By improving outreach, staffing, and data collection and analysis, polio vaccination campaigns can achieve the required immunization coverage to reach GPEI goals. Our priority is to improve the quality of campaigns in Afghanistan and Pakistan, as well as other countries 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, as well as 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 new strategy to stop the spread of circulating vaccine-derived polioviruses (cVDPVs)—rare forms of the virus that can occur in underimmunized populations. In partnership with affected countries, the GPEI aims to carry out more aggressive, higher-quality outbreak response and strengthen routine immunization in high-risk areas.

We support work to understand 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 immunizations they need. Reaching every community requires understanding local barriers to access as well as the use of mapping and planning tools. A coordinated immunization system can also serve as a platform for other important health interventions. We are working with our 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 wild poliovirus is still circulating, and to verify eradication. A strong surveillance system enables accurately targeted campaigns, quick program adjustments, and swift response to outbreaks.

Polio surveillance is especially challenging because only a small percentage of infections result in clinically apparent paralytic disease. Confirming the disease requires analysis of stool specimens to see if poliovirus is present.

Through our investments to evaluate surveillance efforts in the highest-risk areas, we have discovered the need for improved environmental surveillance: testing sewage water samples for evidence of poliovirus transmission in the surrounding community. We have invested in a technology that promises more sensitive sampling with lower specimen volume, as well as more hygienic collection. We also 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 completely eradicate the disease. We are working with partners to improve existing tools while accelerating the development of safer vaccines, better diagnostic tools, new antiviral drugs, and other products. We also work with partners, suppliers, and governments to ensure sufficient vaccine supply and demand and to promote market competition.

The oral polio vaccine (OPV), which is most commonly used in the developing world, is safe, effective, easy to administer, and inexpensive. But this vaccine consists of live, weakened viruses, which in rare cases can revert to a form that can cause paralysis if allowed to circulate in an underimmunized community for a long time. In settings where there have been failures to reach all children with vaccines and raise immunity levels, OPV use poses a challenge to ending all forms of polio for good.

We are supporting the development of new oral polio vaccine formulations that do not pose this risk. In particular, we are working with partners to accelerate the development of novel oral polio vaccine type 2 (nOPV2)—a potential addition to the outbreak response toolbox. nOPV2 is a modified version of existing monovalent oral polio vaccine type 2 (mOPV2) that clinical trials have shown provides comparable protection against the poliovirus while being more genetically stable and less likely to regain strength and cause paralysis. In November 2020, nOPV2 was granted a recommendation for use under WHO’s Emergency Use Listing (EUL) procedure, with the initial rollout beginning as soon as early 2021.

We also assist in efforts to lower the cost of the injectable vaccine and implement the necessary training, supply, delivery, and communications infrastructure to expand its use.

Data collection and sharing are critical to eradicating polio. We work to improve data access to inform decision-making, track progress, improve environmental surveillance, and guide the development of vaccines and diagnostic tools. We are also working 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 key polio data are 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. Reintroduction of the wild poliovirus would present the potentially serious consequences of re-establishing the disease. As part of the GPEI, we are developing a post-eradication containment policy that will be adopted by the World Health Assembly.

In its two decades of operation, the GPEI has trained and mobilized millions of staff and volunteers, identified and reached households and communities that had been 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 are continuing 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 is lending its infrastructure and expertise to protect the vulnerable from COVID-19. From Pakistan to Nigeria, the program is building on years of experience in fighting outbreaks to support countries in responding to the pandemic.

We work closely with GPEI partners to mobilize funding and sustained 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 follow through on 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 such as Rotary International; WHO; United Nations Children’s Fund (UNICEF); Gavi, the Vaccine Alliance; RESULTS; the UN Foundation; and Global Citizen, we use traditional and social media to raise awareness of polio eradication and immunization activities in both donor countries and countries where polio is a threat. We support efforts to tailor communications to particular social, cultural, and political contexts to build demand for vaccination and dispel myths about the safety and efficacy of vaccines.