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Executive summary below; full text is at:

1. Every country with persistent polio transmission, with the exception of India and Angola, has had more cases so far in 2011 than they had by the same time last year. Chad, Afghanistan and DR Congo have already exceeded their entire 2010 total.

2. The rate of occurrence of new outbreaks serves as an ongoing reminder that many countries in the world are under threat from the ease with which polio could be imported across their borders.

3. The 2010-12 Strategic Plan set out four intermediate milestones. Just two are on track. One is highly unlikely to be attained within the planned timeframe. One has missed its deadline and remains elusive.

4. The GPEI is not on track to interrupt polio transmission by the end of 2012 as it planned to. Indeed, unless the fundamental problems highlighted in this report can be addressed, there is a substantial risk that stopping transmission will take far longer than the 15 months that remain between now and the end of 2012.

5. Polio eradication could still be achieved by the end of 2012 if the weaknesses of the Program at both country and global level can be swiftly corrected, and if political commitment and financial support for the GPEI can be bolstered.

6. This report assesses progress in each of the countries with persistent transmission. With the exception of India, none of the endemic countries is making progress at the rate it needs to:

• India has a good chance of interrupting transmission this year

• Afghanistan’s program is strongly managed and innovative, but is still unable to reach one-third of children in 13 high-risk districts

• Nigeria has slipped back on progress made in 2010; it needs to demonstrably regain the commitment of political and traditional leaders

• Pakistan has made little tangible advance over the last 18 months; a fundamental strategy review is needed.

7. Having missed their end-2010 goal, the three countries with re-established transmission are now showing some progress, though the end is not in sight for any of them yet:

• Angola is making good progress, but Luanda remains a real vulnerability

• Chad now has the technical capacity that it desperately needed, and must now deploy this to good effect

• Indicators in DR Congo remain off-target but are moving in the right direction; the potential for election-related disruption is of great concern.

8. The surprises of unexpected outbreaks continue to undermine confidence in the Program. China had been free of polio for a decade until its current outbreak. The detection of a case in Kenya is particularly alarming, because it represents a failure to deal with long-standing transmission between Kenya and Uganda since 2009. The Horn of Africa remains at particular risk of further outbreaks.

9. In addition to our country-specific findings, we describe five problems that run as common threads through the global Program, reducing its chances of success. They relate to culture and approach. Tackling each will require challenging introspection for the Program, but will produce great gains. The style and approach to management of the global Program needs reorientation.

10. Our view remains that polio eradication needs to be treated as a global health emergency. It needs more funding, and broader, more engaged global political commitment – particularly from non-affected countries.

The challenge remains great, but the other option is to allow this terrible disease to resurge.


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