Global Polio Eradication Has Failed: A Tragedy of Errors over 37 Years

Background: The global polio eradication initiative of 1988 has not succeeded after 37 years of intense efforts. The original targets for eradication were the three antigenic types of wild poliovirus. Type 2 was eradicated on time in 1999, type 3 was eradicated in 2012, but type 1 is yet to be eradicated. Moreover, as a consequence of the immunization strategy, new targets for eradication have emerged in the form of vaccine-derived polioviruses. We scrutinize the reasons for these failures to design actions to expedite eradication. Methods: A review of the design of the eradication strategy and immunization tactics was done to analyse the present complex situation with both wild and vaccine viruses needing eradication. Results: The safe and highly efficacious inactivated poliovirus vaccine (IPV), as compared to the live oral polio vaccine (OPV) with problems of safety and efficacy, was not utilized to benefit the eradication programme. Instead, OPV was chosen for exclusive use, not based on epidemiology nor vaccinology. That error was followed by more errors. The tragic consequence was vaccine-failure polio and iatrogenic polio affecting thousands of children in countries relying on OPV. Conclusion: The failure to complete polio eradication is due to the incorrect path taken by the polio eradication initiative. The right path, namely the exclusive use of IPV, must be adopted without delay to eradicate both wild and vaccine-derived polioviruses.