DPR Korea has been maintaining its polio-free status since 1997 and actively implementing the polio eradication and endgame strategic plan (2013-2018) in alignment with the goal three of the South East Asia Regional Vaccine Action Plan (SEARVAP) and the Global Polio End game Initiative (GPEI). The objective two of the global polio end game plan calls for the strengthened routine immunization services, introduction of at least one dose of inactivated polio vaccine (IPV) in the routine immunization schedule. It also calls for withdrawal of oral polio vaccines (OPV) in a phased manner, which began with the global synchronized switch from the trivalent to bivalent OPV in April 2016. Following the above guidance of the GPEI, the national immunization programme in DPRK introduced Inactivated Polio vaccine (IPV) as a single dose at 14 weeks of life along with the Pentavalent-third dose in its national vaccination schedule in May 2015. This was a pre-requisite for preparation for global withdrawal of the type 2 component of OPV. The IPV introduction was followed by switching from trivalent OPV to bivalent OPV (Sabin Type 1+3) in April 2016.
Despite the commitment shown by introducing a single dose of IPV as per the global recommendations, the global scarcity of IPV vaccines affected its continuity of use in DPR Korea. Globally, the limited stocks of IPV were provided to high risk countries (Tier 1 and 2). DPR Korea was categorized as a low risk (tier 4) country and did not receive global supplies of IPV. As a result, the national immunization programme vaccinated the last child with IPV in DPR Korea in April 2016. This ensued in around 700,000 children (two annual cohorts) in DPRK missing their IPV routine vaccinations to date. Since this cohort was not exposed to IPV , their immunity to type 2 polio viruses is nonexistent and they present a risk in terms of susceptibility to type 2 polio viruses ( Sabin and Wild )
In 2017, the Strategic Advisory Group of Experts (SAGE) on immunization expressed their concern over the potential impact of waning mucosal immunity for type 2 polio viruses in the context of the global IPV supply issue and recommended that countries which experienced stock-outs should provide one full dose or two fractional IPV (fIPV) doses (e.g. at 6 and 14 weeks) to all children who were missed as soon as the vaccine becomes available. Based on this recommendation, as soon as the IPV vaccine was available for use , DPRK decided to re-start IPV vaccination in the country.Assuming the availability of IPV stocks by the end of February, DPR Korea decided to re-introduce a full single dose of IPV intramuscularly by the end of April or early May , 2018 considering the time required for distribution of the vaccine stocks to the service delivery points throughout the country. National immunization programme also decided to conduct a catch-up campaign for the missed two cohorts using a single dose of IPV intramuscularly in 2019 or earlier, subject to the availability of the required quantities of IPV.
With the support from “ Gavi The Vaccine Alliance” in terms of provision of IPV stocks, DPR Korea ceremoniously re- introduced IPV intra –muscularly from 15 May 2018 onwards. The ceremony of re-introduction was held at the Mirae policlinic, Pyongchon district, in the capital Pyongyang city. The occasion was graced by Dr. Thushara Fernando, the WHO Representative and Ms Oyunsaihan Dendevnorov, the UNICEF Representative and Dr Choe Suk Hyon of the Ministry of Public Health (MOPH) , along with the Expanded Programme of Immunization (EPI) teams of the MOPH, WHO and UNICEF country offices. Representatives of both United Nations agencies congratulated national EPI on successful re-introduction of IPV, continuation of implementation of the Global Polio Eradication and Endgame Strategic Plan and assured their unwavering support to DPR Korea’s contribution towards a polio free world.