Polio Eradication Strategy 2022-2026: Delivering on a Promise, Extension to 2029

"Governments and health workers, with support from the GPEI [Global Polio Eradication Initiative], have the creative tools and strategies needed to reach every child. But political instability, conflict and misinformation are mounting, and essential immunization programmes and polio vaccination campaigns are struggling to keep up."

In 2024, the Polio Oversight Board (POB) decided to extend the timeline for certifying the eradication of wild poliovirus type 1 (WPV1) to the end of 2027 and certifying the elimination of circulating type 2 variant poliovirus (cVDPV2) - also known as vaccine-derived poliovirus - to the end of 2029. This document complements the Global Polio Eradication Initiative (GPEI)'s 2022-2026 Strategy (at Related Summaries, below) by outlining the obstacles that have hindered progress since the start of the strategic period (2022) and defining adjustments that will be made in the extension period to overcome them. It summarises key tactical shifts - including those firmly grounded in strategic communication - that are expected to enable more effective implementation and accountability, the rationale for continued investment in the promise of a polio-free world, and the plan to sustain eradication once it is achieved.

Based on current epidemiology and after critical analysis of shifting on-the-ground realities, the POB explains in this document that the GPEI must strengthen implementation and improve performance to reach more children more consistently. Below is a summary of the challenges and approaches that will be adopted, with a focus on the communication-centred ones.

Goal One: Interrupt and eradicate WPV1 in the final endemic countries (Afghanistan and Pakistan) - Examples of programmatic challenges: weak cross-border coordination; community boycotts of polio campaigns due to a lack of broader services. Examples of contextual challenges: rising vaccine hesitancy due to the spread of mis- and disinformation, especially among male caregivers; and conservative gender norms, roles, and responsibilities, significantly restricting the ability of vaccination teams to reach and vaccinate all children.

In both Afghanistan and Pakistan, the programme will focus adjustments in several key areas to drive progress, including: intensify cross-border coordination to reach mobile populations and those living along the border; deliver polio vaccines alongside broader health interventions by coordinating with new development partners; refine and intensify post-campaign monitoring to identify missed children, employing immediate corrective measures and informing planning for subsequent rounds; tailor activities according to local gender norms; and increase support for women vaccinators, planners and supervisors. The programme will also intensify advocacy for increased community and national ownership of the eradication effort and adapt context-specific social and behavioural change communication (SBCC) strategies to address vaccine hesitancy. 

Goal Two: Stop and prevent type 2 variant poliovirus outbreaks, especially in eastern Democratic Republic of the Congo (DRC), northern Nigeria, south-central Somalia, and northern Yemen - Example of programmatic challenges: poor microplanning for campaigns, limiting vaccinators' abilities to reach all children. Examples of contextual challenges: inconsistent political commitment, leadership, and accountability at all levels in countries battling outbreaks; and vaccination refusals, especially among male caregivers, due to misinformation and community fatigue, exacerbated due to the COVID-19 pandemic.

The GPEI is using the deep knowledge of in-country health workers and global experts to build a comprehensive approach to stop virus transmission for good by: mapping communities at the micro level, with every child counted, no matter how remote they live; employing vaccination strategies that are not one-size-fits-all but are customised to the geography and political context of each community; using geospatial tracking systems to ensure gender-balanced teams are reaching every community and to offer real-time course corrections as needed; and utilising geographic information systems (GIS) to inform coverage surveys at the end of a campaign to ensure that no child was left behind. In all situations, the GPEI is intensifying advocacy to garner renewed commitment from affected-country leaders. The leadership and support of national governments are critical to ensure rapid, high-quality campaigns and successful improvements in disease surveillance.

With an eye to the need to foster an enabling environment, in the extension period, the GPEI will focus on all cross-cutting activities planned in the original strategy, with a particular focus on tactical adjustments in the following areas:
 

• Integration: The integration of polio eradication activities with broader immunisation and health services will continue to be an important part of the GPEI's approach. The programme will continue to foster greater alignment and awareness of the integration roles and responsibilities of all actors; clear lines of accountability through interruption and certification; and systematic processes for real-time tracking and communicating about polio and other campaigns for vaccine-preventable diseases.
• Gender: The GPEI's comprehensive Gender Equality Strategy (see Related Summaries, below) aims to integrate a gender perspective into every aspect of the programme and to create a more gender-equitable institutional culture. The programme's updated gender strategy will focus efforts on: strengthening existing country-level gender mainstreaming efforts (which are outlined in the document); expanding gender mainstreaming support to new countries; and building capacity in gender at all levels of the programme.

The document concludes by detailing how the extended strategy will be resourced and what plans are in place for a lasting polio-free world. "Ultimately, if every person and institution involved - public health leaders and donors, caregivers, scientists and health workers - keeps up the dedication and drive that have led to the vast progress so far, the world can achieve and sustain a polio-free world."