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Has the billion dollar crusade to eradicate polio come to an end?

BMJ 2021; 374 doi: (Published 29 July 2021) Cite this as: BMJ 2021;374:n1818
  1. Robert Fortner, freelance science journalist
  1. Portland, Oregon, US
  1. robertwfortner{at}

The polio juggernaut, which has skidded past eradication deadline after deadline, seems to have finally run out of fuel, reports Robert Fortner

As covid-19 overran the world, the extensive surveillance and response capacities of the polio eradication programme pivoted towards this new threat. Now, in a surprise move by the World Health Organization, the reorientation looks permanent—perhaps ending a decades long, multibillion dollar crusade engineered by some of the most powerful actors in global health. WHO’s reordering of priorities may also point to a reassertion of its primacy in setting and administering global public health policy.

Since the effort began in 1988 the Global Polio Eradication Initiative (box 1) has pushed polio to near annihilation, pushing down cases by 99.99%. Perhaps tens of millions of people walking today can thank the GPEI.1 Two of the three serotypes of wild poliovirus have been declared eradicated worldwide, leaving only type 1, which has been cornered in just two countries, Afghanistan and Pakistan, which had a total of 140 cases last year.

Box 1

What is the GPEI?

The Global Polio Eradication Initiative ( was created after the World Health Assembly’s 1988 resolution to eradicate the disease. Its goal is to complete the eradication and containment of all wild and vaccine related polioviruses.

It has six core partner organisations:

  • WHO

  • Unicef

  • Bill & Melinda Gates Foundation

  • Rotary International

  • US Centers for Disease Control and Prevention

  • Gavi vaccine alliance


However, the live oral vaccine used to accomplish these feats is double edged: the attenuated vaccine strains can revert to virulence, circulate, and paralyse. Afghanistan and Pakistan now report more cases of paralysis from vaccine derived polio than from the wild virus, and a massive outbreak of vaccine derived infections engulfs much of Africa, with more than 1000 children paralysed last year.2

The polio juggernaut skidded past its eradication …

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