The Bumpy Road to Polio Eradication

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Abstract
The existence of poliomyelitis in the developing world was ignored for many years because epidemic polio was considered a disease of wealthier countries. In the 1960s and 1970s, however, “lameness surveys” of schoolchildren in more than 20 countries revealed lower-limb–paralysis rates of 2 to 11 per 1000 — higher than those of the peak polio-epidemic years in the United States.1 Inspired by the success of global smallpox eradication and poliomyelitis control in the Americas, the World Health Assembly made a commitment in 1988 to eradicate polio by 2000. Although this goal was not met, substantial gains were made through routine immunization of infants with trivalent oral poliovirus vaccine (tOPV), supplemental national or regional rounds of tOPV among young children, active surveillance for acute flaccid paralysis, and rapid response to disease outbreaks. By 2000, annual reports of poliomyelitis cases had fallen by more than 99%, to fewer than 1000; continuous endemic transmission was halted almost everywhere; and the extinction of infection with type 2 wild-type poliovirus (WPV) proved that eradication was possible.