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The Global Pertussis Initiative: Process Overview

Plotkin, Stanley MD*†

The Pediatric Infectious Disease Journal: May 2005 - Volume 24 - Issue 5 - p S7-S9
doi: 10.1097/
Introductory Articles

In 2001, the Global Pertussis Initiative was established as a scientific forum to analyze the status of pertussis globally and to evaluate various immunization strategies to improve disease control. Thirty-seven multidisciplinary experts from 17 countries participated.

The initiative was conducted in 3 stages: assessment of the international epidemiology, diagnosis, health and economic burden, and prevention and treatment of pertussis; evaluation and prioritization of 7 immunization strategies to address the problems; and identification of solutions to surmount potential barriers to the implementation of these strategies. A health-economic model, created for the Initiative, analyzed the cost-effectiveness of the selected immunization strategies. Discussion, debate, and consensus were facilitated via a roundtable meeting, teleconferences and use of a closed, interactive website, allowing the participants to share data, knowledge, experience, and opinion. This article describes the processes undertaken to conduct the Initiative.

From the *University of Pennsylvania, Philadelphia, PA; and †sanofi pasteur, Doylestown, PA

Address for correspondence: Stanley Plotkin, MD, sanofi pasteur, 4650 Wismer Road, Doylestown, PA 18901. E-mail

The Global Pertussis Initiative (GPI) was established in 2001 to assess the problems posed by pertussis around the world and evaluate potential immunization strategies beyond infancy to improve disease control.

The GPI comprised 37 experts in different aspects of pertussis. The group was divided into 3 regional subgroups, North America, Europe and International, and was overseen by a 5-person Steering Committee (Table 1).



The Initiative was undertaken in 3 stages (Fig. 1). A closed GPI Roundtable Meeting in June 2002 was a key part of the overall process.



At each of the 3 stages, draft documents were generated based on standard frameworks developed by the Steering Committee. These statements were posted on a dedicated, password-protected Internet site, enabling other participants to provide additional information and comment on the statements, which were revised accordingly. After a final review by the participants, a vote was taken to establish the level of agreement with each statement and to comment on the quality of the supporting evidence.

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The increasing concern that pertussis is a growing health problem that could be addressed through new or improved immunization strategies was the fundamental issue that resulted in the formation of the GPI. The objectives of the Initiative are outlined in Table 2.



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A Chairman oversaw the Initiative. In addition, each of the 3 regional subgroups, North America, Europe and International, had a representative on the Steering Committee, and a fourth member represented the health economists and developed a mathematical model to analyze the potential cost effectiveness of immunization strategies beyond the currently recommended schedules (Table 1).1

The Chairman and regional Steering Committee members were appointed to take responsibility for driving the process at the global and regional levels, respectively.

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The Initiative participants were divided into 3 regions: North America, Europe, and International. Each of the 3 regions undertook the second and third stages of the initiative separately (Fig. 1).

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A closed, password-protected website was used to simplify the exchange of opinions and ideas. The reasons for using the website were to: facilitate ongoing exchange of ideas; provide an archived record of discussions; assist the provision and exchange of data and reference sources; allow voting on level of agreement; limit potential communication barriers (eg, time zones, language); and facilitate time management for participants.

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PAREXEL, a medical education company, was appointed to coordinate the activities of the GPI as the scientific secretariat. It was responsible for all logistic organization of the process, as well as maintaining the Internet site.

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The Initiative participants initially embarked on a comprehensive review of the international literature on pertussis. The review was divided into 17 topics that were used for reference during stages 2 and 3. The results of this literature review are summarized in this supplement.2–10

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Having evaluated the scale of the problems associated with pertussis worldwide, the Steering Committee developed a list of potential immunization strategies to address these problems.

The resulting draft regional strategy summaries formed the basis for the Initiative's proposed strategies, which are discussed in more detail in this supplement.11–14

All GPI participants were invited to a Roundtable Meeting in Paris, France, on June 1–2, 2002. This closed meeting was part of the overall process and was convened to meet the following objectives: to share global pertussis expertise; to consolidate and conclude findings of the web-based activities, including definition of the problem presented by pertussis and choice of strategy (or strategies) for each region; to explore potential barriers to implementation of the proposed strategies; to define areas of agreement and dissension.

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Based on the proposed immunization strategies chosen for each region and the discussions surrounding the potential barriers to implementation of these strategies, each of the 3 regions compiled an implementation action plan.

The GPI participants also developed a research agenda of areas where further clarification would assist in the development of optimized disease control programs. This and the implementation action plans are discussed further in this supplement.12–14

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Based on a thorough literature review and a series of structured discussions among the GPI participants, a series of documents was produced, which have been used as the primary source material in the preparation of the papers in this supplement. The supplement papers were drafted by the GPI participants and were reviewed via the website by all 37 participants. The amended papers were approved by the entire GPI membership before submission for publication. An additional synopsis of the GPI was prepared in the same way and provides a summary of the key outcomes of the Initiative.15

Australia, Canada, France and Germany have already implemented, or are in the process of implementing, some of the immunization schedules proposed by the GPI.12–14 By monitoring the changing epidemiology of pertussis in these countries, the effectiveness of the new programs can be assessed; this should facilitate the expansion of immunization schedules in other countries and thus significantly improve pertussis disease control.

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pertussis; review

© 2005 Lippincott Williams & Wilkins, Inc.