The global community once stood on the verge of eliminating polio — a paralysing virus that had once terrorised millions across continents. However, in 2025, polio continues to exist. Worse still, it is resurging in specific parts of the world, especially in Afghanistan and Pakistan, the last two countries where the wild poliovirus remains endemic.

This setback is not due to scientific failure alone. Instead, it is a concerning combination of fake vaccination records, inadequate vaccines, poor strategy, and lack of trust, which together have derailed the near-success story.

A nearly won war, now slipping away

The World Health Organization (WHO) has been campaigning for decades to eradicate polio completely, a feat achieved only once before with smallpox. By the early 2020s, the number of polio cases had plummeted to a handful annually, largely thanks to intensive oral polio vaccination (OPV) drives around the world.

Yet, as of mid-2025, there’s a troubling shift. Polio has not only remained in some regions but has also made new appearances in unexpected places — including vaccine-derived outbreaks in Africa and traces of the virus in wastewater in parts of Europe and the U.S.

The roots of the comeback: fake records and false security

A major factor in the failure to eliminate polio is the widespread manipulation of vaccination data. In many regions, especially in parts of rural Pakistan and southern Afghanistan, health workers were pressured to report inflated vaccination figures.

Instead of documenting real cases of vaccine refusal or inaccessibility, some data was forged to show nearly 100% coverage. On paper, the region looked polio-free. But in reality, millions of children were missed.

This gave health officials a false sense of progress, leading to reduced urgency, donor fatigue, and weakened field efforts.

Oral polio vaccine: a miracle with limitations

The oral polio vaccine (OPV), hailed for its ease of administration and effectiveness, has been a cornerstone of global eradication efforts. But this very tool is now under scrutiny.

In rare cases, the weakened virus in the OPV can mutate and regain strength, especially in under-immunised communities. These vaccine-derived poliovirus (VDPV) outbreaks have become a serious concern in the global south, where sanitation is poor and immunisation gaps persist.

Countries like DR Congo, Nigeria, and Mozambique have seen VDPV outbreaks in recent years, despite being declared free of wild polio. This paradox — a vaccine causing the disease it was meant to prevent — has shaken public trust and fuelled anti-vaccine sentiments in many communities.

Pakistan and Afghanistan: the last battlegrounds

Afghanistan and Pakistan, for years, have been considered the final frontiers of polio eradication. Political instability, religious extremism, misinformation, and violence against health workers have made it incredibly difficult to reach all children.

In many areas, Taliban-backed groups and local clerics have spread the belief that polio drops are part of a Western plot to sterilise Muslim children. In other cases, health campaigns have been targeted by militants, with dozens of vaccinators killed over the years.

This fear has pushed families to refuse vaccination, either openly or by pretending to comply — another reason for falsified records and mistrust.

Miscalculated strategies and lost momentum

Beyond field-level failures, larger strategic missteps have weakened the global eradication effort. The COVID-19 pandemic diverted health resources in many countries between 2020 and 2022, delaying polio immunisation rounds.

Additionally, some experts argue that the WHO and its partners became too reliant on OPV, and too slow to transition to the more stable inactivated polio vaccine (IPV), which does not carry the risk of vaccine-derived mutation.

Global funding has also declined, as donors assumed the fight was over. As financial support waned, so did logistical capacity, follow-up, community education, and local engagement — the very things that made early polio successes possible.

Community trust: the missing link

Another critical issue is trust between health authorities and local populations. In many regions where polio persists, especially in tribal or conflict-prone zones, there's a deep distrust of central government programs.

This has led to situations where families hide their children, run from health workers, or outright refuse drops due to conspiracy theories and social pressure.

The WHO and its partners have made some strides in addressing this, recruiting local influencers, religious leaders, and women to help convince families. But these efforts came too late in many areas — after damage had been done.

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