To all polio eradicators:
I began working in the polio eradication effort nearly 25 years ago. The path of progress has not always been linear, and the closer we get to zero, the harder the effort becomes.
At times like this, I remind myself that we are not pursuing a polio-free world because it is easy. We are doing it because it is necessary.
The challenges facing polio eradication today are some of the most serious we have faced. Polio exists in some of the most difficult environments in which to deliver health care—from humanitarian crises in Afghanistan, the Democratic Republic of the Congo, Sudan and Yemen, to persistent insecurity in parts of Nigeria, Somalia and remote and underserved communities in Pakistan. Meanwhile, funding for global health is facing strong headwinds. Together, these forces made it necessary to extend our polio eradication strategy timelines earlier this year.
Turning the tide on wild polio
The polio situation in Pakistan and Afghanistan looks nothing like it did 20 or 30 years ago, when 20,000 children or more were paralyzed by polio each year.
After the most recent peak in 2019, cases declined to near elimination levels—as low as one in Pakistan in 2021 and two in Afghanistan in 2022. And while we set out in January to finally achieve zero transmission, we have since seen our largest outbreak of the virus in the last four years.
This resurgence of the virus underscores that there is no room for error in an eradication programme. To stop wild poliovirus in its last frontier of Pakistan and Afghanistan, the programme is working to strengthen cross-border coordination, deliver a broader range of health interventions alongside polio vaccines, and increase investments to advance gender equity at all levels of the program. Together, these efforts aim to increase vaccine uptake among children, especially focusing on children who are consistently missing vaccination, and reduce the force of virus transmission—strategies that brought India over the finish line more than ten years ago. Importantly, this will all take place with greater community and national ownership, and the critical partnerships with religious and local influencers, all of which are key to achieving and sustaining eradication.
Optimism, and warnings, amid outbreaks
Cases of variant poliovirus have fallen 40% compared to 2023, and nearly 80% from the peak of transmission in 2020. This is a promising trend that we must keep up.
Still, as many as 85% of children paralyzed by polio live in fragile, conflict-affected or otherwise vulnerable settings. These conditions pose immense challenges for routine immunization, outbreak response campaigns and the delivery of basic health services alike, creating a prime environment for variant poliovirus to emerge and spread.
As we have seen before, the poliovirus can spread rapidly within a country, region, or even globally. Recent reports of polio variants detected in the wastewater of several European cities serve as proof of this. Countries worldwide remain at risk as long as polio exists anywhere.
But the programme’s historic success despite all odds—prove that with commitment, resilience and adaptability, it is possible. For example, what the polio eradication programme was able to achieve in Gaza—securing humanitarian pauses for the first time since the conflict started and reaching over half a million children with the polio vaccine and other health interventions—gives us the confidence that we can overcome the challenges in our way and end polio everywhere.
Support for polio eradication at all levels, from heads of government to local community leaders, is giving me hope. Religious and traditional leaders in Nigeria and Somalia, for example, or the commitment from the highest level in Madagascar, have been crucial to building trust and increasing vaccine acceptance in communities. And unique new initiatives, whether increasing local and regional engagement based on the joy of football and music, or bringing global and national partners, celebrities, and influencers together through Team End Polio, Humanly Possible, and The Big Catch-Up to protect children and adults alike from polio, measles, malaria, and other deadly but preventable diseases, are proof of the creative tactics underway to put an end to the variant poliovirus for good.
Meanwhile, the programme will continue to coordinate faster, bigger and more effective response to polio variant outbreaks – support countries in cross-border and synchronizing vaccination efforts, and collaborate with routine immunization partners to improve population immunity. On top of this, we will continue to optimize the use of nOPV2 to maximize the benefits this vaccine offers in stopping outbreaks in a more sustainable way.
2025 will mark five years since the WHO African Region was certified free from endemic wild polio. Then, it was this whole-of-society approach that made stopping the virus possible. Now, as the region faces a disproportionate burden of variant polio, I am heartened to see that same energy and urgency in the polio eradication effort once again and know that if we keep it up, together, we can stop all forms of the virus for good.
Looking up to 2025
In this polarized world, polio eradication has shown a way to work together, from the highest levels of government to health workers, local influencers, to parents and caretakers in communities, and to Rotarians, donors and partners all around the world. Aidan O’Leary, our dear friend, and my counterpart at the World Health Organization who we tragically lost earlier this year, strongly believed in this fact and exemplified it through his life and his work.
We have the tools and strategies to make polio history. Proven and context specific eradication strategies, if fully implemented, will lead to a clear outcome: eradication of wild polio and the end of all variant polioviruses. When we work together, with the financial and political capital we need, we know that a polio-free world is within reach.
Thank you for committing your time and energy to a healthier future for children everywhere, and we look forward to continuing our work together in 2025.
