Wild polio clings on in Afghanistan and Pakistan after four decades of global eradication drive

Afghanistan and Pakistan recorded 48 cases of wild poliovirus type 1 in 2026, according to figures released for World Polio Day, nearly four decades after the world committed to eradicating the disease. Afghanistan accounted for 42 of them, double its 2025 count of 21, while Pakistan reported six, down from 31 the year before.

The two countries are the last places on earth where the wild virus still circulates, and the Global Polio Eradication Initiative reports that global cases have fallen by more than 99 percent since 1988. That remaining fraction, though, is proving expensive to remove. Afghanistan suspended house-to-house vaccination campaigns in October 2024; current efforts rely on fixed sites such as mosques, and a WHO assessment in August found that this approach leaves children unreached, particularly younger ones, with the southern region serving as the main transmission hotspot. Pakistan still goes door to door, but security threats, attacks on vaccination teams, misinformation and parental refusals complicate delivery, with southern Khyber Pakhtunkhwa and Karachi flagged as areas of concern.

The virus does not respect borders, and movement between the two countries carries it into communities where children have missed doses. Environmental surveillance — testing sewage for the virus — now detects circulation even where no paralysis has been reported, which means the official case counts almost certainly understate the true extent of transmission.

The arithmetic of eradication is unforgiving: transmission must stop everywhere, not merely decline. Each year the virus persists, the campaign requires another round of funding, another cohort of vaccinated children in countries that have been declared polio-free, and another budget line for the organizations whose work continues only as long as the disease does. Sustained vaccination, community trust, protection for health workers and reliable funding are, in the WHO's formulation, what it will take to close the gap — a list that has looked much the same for two decades.

Canada declared its measles outbreak over this week after two years and 6,417 cases; Afghanistan's polio count doubled in the same period the global health apparatus spent celebrating a 99 percent reduction.