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Polio: abandoning eradication would result in rapid resurgence of an ancient scourge

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BMJ
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In 1988, the World Health Assembly resolved to eradicate poliomyelitis by the year 2000, resulting in an unprecedented effort to combat one of the major sources of permanent disability. Impressive progress has been achieved, however eradication remains elusive.

Four of six WHO Regions have been certified as free of the three wild poliovirus serotypes—of the two remaining WHO Regions, the African Region is close to certification, but Afghanistan and Pakistan (in the Eastern Mediterranean Region) remain endemic for wild poliovirus type 1.

The major challenges relate to access, conflict and the quality of campaign activities, and increasingly, vaccine hesitancy—in this context, the move to a control programme, rather than continuing efforts to achieve eradication, seems like a logical question to raise.

But this is an unrealistic expectation; controlling the circulation of the polio virus is impossible, because there are many settings with low routine immunisation coverage—if we abandon eradication efforts, we would have to brace for high numbers of outbreaks and children with permanent disabilities.

The global polio eradication objective is feasible, as has been demonstrated repeatedly, over very large geographic areas such as the entire Western hemisphere and the Indian subcontinent, and can be secured as the Region of the Americas has demonstrated since 1991.

Ultimately, the world must decide whether the global good of polio eradication is worth achieving—and to move forward, ownership in the two remaining countries and continuous improvement of eradication efforts is of paramount importance to which the Global Polio Eradication Initiative remains committed.