Nations divided by conflict face the greatest threat from a resurgent polio virus and a 30 per cent cut in global funding that could badly hamper efforts to eliminate the disease by the end of the decade.
Wild polio remains endemic in Afghanistan and Pakistan, with transmission reported in border areas caught in the grip of military conflict. They are the last two countries where wild polio is endemic, meaning it has not been stopped through immunisation and remains capable of sweeping through communities.
Cross border skirmishes in October only added to the challenges health officials face in delivering effective immunisation to thousands of children in Kabul, Jalalabad, Khost and Paktika.
To mark World Polio Day, which is observed on October 24, global experts said polio eradication remained on track, despite the setback of international aid cuts and rising conflicts around the world.
“After several years of historically low numbers of children being paralysed by wild polio, we are still seeing some resurgence in Pakistan and Afghanistan,” said Jamal Ahmed, director of polio eradication at the World Health Organisation.
“This is primarily driven by some challenges in subnational areas on the borderlands between Afghanistan and Pakistan. The challenges are really linked to insecurity, and they're linked to inaccessibility in part of that geography.
“It’s also linked to some other challenges, especially in southern Afghanistan, including access to households and vaccination hesitancy challenges. At the same time, when we look globally, we also see variant polioviruses. These are various polioviruses that have been merged in under-immunised or un-immunised populations following the use of oral polio vaccines.”
Global hotspots
Dr Ahmed said the biggest current polio hotspots were the Sahel region and the Horn of Africa, especially Yemen, Somalia, Nigeria and the Chad Basin.
The Global Polio Eradication Initiative, a partnership including the World Health Organisation (WHO) and the Gates Foundation, is facing a 30 per cent funding cut in 2026, leaving a $1.7 billion shortfall for immunisation programmes up to 2029. Despite the outlook, global efforts to eradicate polio – which can have devastating consequences for children – have been remarkably successful thanks to vaccination efforts.
The number of polio cases reported worldwide have plummeted from 67,443 in 1981 to just 539 in 2023. Effective immunisation campaigns have saved thousands of lives, and spared thousands more from having to live with the complications associated with the virus. While mild forms of polio can bring flu-like symptoms and muscle aches, more severe cases and cases that are left untreated can progress to cause paralysis.
In 2025, Senegal and Mauritania became the first two low-income countries to distribute life-saving hexavalent vaccines, a combination prophylactic that protects against diphtheria, pertussis, tetanus, hepatitis B, and meningitis, as well as a separate polio vaccine. The costs were covered by Gavi, the global health organisation.
Hexavalent vaccines have already been used in Europe and the US since the beginning of the century. To stem further outbreaks, similar vaccination campaigns are required, particularly in war-torn areas.
Polio resurfaced in 2024 in Gaza and left a 10-month-old child paralysed, marking the enclave’s first reported case in 25 years. Wastewater surveillance had already detected poliovirus across multiple sites, allowing the potential for further outbreaks in the devastated enclave.
UAE support
Under the directive of President Sheikh Mohamed, the UAE allocated $5 million to support an emergency vaccination campaign for 640,000 Gazan children, in conjunction with the WHO, Unicef and UNRWA. The campaign achieved wide coverage and no further paralytic cases have been reported – a clear example of how rapid, well-funded collaboration can save lives.
Through the UAE-Pakistan Assistance Programme, the UAE has delivered over 400 million doses, protecting millions of children since 2014.
Mike McGovern, chairman of PolioPlus at Rotary International, one of the largest international donors for polio eradication, said aid cuts are becoming a global problem. “We are not immune from the global trends of reducing international assistance,” he said.
“As a result, the Global Polio Eradication Initiative has recently adopted a new budget for 2026 that is a 30 per cent reduction from the budget in 2025 that includes a reduction of 18 per cent in the endemic countries of Pakistan and Afghanistan.
“It also includes a reduction of 26 per cent in outbreak response, and surveillance outside Pakistan and Afghanistan will be 34 per cent lower. This is impactful and, obviously, it is of concern.”
Millions of dollars in the pipeline
Rotary aims to continue to raise $50 million a year from its members, with a two-for-one-match funding partnership with the Gates Foundation over the next three years to raise $450 million to support the global polio eradication initiative.
Hamid Jafari, director of polio eradication at the WHO Regional Office for the Eastern Mediterranean, said both Pakistan and Afghanistan had made “incredible” progress, despite the recent challenges.
“After almost eradicating polio in the 2022-23 time frame, there was a major resurgence of polio virus that peaked last year, which is now on the decline,” he said. “This resurgence again reaffirms the fact that progress towards polio eradication is never really linear.
“It will keep coming back to cause periodic outbreaks until its transmission is completely stopped. Neither country will be safe from the threat of polio until they both have completely wiped it out concurrently.”
