Thanks to the power of vaccines and decades of global collaboration, wild poliovirus has been nearly wiped out. But the virus - exploiting factors like insecurity, humanitarian crises, persistently underserved communities and inconsistent access to populations on the move - has proved to be a tenacious opponent, still paralysing children today in some of the most fragile settings on the planet.
Since 1988, when the Global Polio Eradication Initiative (GPEI) was formed, the number of children paralysed by polio has been reduced by 99.9%. Through collaboration and commitment from health workers, governments and partners around the world, over 3 billion children have been immunized against polio and 20 million people are walking today who otherwise would have been paralysed (1)
Today, polio persists in some of the world's most challenging environments for the delivery of health care and other basic services -- from humanitarian crises in Afghanistan, the Democratic Republic of the Congo, the Gaza Strip, Somalia, Sudan and Yemen to persistent insecurity in parts of Nigeria and remote and underserved communities in Pakistan. In this landscape, the GPEI continues to protect millions of children each year from paralysis and to work towards the promise of a polio-free world. Yet the reality of eradicating any disease is that the closer the world gets to zero, the harder the effort becomes.
To end polio in the face of these challenges, the GPEI is refining tactics and deploying innovative tools to reach every child in every community with polio vaccines and other life-saving care.
In pursuit of its mission, the GPEI is extending the timeline needed for eradication from 2026 to 2029 and revising its programmatic budget to implement a mix of new and time-tested tactics to consistently reach every child.
While the Polio Eradication Strategy 2022-2026 is robust and eradication tactics have adapted nimbly to shifting ground realities, it is clear that the GPEI must strengthen implementation and improve performance to reach more children more consistently. To end wild poliovirus in Afghanistan and Pakistan, the programme will intensify cross-border coordination to reach mobile populations and those living along the border; deliver polio vaccines alongside broader health interventions by coordinating with new development partners; refine and intensify postcampaign monitoring to identify missed children, employing immediate corrective measures and informing planning for subsequent rounds; tailor activities according to local gender norms; and increase support for women vaccinators, planners and supervisors. The programme will also intensify advocacy for increased community and national ownership of the eradication effort and adapt contextspecific social and behavioural change communication strategies to address vaccine hesitancy.
To stop outbreaks of type 2 variant poliovirus for good, the programme will enhance its focus on improving immunization coverage in four consequential geographies, that is in subnational areas where children are at the highest risk of encountering and spreading the virus: eastern Democratic Republic of the Congo, northern Nigeria, south-central Somalia and northern Yemen. At the same time, in any country with new detections of the virus, the GPEI will implement faster, bigger and better vaccination campaigns that reach every child with the next-generation vaccine, novel oral polio vaccine type 2 (nOPV2). In countries with persistent circulation, it will also implement targeted regional action plans to reach children with vaccines and other life-saving care in the hardest-to-access areas. In all situations, the GPEI is integrating with and supporting essential immunization programmes in a more strategic and systematic manner. This work will set the stage to stop the remaining types of variant poliovirus - types 1 and 3 - by building population immunity and strengthening immunization systems before withdrawal of the oral vaccine.
Dedicated, skilled and gender-balanced teams are already driving forward new approaches, from using geospatial technology to consistently reach remote communities along the Congo River in eastern Democratic Republic of the Congo to forging new partnerships that deliver essential health services to high-risk communities in Somalia. A robust risk and performance monitoring framework now regularly guides the programme, covering all aspects from financing and vaccine procurement to campaign planning and implementation.
With strengthened implementation, additional resources and renewed focus from polioaffected country governments, donors and global advocates, the GPEI can protect the world's most vulnerable children, fulfil its historic promise and end polio for good.
The world still has a window of opportunity to end this devastating disease. Wild poliovirus transmission remains historically low compared to just five years ago and cVDPV transmission has been substantially reduced in the last two years. Governments and health workers, with support from the GPEI, have the creative tools and strategies needed to reach every child. But political instability, conflict and misinformation are mounting, and essential immunization programmes and polio vaccination campaigns are struggling to keep up.
If high vaccination rates against polio are not achieved and maintained, the risk of outbreaks will rise. This risk has started to become a reality as places long polio-free, like the United States of America and the United Kingdom, recently detected transmission of the virus for the first time in decades. The window is closing fast as too many children are left unprotected.
Vaccination is one of public health's most powerful and cost-effective tools to prevent disease, disability and death. Polio eradication could save the world an estimated US$ 33.1 billion in direct costs by 2100 compared to the cost of controlling the virus and responding continuously to outbreaks (2, 3). If the world does not keep striving for eradication, outbreaks will spread, and many thousands of children would be paralysed every year within a decade. The cost to families of caring for a child paralysed by polio is also high, especially paired with the risk of that child missing out on education and work. Not completing the mission of eradication now is costly - both in human and financial terms.
Amid today's landscape, the GPEI's role has never been more critical. In addition to its main goal of stopping polio, the GPEI, in coordination with other global health initiatives, also acts as a lifeline to essential health services for communities left behind. House-to-house polio vaccination campaigns are often the most frequent and, sometimes, only point of contact between these communities and the formal health system. The programme also operates one of the largest disease surveillance systems in the world. Polio staff, and these vaccination and surveillance systems, have helped fight other health emergencies like measles, Ebola, coronavirus disease and, most recently, mpox. Investing in polio eradication is therefore an investment in these critical underlying services and in collective global health security.
Governments and partners have already committed a generous US$ 4.5 billion to the GPEI's current strategy. Providing the programme with the remaining US$ 2.4 billion needed through 2029 is essential to capitalize on the incredible progress that has been made and prevent an exponential rebound of polio around the globe. The world must act now.