Impediments to Progress Toward Polio Eradication During 2014-2024: Effectively Addressing the Current Challenges

When the Global Polio Eradication Initiative (GPEI) began in 1988, the year 2000 target was clearly ambitious. Nonetheless, among 20 countries with endemic wild poliovirus transmission in 2000, only Afghanistan, Nigeria and Pakistan remained endemic in 2014; successful global eradication was anticipated within years. Transmission was interrupted in Nigeria after implementing innovative activities; unfortunately, transmission in Afghanistan and Pakistan has continued into 2025. An additional challenge has been controlling outbreaks and interrupting persistent transmission of circulating vaccine-derived poliovirus type 2 detected after global withdrawal of the use of Sabin strain type 2 oral poliovirus vaccine. The impediments to progress since 2014 are detailed and the challenges that the GPEI must successfully mitigate are reviewed herein. Primary challenges since the acute phase of the COVID-19 pandemic include the loss of a sense of urgency and political will/national ownership in stopping poliovirus transmission, lower childhood routine immunization coverage and the decreased quality of outbreak response campaigns. These facets need to be strengthened. Ongoing security challenges require continued vigilance in affected areas of wild poliovirus-endemic countries as well as in countries with persistent transmission of vaccine-derived poliovirus. Eradication can be achieved if the multiple challenges mentioned are urgently and more effectively mitigated. Decreased funding for the GPEI in 2025 represents the primary, acute challenge that, if not urgently addressed, may allow for the reversal of all progress to date.