Professor Natan Goldblum and the Combined Vaccination Program in Gaza

Blum et al. in November 2010 described the pioneering work of Natan Goldblum, a great Israeli virologist and innovator in polio immunization.1 Another important facet of his work was as a key contributor to development of the combined or sequential oral polio vaccine (OPV) and inactivated polio vaccine (IPV) programs used in the West Bank and Gaza since the late 1970s. Goldblum and Joseph Melnick from Baylor University were asked to consult in 1978 with the Israel Ministry of Health and the Gaza and West Bank public health services. During this time, I was the Coordinator for Health in the West Bank and Gaza for the Israeli Ministry of Health (from 1978-1994), with oversight responsibility for health in the West Bank and Gaza including immunization policy and other aspects of health services and training of Palestinian health providers. At that time, we faced continuing polio epidemics, mostly in Gaza where sanitary conditions were poor, despite high levels of OPV coverage. As an outcome of the discussions with Goldblum and Melnick, a new approach they recommended was jointly agreed to by the Israeli and Palestinian health officials. This accord expanded the routine immunization program from four doses of OPV by adding three doses of IPV given in a mixed sequence during the first year of life. This method was later dubbed the Gaza system. Coverage was soon greater than 85%, and catch-up campaigns were conducted for persons aged up to 18 years. Polio disappeared during the next two years and was effectively eradicated from these previously endemic areas.2 During the 1980s, Israel maintained an OPV-only policy, but with a trial IPV program in 2 districts of the country. In 1988, an outbreak of paralytic poliomyelitis occurred mainly among adolescents and young adults in one of these trial districts where the IPV-only policy was in effect (15 cases and one death). As a result of this episode, Israel adopted the Gaza system, and total eradication of polio was rapidly achieved.3,4 After eradication of polio in Gaza, the West Bank, and subsequently in Israel, the Gaza system was adopted and continues in other parts of the Middle East. A combined or sequential OPV and IPV program is an important policy option for polio control.5,6 In light of challenges in countries in which the virus is still endemic (Nigeria, India, Afghanistan, and Pakistan), with recent spread to other countries, the combination of OPV and IPV should again be considered for the end stage of polio eradication in remaining high-risk areas.7,8