World: Statement of the Forty-fifth Meeting of the Polio IHR Emergency Committee (25 August 2026)

Countries: World, Afghanistan, Malawi, Nigeria, Pakistan, Somalia, Togo Source: World Health Organization Please refer to the attached file. The 45th meeting of the Emergency Committee under the International Health Regulations (IHR or Regulations) on the international spread of poliovirus was convened by the WHO Director-General on 14 May 2026 via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the latest epidemiological data on wild poliovirus type 1 (WPV1) and circulating vaccine-derived polioviruses (cVDPV) in the context of the global targets to interrupt endemic WPV1 transmission in 2026 and to stop cVDPV2 outbreaks by 2028 with subsequent certification of WPV1 eradication and cVDPV2 elimination. Technical updates were received about the situation in the following countries: Afghanistan, Malawi, Nigeria, Pakistan, Somalia, and Togo. Amendments to the IHR, adopted by the Seventy-seventh World Health Assembly, through resolution WHA77. 17 in June 2024, entered into force, generally, on 19 September 2025. 1 Key amendments to the IHR include, inter alia, broader poliovirus notification requirements; the introduction of the determination of “pandemic emergency”2, a higher level of global public health alert with respect to a public health emergency of international concern (PHEIC); measures to strengthen equitable access to relevant health products; and recognition of health documents in non-digital and digital formats. Wild poliovirus Since the last Emergency Committee meeting in January 2026, 16 new WPV1 cases have been reported from the two endemic countries, Afghanistan (14) and Pakistan (2). Of the 14 new WPV1 cases reported in Afghanistan, 11 had onset in 2025. The cases in Afghanistan were reported from the South and East Regions of the country, while in Pakistan the cases were reported from Khyber Pakhtunkhwa and Sindh provinces. In 2026 to date, four WPV1 cases have been reported: three in Afghanistan and one in Pakistan. In 2025, 52 WPV1 cases were reported: 21 in Afghanistan and 31 in Pakistan. For environmental surveillance, a total of 74 WPV1 positive samples have been reported so far in 2026 (17 from Afghanistan and 57 from Pakistan). In 2025, a total of 747 WPV1 positive samples were reported; 94 from Afghanistan, 651 from Pakistan and two from Germany. No further WPV1 detections were reported from Germany after the first half of October 2025. Following the closure of the Afghanistan–Pakistan land border, which prevented shipment of AFP and environmental surveillance samples from Afghanistan to the Pakistan Regional Reference Laboratory (RRL) between 12 October 2025 and early January 2026, the programme was able to resume sample shipments during the second week of January 2026. All Afghanistan samples from 2025 have now been tested and finalized. While the land border between Afghanistan and Pakistan remains closed, the programme has established a regular aerial shipment mechanism to transport samples to the RRL in Islamabad. In addition, WHO is coordinating with other laboratories in the Region to establish contingency testing capacity for Afghanistan samples, should the need arise. While the overall trajectory of WPV1 cases and environmental sample positivity is declining, the Committee noted with concern the continued WPV1 transmission in both endemic countries, which persisted throughout the most recent low transmission season (October 2025–April 2026), particularly along the southern (South Afghanistan–Quetta Block) and central (Northwest Pakistan/South Khyber Pakhtunkhwa–Southeast Afghanistan) cross-border epidemiological corridors, as well as in Karachi, Pakistan. The Committee further noted that sustained local WPV1 transmission continues to be concentrated in three critical geographies: the South Region of Afghanistan, South Khyber Pakhtunkhwa (KP), and Karachi. The South Region of Afghanistan remains the area of greatest concern, with intense transmission and evidence of prolonged undetected circulation. Southern Khyber Pakhtunkhwa continues to present significant operational and security challenges that impede implementation of high-quality vaccination activities, while Karachi remains a significant reservoir for poliovirus transmission, with widespread environmental surveillance positivity indicating continued local transmission. The Committee noted encouraging progress in the northern cross-border epidemiological corridor, encompassing Peshawar in Pakistan and the East Region of Afghanistan, where programme quality has improved. At the same time, the Committee noted that these gains remain at risk, highlighting the recent environmental detection in Peshawar, immunity gaps, surveillance sensitivity concerns, population movement and persistent refusal pockets. The Committee emphasized the need to sustain high quality surveillance and immunization activities to maintain the progress achieved. The Committee also noted encouraging progress in the Quetta Block, particularly the marked decline in positive environmental samples during the last 6 months. However, the Committee emphasized that these gains remain fragile because of continued intense WPV1 transmission in the adjoining South Region of Afghanistan, as well as uneven quality of vaccination campaigns and low routine immunization coverage. The Committee underscored the need for targeted measures to sustain and consolidate the progress achieved by boosting population immunity in areas with persistent immunity gaps. Regarding molecular epidemiology, there has been an overall decrease in genetic biodiversity between 2020 and 2023. However, an increase in the genetic biodiversity was observed in 2024, necessitating a split of two genetic clusters into eight genetic clusters, three of which are active in 2025, and four are active in 2026. The remaining chains of transmission continue to circulate in populations and geographies with persistently low immunization coverage, including the bordering districts of the southern and northern epidemiological corridors across the two endemic countries. Evidence of shared cross-border transmission between the two WPV1-endemic countries was documented as recently as first quarter of 2026. Afghanistan and Pakistan continue to implement an intensive and mostly synchronized campaign schedule, with a focus on achieving high vaccination coverage in core reservoirs and ensuring timely, effective response to WPV1 detections in other areas of each country. There have been two nationwide and five sub-national vaccination campaigns in 2025, and two sub-national and a national campaign in 2026 so far. Additionally, targeted fractional IPV campaigns were implemented in the high-risk areas of the East, South, and Southeast Regions between August and September 2025. Pakistan implemented five nationwide and one sub-national vaccination campaign in 2025 and nationwide campaigns in 2026 so far. Bivalent OPV was integrated into the measles campaign in high-risk areas of the country in December 2025, and targeted fractional dose IPV campaigns were implemented in Karachi, Quetta Bloc and Lahore. In Afghanistan, campaigns are being conducted using the site-to-site strategy, with focused efforts to strengthen operational and communication approaches to maximize coverage of target children under this modality. House-to-house campaigns have not been implemented since October 2024 due to security concerns, limiting full campaign access to all children; at the same time, the overall inclusion of women as vaccination health workers remains very low, particularly in the South Region. The Committee expressed concern that, in the absence of house-to-house campaigns and with limited participation of women health workers, site-to-site campaigns often fail to reach all children, particularly younger children, which could contribute to further geographic spread within Afghanistan and beyond. The Committee noted with appreciation the strong leadership and high-level commitment to polio eradication in Pakistan at all levels, including the direct engagement of the Prime Minister, the Federal Minister for Health, and the Prime Minister’s Focal Person for Polio Eradication. The Committee also acknowledged consistently high reported coverage and Lot Quality Assurance Sampling (LQAS) pass rates at the national and provincial levels. However, the Committee noted that the quality at district level remains variable and inconsistent, including in several critical areas such as Quetta Bloc, South KP and the Central Pakistan Bloc, attributed to operational challenges and prevailing insecurity, particularly in Khyber Pakhtunkhwa, and Balochistan provinces. The programme in Pakistan is facing substantial challenges in consistently and effectively reaching all target children in South KP, which is currently experiencing the most intense WPV1 transmission in the country, with an estimated 250 000 children reportedly unreached, primarily due to access constraints driven by insecurity. The Committee noted encouraging early signs of improvement following implementation of the Karachi Audit recommendations, including declining environmental surveillance detections and improving LQAS results. However, the Committee emphasized that these gains are still at an early stage and do not yet reflect eradication-level programme quality, as local transmission and evidence of undetected transmission persist in Karachi. The Committee underscored that full implementation of the audit recommendations will be critical to achieving the programme quality needed to interrupt WPV1 transmission. In summary, available data indicate that global WPV1 transmission remains geographically confined to the two endemic countries. There is measurable progress achieved during the last 6 months in several key geographies, including the East Region of Afghanistan and the Peshawar, Quetta and Karachi Blocks of Pakistan. However, the decline in WPV1 cases and environmental detections, particularly following the low transmission season and a period of intensified programme activities, do not necessarily indicate that eradication-level programme quality has been achieved. The Committee noted that programme quality gaps persist across critical geographies and beyond, and that sustained efforts to strengthen surveillance, improve routine and supplementary immunization, fully implement programme improvement recommendations from TAG and Karachi audit, and ensure access to all children will be essential to interrupt WPV1 transmission and achieve eradication. The Committee reinforced that Afghanistan and Pakistan constitute a single epidemiological bloc for the purposes of polio eradication, with a continued risk of cross-border transmission. It therefore remains essential that both country programmes, with support from the GPEI, maintain strong cross-border coordination at the national and subnational levels and continue efforts towards synchronized programme implementation, particularly in border areas. Both countries should also maintain close coordination to reach and vaccinate populations moving across the border, including undocumented migrants returning from Pakistan to Afghanistan, whose movement continues to compound the programme’s operational challenges. Circulating vaccine derived polioviruses (cVDPV) In 2026 (as of 30 April), a total of 32 cVDPV cases and 27 environmental detections were reported globally across 12 countries. Of the 32 cVDPV cases in 2026, 28 are cVDPV2, two are cVDPV3, and two are cVDPV1 cases. All the 27 positive environmental samples in 2026 tested positive for cVDPV2. In 2025, a total of 238 cVDPV cases and 247 confirmed cVDPV environmental detections were reported globally across 30 countries. Nigeria in the African Region reported the highest number of cVDPV2 cases in 2025 (66) and 2026 (14) so far, representing 30% and 50% of the global cVDPV2 case load, respectively. Nigeria reported co-circulation of cVDPV2 and cVDPV3 in 2026. In 2025, Algeria, DR Congo, Djibouti and Israel had reported co-circulation of cVDPV1 and cVDPV2 while Cameroon, Chad and Nigeria had reported co-circulation of cVDPV2 and cVDPV3. As of 30 April, 13 unique cVDPV2 emergence groups have been detected in 2026, compared with 36 in 2025, 31 in 2024 and 28 in 2023. All the 13 cVDPV2 emergences detected in 2026 represent a continuation from 2025, with no new cVDPV2 emergence in 2026. Since its introduction in 2021, more than 2 billion doses of nOPV2 have been administered and a total of 42 cVDPV2 emergences have been associated with it. The Committee noted that nOPV2 continues to demonstrate significantly greater genetic stability and a substantially lower risk of reversion to neurovirulence compared to Sabin OPV2. More than 80% of cVDPV2-affected countries have interrupted outbreaks with three or fewer SIAs using nOPV2. In 2026 (as of 30 April), two cVDPV1 cases have been reported, both from South Sudan. In 2025, three cVDPV1 cases were reported, one each from Algeria, the Democratic Republic of Congo, and Lao People’s Democratic Republic. In addition, cVDPV1 outbreaks were reported in Djibouti and Israel, based on environmental surveillance detections (ten detections each from Djibouti and Israel). Nigeria is the only country in 2026 that reported cVDPV3, hence it is now affected by cVDPV2 and cVDPV3 outbreaks. In 2025, four countries, Cameroon, Chad, Guinea, and Nigeria reported cVDPV3 outbreaks. The Committee noted that although global transmission of cVDPV1 and cVDPV3 remains at lower levels compared to cVDPV2, the upward trend observed in 2025 is a concern. This underscores the critical importance of sustaining high population immunity against type 1 and type 3 polioviruses through robust routine immunization, as well as ensuring timely and high-quality response activities in the event of any detections. The Committee noted that the risk of cVDPV outbreaks is largely driven by a combination of inaccessibility, insecurity, high concentrations of zero-dose and under-immunized children, and ongoing population displacement. Conclusion The Committee unanimously concluded that the risk of international spread of polioviruses continues to constitute a Public Health Emergency of International Concern (PHEIC) and recommended extending the Temporary Recommendations for a further three months. The Committee, after a thorough review of the epidemiological and programmatic situation, unanimously concluded that the event does not constitute a pandemic emergency. In reaching the conclusion that the risk of international spread of poliovirus continues to constitute a PHEIC, the Committee considered the following factors: Ongoing risk of WPV1 international spread The Committee noted that the risk of international spread of WPV1 persists due to the following factors: Ongoing WPV1 transmission in the core reservoirs, particularly in the southern region of Afghanistan and Karachi and South KP in Pakistan. Persistent inconsistencies in campaign quality and a substantial number of unimmunized and under-immunized children in some key areas, driven by access constraints due to insecurity (e. g. South KP, South Afghanistan), sub-optimal operational performance (e. g. site-to-site vaccination modality in Afghanistan and uneven quality in parts of Pakistan), and vaccine hesitancy in certain communities (e. g. South KP, Quetta Block, Southeast Afghanistan), all contributing to gaps in the population immunity. Ongoing population movement between the two endemic countries, including the returnees from Pakistan to Afghanistan, leading to continued risk of cross-border WPV1 transmission. Population movement from the two endemic countries to other neighbouring and distant countries, demonstrating risk of international spread (recent example from late 2025: Germany). Ongoing risk of cVDPV international spread Based on the following factors, the risk of international spread of cVDPV appears to remain high: Continued cVDPV2 transmission in Lake Chad Basin, particularly in high-risk areas of Nigeria, with continued potential for amplification of spread. Ongoing cVDPV2 transmission in the Horn of Africa, including Somalia, Ethiopia, and Yemen. The Horn of Africa countries continue to experience overlapping humanitarian and health emergencies, making it challenging to implement high-quality vaccination campaigns in a timely manner. A large pool of unimmunized and susceptible children in the northern governorates of Yemen (more than 4. 5 million children aged less than five years), where a proper OPV response to the ongoing cVDPV2 outbreak has not yet been implemented due to insecurity and lack of access. Challenges also persist regarding timely shipment of AFP stool specimens from these areas. Full access to all children in Nigeria, southern and central Somalia also remains a significant challenge. A widening gap in intestinal mucosal immunity among young children since the global withdrawal of OPV2 in 2016, as well as high concentration of zero dose children in certain areas. Continued low routine immunization and IPV coverage in several countries, resulting in persistent immunity gaps, indicates an ongoing risk of cVDPV1 and cVDPV3 outbreaks. This is underscored by the cVDPV1 outbreaks reported in 2025 in Algeria, Djibouti, the Lao People’s Democratic Republic, and Israel, and in 2026 in South Sudan, as well as the cVDPV3 outbreaks in Cameroon, Chad, Guinea, and Nigeria. Ongoing cross-border transmission, including spread into newly re-infected countries and territories. Additional Contributing factors include: Sub-optimal routine immunization: Many countries have weak immunization systems that can be further impacted by humanitarian emergencies including conflict, protracted complex emergencies and lack of political commitment. This growing vulnerability leaves populations in fragile states at increased risk of polio outbreaks. Ongoing insecurity and conflict in several areas that serve as persistent source of cVDPV transmission. The current resource-constrained environment further challenges the full and effective implementation of critical eradication activities. Risk categories The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows: States infected with WPV1, cVDPV1 or cVDPV3, with or without evidence of local transmission. States infected with cVDPV2, with or without evidence of local transmission. States previously infected by WPV1 or cVDPV within the last 24 months (last detection > 13 months) Criteria to assess States as no longer infected by WPV1 or cVDPV: Poliovirus Case: 12 months after the date of onset of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer. Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period. These criteria may be varied for the WPV1 endemic countries and countries with longstanding persistent polio outbreaks, where more rigorous assessment is needed in reference to surveillance quality. Once a country meets these criteria as no longer infected, the country will remain on a ‘watch list’ for a further 12 months as a period of heightened monitoring. After this period, the country will no longer be subject to Temporary Recommendations.

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