Polio should have been eradicated by now. What’s plan B? - Nature

What the report says

Nature reports that the global drive to eliminate polio has missed another milestone, renewing questions about whether eradication remains achievable under current conditions. The article says optimism was high after Nigeria’s last wild-virus cases in 2016 left transmission confined to Afghanistan and Pakistan, but deadlines in 2019, 2023 and 2025 passed without success. So far this year, 14 new cases have been reported, according to the report.

The campaign, led through the Global Polio Eradication Initiative with the WHO and national governments among its partners, still relies heavily on oral polio vaccine, which can interrupt transmission by building gut immunity. Nature notes that the initiative has reduced wild polio from an estimated 350,000 annual cases in 125 countries nearly four decades ago to 52 cases in 2025, while modelling suggests millions of cases of paralysis have been prevented. Yet cases have repeatedly fallen and rebounded, including rises in 2019 and 2024 after earlier lows.

Researchers and officials cited by Nature describe the remaining barriers as largely operational rather than scientific. In parts of Afghanistan and Pakistan, some children remain unreachable or unvaccinated, local immunization rates can be low, cross-border movement sustains reservoirs, and mistrust and violence have affected campaigns. The report highlights bans on female and house-to-house vaccinators in southern Afghanistan and attacks on police protecting vaccinators in Pakistan.

The stakes extend beyond the two endemic countries because poliovirus can spread internationally where immunity gaps exist. Nature also points to newer pressures: vaccine hesitancy, political obstacles and a major funding shortfall, including a 30% budget reduction this year. While campaign leaders say progress continues, several researchers interviewed by Nature question whether the world needs a contingency strategy if eradication cannot be completed soon.