LAUSR

Eradication is an all-or-nothing affair. The aspirational goal set by the World Health Assembly in 1988 of eradicating poliomyelitis by 2000 was not achieved. 1 A 99.9% reduction in cases is a wonderful outcome for the estimated 1.5 million people whose lives have been saved and the 16 million people who have been spared lifelong disability since the Global Polio Eradication Initiative was launched, but it is an eradication failure! The massive sustained global investment that saw improved immunisation coverage and enhanced surveillance in most countries did result in the reporting of the last human cases of wild poliovirus type 2 in 1999 and type 3 in 2012. Certification of wild poliovirus type 2 and type 3 eradication occurred in 2015 and 2019, respectively. 2 It is thus tempting to consider eradication of poliomyelitis two-thirds complete, with wild poliovirus type 1 in Pakistan and Afghanistan being the final hurdle to finishing the ‘polio end-game’. But this is sadly not the case. The protracted eradication efforts and perpetually underperforming vaccination programmes using oral live attenuated Sabin poliovirus vaccine (OPV) have birthed calamitous outbreaks of types 1, 2 and 3 circulating vaccine-derived poliovirus (cVDPV) in countries in every World Health Organization region