At a glance
- In 1988, when the Global Polio Eradication Initiative (GPEI) was launched, polio was present in more than 125 countries and paralyzed about 1,000 children per day.
- Thanks to global immunization efforts, the incidence of polio has decreased by 99% since then. Today, wild polio is found only in Afghanistan and Pakistan.
- Our foundation is a key supporter of the GPEI, along with partners that include the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention, UNICEF, and Gavi, the Vaccine Alliance.
- GPEI continues to innovate to keep children safe from paralysis. Health workers have already delivered nearly 2 billion doses of nOPV2, a next-generation polio vaccine, and regional response efforts have helped control outbreaks in countries including Malawi and Mozambique.
- Despite this progress, if we fail to stop wild polio and end all forms of poliovirus globally, within a decade the world could have a resurgence of 200,000 new cases annually. This makes polio a critical priority in global health.
Our strategy
Polio eradication is a top priority for our foundation. Since joining the GPEI in 2007, we have contributed technical and financial resources to advance the development of innovations, expand routine immunization, accelerate targeted vaccination campaigns, and support community mobilization. We also make grants to partners to improve polio surveillance and outbreak response; develop safer, more effective vaccines; and galvanize financial and political support for polio eradication efforts.
We have a unique ability to contribute to the fight against polio by taking big risks and making nontraditional investments. Examples include our investments in vaccine research leading to the development of novel oral polio vaccine type 2 (nOPV2), which is used to stop outbreaks of type 2 variant poliovirus, the most prevalent form of the variant virus; establishing new labs across the WHO African Region that can more quickly detect traces of the virus; and building emergency operations centers in Nigeria, Pakistan, and Afghanistan.
Areas of focus
Better approaches to outreach, staffing, and data collection and analysis can strengthen polio vaccination campaigns and increase immunization coverage.
Better approaches to outreach, staffing, and data collection and analysis can strengthen polio vaccination campaigns and increase immunization coverage.
We support country leaders in improving the quality of polio vaccination campaigns in Afghanistan and Pakistan, as well as other countries affected by outbreaks of variant poliovirus and where population immunity to polio is persistently low. With eradication in sight, it is more important than ever that countries sustain high-quality campaigns, even if they have no active polio cases.
The GPEI’s polio eradication strategy focuses on national and local campaigns in the highest-risk countries to provide all children with multiple doses of oral polio vaccine. Efforts include door-to-door immunization in areas where poliovirus is known or suspected to be circulating and in areas that have risk of reimportation, limited access to health care, high population density and mobility, poor sanitation, and/or low routine immunization coverage.
The GPEI is also implementing a comprehensive strategy to stop the spread of variant polioviruses—rare forms of the virus that can occur in under immunized populations. In partnership with affected countries, the GPEI is carrying out more aggressive, better coordinated, higher-quality outbreak response and strengthening routine immunization in high-risk areas.
We support work to understand the social, cultural, political, and religious barriers to improving vaccination coverage, and we seek ways to work with local political leaders and health professionals. We also focus on expanding staffing and training of vaccination teams, as well as providing technical assistance.
Nearly 20 million children worldwide do not receive all of the vaccines they need.
Nearly 20 million children worldwide do not receive all of the vaccines they need.
Routine immunization is essential to the success of polio eradication efforts. The foundation is working with partners to strengthen routine immunization programs for polio and other preventable diseases, including diphtheria, tetanus, whooping cough, and measles.
It is essential to pinpoint where and how poliovirus is still circulating, and to verify eradication.
It is essential to pinpoint where and how poliovirus is still circulating, and to verify eradication.
Because only a small percentage of infections result in clinically apparent paralytic disease, polio surveillance is critical for tracking virus spread and stopping future outbreaks. This involves collecting and analyzing stool specimens to detect the presence of poliovirus.
A strong environmental surveillance system enables polio teams to more accurately target campaigns, implement quick program adjustments, and swiftly respond to outbreaks.
Through our investments to evaluate surveillance efforts in the highest-risk areas, we have discovered the need for improved environmental surveillance—namely, testing sewage water samples for evidence of poliovirus transmission in the surrounding community. We have supported development of a technology that promises more sensitive sampling with lower specimen volume, as well as more hygienic collection. We have also invested in new labs across the WHO African Region that can quickly detect any trace of the virus. In addition, we fund efforts to develop less expensive and more reliable lab tools, such as a diagnostic kit that local labs can use to rule out negative samples and send positive specimens to reference labs for confirmation.
Although current vaccines and detection tools have proven highly effective in eliminating polio from most countries, they may not be sufficient to completely eradicate the disease.
Although current vaccines and detection tools have proven highly effective in eliminating polio from most countries, they may not be sufficient to completely eradicate the disease.
We work with partners to improve existing tools while accelerating the development of new vaccines, better diagnostic tools, more effective wastewater surveillance devices, , and other products. We also work with partners, suppliers, and governments to ensure sufficient vaccine supply.
The oral polio vaccine (OPV) is a vital tool in the effort to end polio everywhere and is most commonly used in lower-income countries. This vaccine has the unique ability to stop person-to-person transmission of the virus. However, if not enough children have already been immunized against polio, the weakened, live virus contained in this vaccine can pass through the under immunized community and, over time, revert to a form that can cause paralysis. In settings where not all children have been reached with vaccines, OPV use poses a challenge to ending all forms of polio for good.
We have supported the development of new OPV formulations that do not pose this risk. In particular, we worked with partners to accelerate the development of nOPV2, a next-generation polio vaccine that is being used to more sustainably stop outbreaks of type 2 variant poliovirus, the most prevalent form of the variant virus. nOPV2 is more genetically stable and therefore less likely to seed new variant outbreaks. The rollout of nOPV2 began in 2021, after the vaccine was granted WHO Emergency Use Listing approval; in 2023, it earned full licensure and WHO prequalification. nOPV2 is now the vaccine of choice for responding to type 2 variant outbreaks and is an important piece of the global polio program’s strategy to achieve eradication.
We also support efforts to produce and introduce hexavalent vaccine, or 6-in-1 vaccine, to protect against multiple diseases including polio. By combining the inactivated polio vaccine (IPV) with the existing pentavalent vaccine, hexavalent vaccine will help keep more people safe from polio with a single shot. We also assist in efforts to lower the cost of other vaccines and implement the necessary training, supply, delivery, and communications infrastructure to expand vaccine use.
Data collection and sharing are critical to eradicating polio.
Data collection and sharing are critical to eradicating polio.
We support partners that improve data access to inform decision-making, track progress, improve environmental surveillance, and guide the development of vaccines and diagnostic tools.
We also work with partners to develop a decision framework that identifies key decision areas, the data needed to inform decisions, and the staff and partners needed to analyze the data and create models. We support a data access platform at WHO that ensures that key polio data is standardized, quality-assured, and available for analysis and decision-making.
Once wild poliovirus transmission has stopped globally, it will be important to ensure safe handling and containment of materials in laboratory and vaccine production facilities.
Once wild poliovirus transmission has stopped globally, it will be important to ensure safe handling and containment of materials in laboratory and vaccine production facilities.
Reintroduction of the wild poliovirus could lead to the disease being reestablished. As part of the GPEI, we are developing a post-eradication containment policy for adoption by the World Health Assembly.
Since its inception, the GPEI has trained and mobilized millions of staff and volunteers, identified and reached households and communities previously untouched by other initiatives, and established a robust global surveillance and response system.
Since its inception, the GPEI has trained and mobilized millions of staff and volunteers, identified and reached households and communities previously untouched by other initiatives, and established a robust global surveillance and response system.
Through polio eradication efforts, GPEI partners have learned how to overcome logistical, geographic, social, political, cultural, ethnic, gender, financial, and other barriers to working with people in the poorest and least accessible areas. The fight against polio has created new ways of addressing human health in the developing world—including through political engagement, funding, planning and management strategies, and research.
The GPEI has also developed a wide range of assets, including detailed knowledge of high-risk groups and migration patterns; effective planning and monitoring procedures; highly trained technical staff; local and regional technical advisory bodies; and commitments based on successful partnerships among global, national, religious, and local leaders. These assets have already been used to respond to other public health threats, including COVID-19, Ebola, meningitis in western and central Africa, H1N1 flu in sub-Saharan Africa and the Asian subcontinent, and flooding and tsunami disasters in South Asia.
We continue to work with the GPEI to identify ways in which the polio infrastructure—including supply chains, surveillance and laboratory systems, and social mobilization networks—can be used to support other health initiatives and immunization programs in the long term. Around the world, the GPEI lent its infrastructure and expertise to protect people in the poorest communities from COVID-19. From Pakistan to Nigeria, it built on years of experience in fighting outbreaks to support countries in their pandemic response.
We work closely with GPEI partners to mobilize funding and sustain global and national political momentum for polio eradication.
We work closely with GPEI partners to mobilize funding and sustain global and national political momentum for polio eradication.
This involves promoting efforts to increase polio funding from government donors and cultivating new and nontraditional donors. We also encourage leaders of polio-affected countries to maintain their commitments to ongoing campaigns, and we help them identify and implement sources of financing for those campaigns.
We also align and mobilize other advocates, including influential community members such as religious leaders, volunteer organizations, and employers. With partners including Rotary International, WHO, UNICEF, Gavi, Results UK, the United Nations Foundation, and Global Citizen, we use traditional media and social media to raise awareness of the importance of polio eradication and immunization activities in both donor and polio-affected countries, celebrate important program milestones, and recognize critical donor contributions. We work with important champions to share these messages and support efforts to tailor communications to particular social, cultural, and political contexts to increase vaccine acceptance, dispel myths about the safety and efficacy of vaccines, and underscore why eradication is urgently needed.
Why focus on polio?
Over the past four decades, the world has made tremendous progress toward eradicating polio. In 1988—when wild poliovirus was present in more than 125 countries and paralyzed 350,000 people every year, most of them young children—the World Health Assembly set a goal to eliminate the disease and the GPEI was launched. Since then, immunization efforts have reduced the number of cases by more than 99%, and an estimated 20 million children are walking who would have otherwise been paralyzed. Today, wild polio is found only in Pakistan and Afghanistan.
Despite this progress, several challenges remain in reaching all children with vaccines. In addition to wild poliovirus continuing to circulate in parts of Pakistan and Afghanistan, outbreaks of variant poliovirus, a rare form of the virus that can also cause paralysis in underimmunized communities, are ongoing in parts of Africa and Asia. Efforts to reach unvaccinated children are often hampered by conflict, insecurity, displacement, and health system disruptions. These challenges allow the virus to spread among communities. If we fail to eradicate this highly contagious disease, polio could quickly spread around the world and paralyze hundreds of thousands of children again, including in countries that have long been polio-free.
WHO has certified five of its six regions (all but the Eastern Mediterranean region, which includes Pakistan and Afghanistan) as free of wild polio: the Region of the Americas in 1994, the Western Pacific Region in 2000, the European Region in 2002, the South-East Asia Region in 2014, and the African Region in 2020. The African Region’s certification came after Nigeria, the last polio-endemic country in Africa, recorded its final case in 2016. This incredible public health achievement was the result of a decades-long effort across 47 African countries involving millions of health workers, innovative strategies to vaccinate children amid conflict and insecurity, and a huge disease surveillance network to test cases of paralysis and check sewage for the virus.
Global collaboration and innovation have produced new tools and approaches to make gains against the virus—including nOPV2; needle-free injections of IPV, an easier and more affordable way to boost routine coverage; and geographic information system data to help improve campaign planning and track coverage. Today, the GPEI vaccinates nearly 370 million children against polio every year, and only one strain of wild poliovirus (wild poliovirus type 1) remains in circulation. Wild poliovirus type 2 was declared eradicated in 2015, and wild poliovirus type 3 was declared eradicated in 2019.
To end polio in the face of today’s challenges, Pakistan and Afghanistan are leading efforts within their countries to deliver more effective campaigns by strengthening cross-border coordination and intensifying efforts to reach populations on the move. They are also focusing on activities to boost routine coverage rates. To stop outbreaks of variant polio for good, countries are carrying out more rapid vaccination campaigns and implementing regional action plans to more consistently reach children in the hardest-to-access areas with persistent circulation.
Governments and partners have demonstrated their collective resolve to eradicate polio. Since the inception of the GPEI, donors have played a vital role in advancing eradication efforts. In 2022, at the World Health Summit, global leaders committed US$2.6 billion in funding for the GPEI’s strategy. Since then, the European Commission and the European Investment Bank, Saudi Arabia, and the United Arab Emirates, among others, have made critical contributions to the fight to end polio. But continued funding is critical. Delivering a polio-free world is the right thing to do for children and humanity and is a smart investment in the health of future generations.
