Will there be a year without polio before 2030?

Security disruptions consistently hinder polio vaccination in Southern KP and Eastern Afghanistan. The Global Polio Eradication Initiative (GPEI) consistently reports that security-related disruptions, including attacks on vaccinators and security personnel, alongside campaign suspensions, pose a significant and persistent barrier to polio eradication efforts. These challenges are particularly acute in the seven endemic districts of Southern Khyber Pakhtunkhwa (KP), Pakistan, and Afghanistan's Eastern Region, which includes provinces like Nangarhar, Kunar, and Nuristan. The 24th Independent Monitoring Board (IMB) Report in September 2025 specifically noted that security concerns limit access to children in parts of Southern KP, with attacks on vaccination teams often leading to campaign suspensions and reduced reach ^[2]. Similarly, insecurity in Afghanistan's Eastern Region continues to restrict access and disrupt campaign implementation, resulting in missed children ^[2]. GPEI documents describe these disruptions as ongoing, indicating a consistent negative trend rather than fluctuating quarterly incident counts ^[1].

News reports confirm ongoing security incidents, including attacks on personnel. Although GPEI documents do not detail specific quarterly statistics on the frequency of security-related disruptions, news reports corroborate their continuous occurrence. For instance, in February 2026, police personnel sustained injuries during an attack on a polio security team in Hangu, Southern KP ^[3]. Throughout 2025, several security officers guarding polio teams were reportedly attacked and martyred in various parts of Khyber Pakhtunkhwa, with incidents noted in August, September, and January ^[4]. These events underscore the persistent militant threats and security challenges impeding eradication efforts in Pakistan, aligning with GPEI's assessment of ongoing security concerns in the region ^[5].

Wild poliovirus detections significantly increased across Pakistan in the last year. Environmental surveillance in Pakistan recorded a substantial rise in wild poliovirus type 1 (WPV1) detections, with 56 positive environmental samples isolated in the most recent 12-month period (approximately March 2025 to February 2026). This marks a significant increase from the 11 positive samples found in the preceding 12-month period (March 2024 to February 2025) ^[1]. In contrast, Quetta consistently reported zero WPV1 positive environmental surveillance sites and samples throughout 2024, 2025, and into early 2026 ^[2].

Karachi and Peshawar show a clear increase in WPV1 positivity. While precise aggregated percentages of positive sites for Karachi and Peshawar over the entire 12-month periods are not fully detailed, available data indicates an increasing trend in WPV1 presence. Snapshot data from March 2025 showed Karachi with 5% positivity (1 of 20 sites) and Peshawar with 10% positivity (1 of 10 sites) ^[3]. Peshawar also reported 10% positivity in January 2026, with one out of ten samples testing positive ^[4]. Furthermore, both cities experienced a notable increase in annual positive WPV1 environmental samples: Karachi's detections rose from 6 in 2024 to 20 in 2025, and Peshawar's from 3 in 2024 to 14 in 2025 ^[2]. As of early February 2026, both cities continued to report WPV1 detections, each with 2 positive samples ^[5].

New outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) continued across 15 countries. Between October 2025 and March 2026, new emergences or expansions of cVDPV2 were reported in Chad, Mali, Nigeria, Niger, Somalia, Afghanistan, Democratic Republic of the Congo (DRC), Burundi, Central African Republic, Guinea, Mauritania, Mozambique, Pakistan, South Sudan, and Yemen ^[1]. These detections highlight an ongoing challenge, particularly within the African region, with Burundi and DRC specifically reporting cVDPV2 detections in October 2025 ^[3]. These outbreaks occurred amidst widespread global deployment of the novel Oral Polio Vaccine type 2 (nOPV2), which has been extensively utilized in response efforts, such as campaigns in Ethiopia reaching over 24 million children in a single round ^[1].

Despite nOPV2's widespread use, new cVDPV2 emergences remain a concern. The Global Polio Eradication Initiative (GPEI) recognizes that nOPV2's broad application is having a significant impact on outbreak response and mitigation ^[1]. However, the concurrent detection of multiple new cVDPV2 emergences and expansions since October 2025 suggests that while nOPV2 is crucial for controlling outbreaks, it has not yet fully prevented new emergences in all contexts ^[1]. The Polio IHR Emergency Committee's continued expression of concern over rising cVDPV2 cases underscores the critical need for sustained vigilance and vaccination efforts to address the persistent threat of poliovirus ^[1].

Tajikistan and Iran demonstrate high inactivated polio vaccine coverage. In 2022, Tajikistan reported an estimated 99% of children by 12 months receiving their first IPV dose (IPV1) and 98% receiving their second (IPV2) ^[1]. Similarly, the Islamic Republic of Iran achieved 99% coverage for both IPV1 and IPV2 among children by 12 months in the same year ^[2]. Furthermore, a study on Afghan refugee children aged 12–23 months in Iran indicated that 92.1% had received at least one IPV dose, with 71.3% being fully vaccinated overall ^[3].

Somalia faces substantial challenges in achieving adequate polio vaccination rates. In 2022, only 53% of children in Somalia had received one dose of IPV (IPV1), and a significantly lower 22% had received two doses (IPV2) ^[2]. While a 2023 survey showed national fractional IPV (fIPV) coverage at 73.1% among children under five, regional disparities were evident, such as 76.5% in Puntland and 69.4% in South-Central regions ^[4]. This reflects a broader concern about under-immunization, as only 38% of children aged 12–23 months had received all basic vaccinations ^[5]. The persistent wild poliovirus transmission in neighboring Pakistan and Afghanistan intensifies the need for improved vaccination efforts in these interconnected, high-risk areas ^[6].

The Global Polio Eradication Initiative (GPEI) projects the last WPV1 case by late 2024. In its "Strategy Extension 2024-2026," the GPEI targets the interruption of all wild poliovirus type 1 (WPV1) transmission by the end of 2024 ^[1]. This strategic update also aims to achieve the eradication of all polioviruses, including circulating vaccine-derived polioviruses (cVDPV), by 2026 ^[1].

WHO mandates three consecutive years with zero WPV1 for certification. Global polio eradication certification, as required by the World Health Organization (WHO), necessitates a three-year period without any detected WPV1 cases following the last reported instance ^[2]. To achieve certification before the end of 2029 or early 2030, the final WPV1 case must be identified no later than late 2026. This timeline would enable three full calendar years (2027, 2028, and 2029) to pass without WPV1 cases, thus satisfying the WHO's essential requirement for certification by the close of 2029 ^[2].

GPEI's 2024 target provides a significant buffer for certification. The GPEI's projected date for the last WPV1 case by the end of 2024 aligns favorably with the practical deadline needed for pre-2030 certification. Should the GPEI successfully meet this target, the last WPV1 case would occur approximately two years ahead of the late-2026 cutoff required for certification before 2030. This provides a substantial buffer for the three-year disease-free surveillance period mandated by the WHO ^[1].