫情风险的分析表明，需要创建和维持用于应对疫情的全球疫苗储备。博弈论考量显示，OPV停用的协调可在全球范围内优化预期成本和风险，尽管各国可能认为存在早于或晚于其他国家停止OPV使用，或无限期继续使用OPV的潜在诱因。
本文有力地论证了在风险管理方面开展全球合作的必要性，并表明尽管个别国家可能认为自身风险较小，但全球层面的风险需要采取合作行动以及协调OPV停用。
