· While cases of polio have fallen over 99% worldwide since 1988, the final stretch of the eradication effort is proving more difficult than expected, and the program is currently facing two core challenges: ongoing transmission of wild poliovirus in Pakistan and Afghanistan and increasing type 2 circulating vaccine-derived poliovirus (cVDPV2) outbreaks across Africa, Southeast Asia and the Middle East.* [SEE ADDENDUM ON VDPVs BELOW]. 

· There have been 175 cases of wild poliovirus reported in 2019. Current case counts for 2020 can be found at 




· In Pakistan, 146 cases of wild poliovirus were reported in 2019, compared to 12 in 2018. In addition, the country reported 22 cVDPV2 cases.* [SEE ADDENDUM ON VDPVs BELOW]. This concerning spike in children paralyzed from the virus can be attributed to several underlying issues for the polio program, including poor campaign quality, insecurity and mobile populations, politicization of the polio program and in some cases, vaccine refusals. 

· While the overwhelming majority of parents in Pakistan still want their children vaccinated, the number of refusals surged last year in part due to the spread of misinformation and misconceptions about the polio vaccine. 

· Another major factor behind vaccine refusals is frustration with repeated polio campaigns, particularly when communities face high rates of malnutrition and limited access to other basic services like safe drinking water, sanitation and routine immunization. 



· The government has responded to the serious challenges facing the polio program and has reassessed its strategies to stop polio. Pakistan implemented an emergency plan and is deploying new tactics to strengthen essential immunization, better target high-risk areas, and integrate basic health services to complement polio immunization activities. 


· To address vaccine refusals, new tactics include tailoring strategies and deploying appropriate community influencers based on a family’s specific reason for refusal. The program is also emphasizing communications activities to combat misinformation, improve trust, and better communicate the importance of polio eradication. 

· Rotary continues to hold workshops for religious leaders throughout Pakistan to help to communicate to vaccine-hesitant communities about the safety and importance of vaccination. 

· Rotary has established 20 solar water filtration plants throughout high-risk areas of Pakistan to build trust and ensure communities have access to clean water. Provision of complementary services like clean water are a key component of the polio eradication strategy. 

· The Government of Pakistan is also strengthening political commitment to ending polio. In February 2020, Prime Minister Imran Khan met with a delegation of Rotary leaders including President Elect Holger Knaack, Trustee Chair Elect K.R. “Ravi” Ravindran, and International PolioPlus Committee Chair Michael K. McGovern. 

· The Prime Minister praised Rotary for its prominent role in polio eradication and for providing vital financial support to Pakistan and other polio-threatened countries. The Prime Minister assured the delegation that polio eradication is Pakistan’s top priority. 

· Stemming from these new strategies, Pakistan’s last immunization campaign in December 2019 showed promising improvements. The number of children missed decreased from 1.8 million in April 2019 to 500,000 in December, and the number missed due to refusal declined from nearly 1 million down to around 228,0000 in the same time period. 



· In Afghanistan, 29 cases of WPV1 were reported in 2019 compared to 21 in 2018 (data as of 3 March 2020) and insecurity and access issues continue to leave children vulnerable to the virus. 

· From April to September 2019, the Taliban banned all the WHO’s polio vaccination activities in occupied territories. As a result, the June 2019 national vaccination campaign could not take place, leaving all 10 million targeted children in the country temporarily without access to polio vaccine. 

· In late September, the Taliban partially lifted the ban to allow health facility-based vaccination, but house-to-house vaccination remains prohibited in many areas. 

· This partial ban has greatly impeded the program’s ability to conduct high-quality campaigns and it is estimated that the current situation leaves at least five million children inaccessible across the country. 


· Rotary and its partners are working with all stakeholders to increase vaccinator access and ensure children everywhere are reached with polio vaccine. 

· Given the ongoing conflict in many parts of the country, the program is conducting rapid, flexible immunization campaigns when and where possible. 

· The government has also doubled the number of permanent vaccination points strategically placed to vaccinate children in the inaccessible areas, which has helped increase the average number of children vaccinated monthly. 

· To combat vaccine refusals, the program has employed thousands of social mobilizers to reach high-risk families and plans to collaborate with other basic health initiatives to offer integrated services to underserved communities in several provinces.