Cooperation in Managing and Maintaining End of Poliomyelitis-Stockpile Need

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 2. Net Present Value of Expected (Fifth Percentile to 95th Percentile) Costs (in Billions of Year 2002 Dollars, 3% Discount Rate) and Expected Number of Outbreaks for Different Decision Options by Income Group (ie, Sums Over All Countries in the Group) for a 20-Year Time Horizon^[10,11]
	Low	Lower Middle	Upper Middle	High
Total income group costs ($ billions)
OPV with SIAs	4.5 (2.8-6.5)	4.4 (2.6-6.9)	3.3 (1.9-5.2)	NA
OPV without SIAs	2.0 (1.1-3.0)	1.2 (0.62-1.8)	0.75 (0.35-1.2)	NA
IPV	5.5 (2.4-7.9)	4.0 (2.5-5.8)	2.2 (1.5-3.1)	9.7 (5.6-15.1)
Number of outbreaks
OPV with SIAs	7.1 (1-16)	5.3 (0-13)	0.30 (0-1)	NA
OPV without SIAs	51 (23-93)	38 (17-69)	2.0 (0-6)	NA
IPV	2.6 (0-6)	2.0 (0-5)	0.21 (0-1)*	0.025 (0-0)^†
No routine	3.4 (0-8)	2.6 (0-6)	0.17 (0-1)	NA

*The expected number of outbreaks with IPV in the upper middle-income group increases to 0.61 (0-3), if we assume that containment is not fully maintained due to the higher chance of release of wild polioviruses from IPV production facilities in countries in this income group.
^†The expected number of outbreaks with IPV in the high-income group increases to 0.077 (0-1), if we assume that containment is not fully maintained due to the higher chance of release of wild polioviruses from IPV production facilities in countries in this income group.
IPV = inactivated poliovirus vaccine; NA = not applicable, refers to a policy permutation that we did not model; OPV = oral poliovirus vaccine; SIAs = supplemental immunization activities

Table 2. Net Present Value of Expected (Fifth Percentile to 95th Percentile) Costs (in Billions of Year 2002 Dollars, 3% Discount Rate) and Expected Number of Outbreaks for Different Decision Options by Income Group (ie, Sums Over All Countries in the Group) for a 20-Year Time Horizon^[10,11]
	Low	Lower Middle	Upper Middle	High
Total income group costs ($ billions)
OPV with SIAs	4.5 (2.8-6.5)	4.4 (2.6-6.9)	3.3 (1.9-5.2)	NA
OPV without SIAs	2.0 (1.1-3.0)	1.2 (0.62-1.8)	0.75 (0.35-1.2)	NA
IPV	5.5 (2.4-7.9)	4.0 (2.5-5.8)	2.2 (1.5-3.1)	9.7 (5.6-15.1)
Number of outbreaks
OPV with SIAs	7.1 (1-16)	5.3 (0-13)	0.30 (0-1)	NA
OPV without SIAs	51 (23-93)	38 (17-69)	2.0 (0-6)	NA
IPV	2.6 (0-6)	2.0 (0-5)	0.21 (0-1)*	0.025 (0-0)^†
No routine	3.4 (0-8)	2.6 (0-6)	0.17 (0-1)	NA

*The expected number of outbreaks with IPV in the upper middle-income group increases to 0.61 (0-3), if we assume that containment is not fully maintained due to the higher chance of release of wild polioviruses from IPV production facilities in countries in this income group.
^†The expected number of outbreaks with IPV in the high-income group increases to 0.077 (0-1), if we assume that containment is not fully maintained due to the higher chance of release of wild polioviruses from IPV production facilities in countries in this income group.
IPV = inactivated poliovirus vaccine; NA = not applicable, refers to a policy permutation that we did not model; OPV = oral poliovirus vaccine; SIAs = supplemental immunization activities

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 2. Net Present Value of Expected (Fifth Percentile to 95th Percentile) Costs (in Billions of Year 2002 Dollars, 3% Discount Rate) and Expected Number of Outbreaks for Different Decision Options by Income Group (ie, Sums Over All Countries in the Group) for a 20-Year Time Horizon^[10,11]
	Low	Lower Middle	Upper Middle	High
Total income group costs ($ billions)
OPV with SIAs	4.5 (2.8-6.5)	4.4 (2.6-6.9)	3.3 (1.9-5.2)	NA
OPV without SIAs	2.0 (1.1-3.0)	1.2 (0.62-1.8)	0.75 (0.35-1.2)	NA
IPV	5.5 (2.4-7.9)	4.0 (2.5-5.8)	2.2 (1.5-3.1)	9.7 (5.6-15.1)
Number of outbreaks
OPV with SIAs	7.1 (1-16)	5.3 (0-13)	0.30 (0-1)	NA
OPV without SIAs	51 (23-93)	38 (17-69)	2.0 (0-6)	NA
IPV	2.6 (0-6)	2.0 (0-5)	0.21 (0-1)*	0.025 (0-0)^†
No routine	3.4 (0-8)	2.6 (0-6)	0.17 (0-1)	NA

*The expected number of outbreaks with IPV in the upper middle-income group increases to 0.61 (0-3), if we assume that containment is not fully maintained due to the higher chance of release of wild polioviruses from IPV production facilities in countries in this income group.
^†The expected number of outbreaks with IPV in the high-income group increases to 0.077 (0-1), if we assume that containment is not fully maintained due to the higher chance of release of wild polioviruses from IPV production facilities in countries in this income group.
IPV = inactivated poliovirus vaccine; NA = not applicable, refers to a policy permutation that we did not model; OPV = oral poliovirus vaccine; SIAs = supplemental immunization activities

Table 3. Key Assumptions of the Models That Generated mOPV Demand for the Stockpile
Modeling Aspect	Assumptions	References
Analytic time horizon	Outbreak and response model limited to 2-year time horizon after virus introduction, such that viruses that do not lead to detected cases within 2 years do not necessitate a response. For Figure 1, the "no routine" ("universal IPV") results reflect approximately 86% (78%) of outbreaks for which virus detection and all 3 response rounds occurred within 2 years of the virus introduction, approximately 12.5% (19%) of outbreaks that did not lead to detection within 2 years, and approximately 1.5% (3%) of outbreaks for which detection occurred within 2 years, but some or all of the response rounds occurred more than 2 years after the virus introduction with the doses for all response rounds included in the totals.	15,16
Interpopulation spread	The model does not account for outbreaks due to outbreak virus exportations or exportations of OPV viruses used for the outbreak response.	15,16
Population immunity	Preoutbreak immunity profile depends on the time elapsed and policies followed after OPV cessation.	9,11, 13-16
Population size	Outbreak population sizes randomly drawn on the basis of the projected distribution of population size.	15,16,28
Response	Response strategy of 3 mOPV rounds covering 90% of each cohort born since cessation, rounded to the next multiple of 5. For example, with "no routine" a response 7 years after cessation would target all children younger than 10 years, whereas with continued IPV the response would target only children younger than 5 years. The model assumes that the response rounds would control the outbreaks.	13-16
Surveillance	Outbreak detection occurs at the onset of the fifth paralytic case, and the first response round starts 70 days after detection.	13-16

mOPV = monovalent oral poliovirus vaccine; IPV = inactivated poliovirus vaccine

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 1. Point Estimates of the Probability of at Least 1 Outbreak (Defined as 1 or More Cases of Paralytic Polio) During the First 6 or 20 Years After the Time When the World Is Certified as Free of Circulating Wild Polioviruses (T₀) in a Country With a Population of 100 Million People by Income Level, Routine Immunization Policy, SIAs Policy, Containment Policy, Initial Population Immunity Assumption, and VDPV Risk Assumption^[11]*
Routine	SIAs	VDPV Risk Case	Population Immunity	Containment	Probability of at Least 1 Outbreak (1 or More Cases of Paralytic Polio) in the First 6 or 20 Years After T₀ in a Country With 100 Million People (by Income Level)
					First 6 Years				First 20 Years
					LOW	LMI	UMI	HIGH	LOW	LMI	UMI	HIGH
OPV	Yes	cVDPVs	Either	Either	0.02	0.02	0.004		0.08	0.08	0.01
OPV	Yes	cVDPVs and aVDPVs	Either	Either	0.09	0.09	0.01		0.3	0.3	0.04
OPV	No	cVDPVs	Realistic	Either	0.3	0.3	0.04		0.7	0.7	0.1
OPV	No	cVDPVs	Maximum	Either	0.2	0.2	0.03		0.7	0.7	0.1
OPV	No	cVDPVs and aVDPVs	Realistic	Either	0.4	0.4	0.06		0.9	0.9	0.2
OPV	No	cVDPVs and aVDPVs	Maximum	Either	0.3	0.3	0.04		0.8	0.8	0.2
IPV	No	cVDPVs	Realistic	Maintained	0.06	0.06	0.008	0.0007	0.06	0.06	0.02	0.002
IPV	No	cVDPVs	Realistic	Not maintained	0.06	0.06	0.01	0.002	0.08	0.07	0.05	0.006
IPV	No	cVDPVs	Maximum	Maintained	0.005	0.005	0.002	0.0007	0.008	0.006	0.01	0.002
IPV	No	cVDPVs	Maximum	Not maintained	0.007	0.006	0.007	0.002	0.02	0.01	0.04	0.006
IPV	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.09	0.01	0.0007	0.1	0.1	0.02	0.002
IPV	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.02	0.002	0.1	0.1	0.05	0.006
IPV	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.004	0.0007	0.02	0.02	0.01	0.002
IPV	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.009	0.002	0.03	0.03	0.04	0.006
No	No	cVDPVs	Realistic	Maintained	0.08	0.07	0.008		0.08	0.07	0.01
No	No	cVDPVs	Realistic	Not maintained	0.08	0.07	0.008		0.08	0.07	0.02
No	No	cVDPVs	Maximum	Maintained	0.006	0.005	0.002		0.01	0.009	0.007
No	No	cVDPVs	Maximum	Not maintained	0.006	0.006	0.002		0.01	0.01	0.01
No	No	cVDPVs and aVDPVs	Realistic	Maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Realistic	Not maintained	0.1	0.1	0.01		0.1	0.1	0.02
No	No	cVDPVs and aVDPVs	Maximum	Maintained	0.02	0.02	0.003		0.03	0.02	0.008
No	No	cVDPVs and aVDPVs	Maximum	Not maintained	0.02	0.02	0.004		0.03	0.02	0.01

*These estimates are intended to provide context about the relative probabilities under different conditions, not as the actual estimates for any individual country.
aVDPV = ambiguous vaccine-derived poliovirus; cVDPV = circulating vaccine-derived poliovirus; LMI = lower middle-income country; LOW = low-income country; HIGH = high-income country; OPV = (trivalent) oral poliovirus vaccine; SIAs = supplemental immunization activities; UMI = upper middle-income country

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

Table 4. Consequences Matrix for Options Related to the Simple OPV Cessation Game
Action Taken by Self	Action Taken by Others
	Stop OPV Prior to T₀		Stop OPV at T₀		Stop OPV After to T₀		Use OPV Indefinitely
	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others	Costs for Self	Costs for Others
Stop OPV prior to T₀	C_pre	C_pre	C_pre	C_min	C_pre + C_exp	C_post	C_pre + C_inf	C_max
Stop OPV at T₀	C_min	C_pre	C_min	C_min	C_min + C_exp	C_post	C_min + C_inf	C_max
Stop OPV after T₀	C_post	C_pre + C_exp	C_post	C_min + C_exp	C_post + C_exp	C_post + C_exp	C_post + C_inf	C_max
Use OPV indefinitely	C_max	C_pre + C_inf	C_max	C_min + C_inf	C_max	C_post + C_inf	C_max	C_max

cVDPV = circulating vaccine-derived poliovirus; OPV = oral poliovirus vaccine
C_exp = expected costs of increased risk of circulating vaccine-derived polioviruses (cVDPVs) exported to other countries due to delayed OPV cessation and paid for by other countries
C_inf = expected costs of increased risk of cVDPVs exported to other countries indefinitely and paid for by other countries (C_inf > C_exp)
C_imp = expected costs of increased risk of cVDPVs imported from neighbors (C_imp > C_vac1)
C_min = cost of vaccinating with OPV until time of coordinated OPV cessation (T₀), including costs of vaccination until T₀, vaccine-associated paralytic polio (VAPP) treatment costs, and response and treatment costs associated with potential cVDPV outbreaks within the country's own borders, with the minimum risk of cVDPVs due to coordinated cessation
C_max = cost of vaccinating with OPV indefinitely, including vaccination costs before and after T₀, VAPP treatment costs, and increasing expected risks and costs of creating cVDPV outbreaks within the country's own borders^[15,16]
C_own = expected costs of increased risk of cVDPV outbreaks within a country's own borders due to use of OPV after T₀
C_pre = C_min + C_imp - C_vac1 = expected costs of stopping OPV before T₀ (C_pre > C_min)
C_post = C_min + C_own + C_vac2 = expected costs of stopping OPV after T₀ (C_post > C_min)
C_vac1 = expected costs of vaccination avoided by stopping OPV prior to T₀
C_vac2 = expected costs of vaccination paid extra by stopping OPV after T₀

The Case for Cooperation in Managing and Maintaining the End of Poliomyelitis: Stockpile Needs and Coordinated OPV Cessation

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The Case for Cooperation in Managing and Maintaining the End of Poliomyelitis: Stockpile Needs and Coordinated OPV Cessation

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