The forty fifth assembly of the Emergency Committee underneath the Worldwide Well being Rules (IHR or Rules) on the worldwide unfold of poliovirus was convened by the WHO Director-Normal on 14 Could 2026 through video convention with affected international locations, supported by the WHO Secretariat. The Emergency Committee reviewed the newest epidemiological knowledge on wild poliovirus sort 1 (WPV1) and circulating vaccine-derived polioviruses (cVDPV) within the context of the worldwide targets to interrupt endemic WPV1 transmission in 2026 and to cease cVDPV2 outbreaks by 2028 with subsequent certification of WPV1 eradication and cVDPV2 elimination. Technical updates had been obtained concerning the state of affairs within the following international locations: Afghanistan, Malawi, Nigeria, Pakistan, Somalia, and Togo.
Amendments to the IHR, adopted by the Seventy-seventh World Well being Meeting, by way of decision WHA77.17 in June 2024, entered into drive, usually, on 19 September 2025.1 Key amendments to the IHR embrace, inter alia, broader poliovirus notification necessities; the introduction of the willpower of “pandemic emergency”2, a better degree of world public well being alert with respect to a public well being emergency of worldwide concern (PHEIC); measures to strengthen equitable entry to related well being merchandise; and recognition of well being paperwork in non-digital and digital codecs.
Wild poliovirus
For the reason that final Emergency Committee assembly in January 2026, 16 new WPV1 circumstances have been reported from the 2 endemic international locations, Afghanistan (14) and Pakistan (2). Of the 14 new WPV1 circumstances reported in Afghanistan, 11 had onset in 2025. The circumstances in Afghanistan had been reported from the South and East Areas of the nation, whereas in Pakistan the circumstances had been reported from Khyber Pakhtunkhwa and Sindh provinces. In 2026 to this point, 4 WPV1 circumstances have been reported: three in Afghanistan and one in Pakistan. In 2025, 52 WPV1 circumstances had been reported: 21 in Afghanistan and 31 in Pakistan. For environmental surveillance, a complete of 74 WPV1 optimistic samples have been reported up to now in 2026 (17 from Afghanistan and 57 from Pakistan). In 2025, a complete of 747 WPV1 optimistic samples had been reported; 94 from Afghanistan, 651 from Pakistan and two from Germany. No additional WPV1 detections had been reported from Germany after the primary half of October 2025.
Following the closure of the Afghanistan–Pakistan land border, which prevented cargo 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 in a position to resume pattern shipments in the course of the second week of January 2026. All Afghanistan samples from 2025 have now been examined and finalized. Whereas the land border between Afghanistan and Pakistan stays closed, the programme has established a daily aerial cargo mechanism to move samples to the RRL in Islamabad. As well as, WHO is coordinating with different laboratories within the Area to determine contingency testing capability for Afghanistan samples, ought to the necessity come up.
Whereas the general trajectory of WPV1 circumstances and environmental pattern positivity is declining, the Committee famous with concern the continued WPV1 transmission in each endemic international locations, which endured all through the latest low transmission season (October 2025–April 2026), notably alongside the southern (South Afghanistan–Quetta Block) and central (Northwest Pakistan/South Khyber Pakhtunkhwa–Southeast Afghanistan) cross-border epidemiological corridors, in addition to in Karachi, Pakistan.
The Committee additional famous that sustained native WPV1 transmission continues to be concentrated in three vital geographies: the South Area of Afghanistan, South Khyber Pakhtunkhwa (KP), and Karachi. The South Area of Afghanistan stays the realm of biggest concern, with intense transmission and proof of extended undetected circulation. Southern Khyber Pakhtunkhwa continues to current important operational and safety challenges that impede implementation of high-quality vaccination actions, whereas Karachi stays a big reservoir for poliovirus transmission, with widespread environmental surveillance positivity indicating continued native transmission.
The Committee famous encouraging progress within the northern cross-border epidemiological hall, encompassing Peshawar in Pakistan and the East Area of Afghanistan, the place programme high quality has improved. On the identical time, the Committee famous that these beneficial properties stay in danger, highlighting the latest environmental detection in Peshawar, immunity gaps, surveillance sensitivity issues, inhabitants motion and chronic refusal pockets. The Committee emphasised the necessity to maintain prime quality surveillance and immunization actions to keep up the progress achieved. The Committee additionally famous encouraging progress within the Quetta Block, notably the marked decline in optimistic environmental samples over the last 6 months. Nevertheless, the Committee emphasised that these beneficial properties stay fragile due to continued intense WPV1 transmission within the adjoining South Area of Afghanistan, in addition to uneven high quality of vaccination campaigns and low routine immunization protection. The Committee underscored the necessity for focused measures to maintain and consolidate the progress achieved by boosting inhabitants immunity in areas with persistent immunity gaps.
Relating to molecular epidemiology, there was an total lower in genetic biodiversity between 2020 and 2023. Nevertheless, a rise within the genetic biodiversity was noticed in 2024, necessitating a cut up of two genetic clusters into eight genetic clusters, three of that are lively in 2025, and 4 are lively in 2026. The remaining chains of transmission proceed to flow into in populations and geographies with persistently low immunization protection, together with the bordering districts of the southern and northern epidemiological corridors throughout the 2 endemic international locations. Proof of shared cross-border transmission between the 2 WPV1-endemic international locations was documented as just lately as first quarter of 2026.
Afghanistan and Pakistan proceed to implement an intensive and principally synchronized marketing campaign schedule, with a concentrate on attaining excessive vaccination protection in core reservoirs and making certain well timed, efficient response to WPV1 detections in different areas of every nation. There have been two nationwide and 5 sub-national vaccination campaigns in 2025, and two sub-national and a nationwide marketing campaign in 2026 up to now. Moreover, focused fractional IPV campaigns had been applied within the high-risk areas of the East, South, and Southeast Areas between August and September 2025. Pakistan applied 5 nationwide and one sub-national vaccination marketing campaign in 2025 and nationwide campaigns in 2026 up to now. Bivalent OPV was built-in into the measles marketing campaign in high-risk areas of the nation in December 2025, and focused fractional dose IPV campaigns had been applied in Karachi, Quetta Bloc and Lahore.
In Afghanistan, campaigns are being carried out utilizing the site-to-site technique, with centered efforts to strengthen operational and communication approaches to maximise protection of goal kids underneath this modality. Home-to-house campaigns haven’t been applied since October 2024 as a consequence of safety issues, limiting full marketing campaign entry to all kids; on the identical time, the general inclusion of girls as vaccination well being employees stays very low, notably within the South Area. The Committee expressed concern that, within the absence of house-to-house campaigns and with restricted participation of girls well being employees, site-to-site campaigns typically fail to succeed in all kids, notably youthful kids, which might contribute to additional geographic unfold inside Afghanistan and past.
The Committee famous with appreciation the sturdy management and high-level dedication to polio eradication in Pakistan in any respect ranges, together with the direct engagement of the Prime Minister, the Federal Minister for Well being, and the Prime Minister’s Focal Individual for Polio Eradication. The Committee additionally acknowledged constantly excessive reported protection and Lot High quality Assurance Sampling (LQAS) go charges on the nationwide and provincial ranges. Nevertheless, the Committee famous that the standard at district degree stays variable and inconsistent, together with in a number of vital areas reminiscent of Quetta Bloc, South KP and the Central Pakistan Bloc, attributed to operational challenges and prevailing insecurity, notably in Khyber Pakhtunkhwa, and Balochistan provinces. The programme in Pakistan is dealing with substantial challenges in constantly and successfully reaching all goal kids in South KP, which is at the moment experiencing probably the most intense WPV1 transmission within the nation, with an estimated 250 000 kids reportedly unreached, primarily as a consequence of entry constraints pushed by insecurity. The Committee famous encouraging early indicators of enchancment following implementation of the Karachi Audit suggestions, together with declining environmental surveillance detections and bettering LQAS outcomes. Nevertheless, the Committee emphasised that these beneficial properties are nonetheless at an early stage and don’t but mirror eradication-level programme high quality, as native transmission and proof of undetected transmission persist in Karachi. The Committee underscored that full implementation of the audit suggestions shall be vital to attaining the programme high quality wanted to interrupt WPV1 transmission.
In abstract, accessible knowledge point out that world WPV1 transmission stays geographically confined to the 2 endemic international locations. There’s measurable progress achieved over the last 6 months in a number of key geographies, together with the East Area of Afghanistan and the Peshawar, Quetta and Karachi Blocks of Pakistan. Nevertheless, the decline in WPV1 circumstances and environmental detections, notably following the low transmission season and a interval of intensified programme actions, don’t essentially point out that eradication-level programme high quality has been achieved. The Committee famous that programme high quality gaps persist throughout vital geographies and past, and that sustained efforts to strengthen surveillance, enhance routine and supplementary immunization, absolutely implement programme enchancment suggestions from TAG and Karachi audit, and guarantee entry to all kids shall be important to interrupt WPV1 transmission and obtain eradication. The Committee strengthened that Afghanistan and Pakistan represent a single epidemiological bloc for the needs of polio eradication, with a continued threat of cross-border transmission. It due to this fact stays important that each nation programmes, with assist from the GPEI, keep sturdy cross-border coordination on the nationwide and subnational ranges and proceed efforts in the direction of synchronized programme implementation, notably in border areas. Each international locations also needs to keep shut coordination to succeed in and vaccinate populations transferring throughout the border, together with undocumented migrants getting back from Pakistan to Afghanistan, whose motion continues to compound the programme’s operational challenges.
Circulating vaccine derived polioviruses (cVDPV)
In 2026 (as of 30 April), a complete of 32 cVDPV circumstances and 27 environmental detections had been reported globally throughout 12 international locations. Of the 32 cVDPV circumstances in 2026, 28 are cVDPV2, two are cVDPV3, and two are cVDPV1 circumstances. All of the 27 optimistic environmental samples in 2026 examined optimistic for cVDPV2. In 2025, a complete of 238 cVDPV circumstances and 247 confirmed cVDPV environmental detections had been reported globally throughout 30 international locations. Nigeria within the African Area reported the best variety of cVDPV2 circumstances in 2025 (66) and 2026 (14) up to now, representing 30% and 50% of the worldwide 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 whereas Cameroon, Chad and Nigeria had reported co-circulation of cVDPV2 and cVDPV3.
As of 30 April, 13 distinctive cVDPV2 emergence teams have been detected in 2026, in contrast with 36 in 2025, 31 in 2024 and 28 in 2023. All of the 13 cVDPV2 emergences detected in 2026 characterize a continuation from 2025, with no new cVDPV2 emergence in 2026. Since its introduction in 2021, greater than 2 billion doses of nOPV2 have been administered and a complete of 42 cVDPV2 emergences have been related to it. The Committee famous that nOPV2 continues to show considerably larger genetic stability and a considerably decrease threat of reversion to neurovirulence in comparison with Sabin OPV2. Greater than 80% of cVDPV2-affected international locations have interrupted outbreaks with three or fewer SIAs utilizing nOPV2.
In 2026 (as of 30 April), two cVDPV1 circumstances have been reported, each from South Sudan. In 2025, three cVDPV1 circumstances had been reported, one every from Algeria, the Democratic Republic of Congo, and Lao Folks’s Democratic Republic. As well as, cVDPV1 outbreaks had been reported in Djibouti and Israel, primarily based on environmental surveillance detections (ten detections every from Djibouti and Israel). Nigeria is the one nation in 2026 that reported cVDPV3, therefore it’s now affected by cVDPV2 and cVDPV3 outbreaks. In 2025, 4 international locations, Cameroon, Chad, Guinea, and Nigeria reported cVDPV3 outbreaks.
The Committee famous that though world transmission of cVDPV1 and cVDPV3 stays at decrease ranges in comparison with cVDPV2, the upward development noticed in 2025 is a priority. This underscores the vital significance of sustaining excessive inhabitants immunity towards sort 1 and kind 3 polioviruses by way of sturdy routine immunization, in addition to making certain well timed and high-quality response actions within the occasion of any detections.
The Committee famous that the chance of cVDPV outbreaks is essentially pushed by a mixture of inaccessibility, insecurity, excessive concentrations of zero-dose and under-immunized kids, and ongoing inhabitants displacement.
Conclusion
- The Committee unanimously concluded that the chance of worldwide unfold of polioviruses continues to represent a Public Well being Emergency of Worldwide Concern (PHEIC) and really useful extending the Momentary Suggestions for an additional three months.
- The Committee, after a radical evaluation of the epidemiological and programmatic state of affairs, unanimously concluded that the occasion doesn’t represent a pandemic emergency.
In reaching the conclusion that the chance of worldwide unfold of poliovirus continues to represent a PHEIC, the Committee thought of the next components:
Ongoing threat of WPV1 worldwide unfold
The Committee famous that the chance of worldwide unfold of WPV1 persists as a result of following components:
- Ongoing WPV1 transmission within the core reservoirs, notably within the southern area of Afghanistan and Karachi and South KP in Pakistan.
- Persistent inconsistencies in marketing campaign high quality and a considerable variety of unimmunized and under-immunized kids in some key areas, pushed by entry constraints as a consequence of insecurity (e.g. South KP, South Afghanistan), sub-optimal operational efficiency (e.g. site-to-site vaccination modality in Afghanistan and uneven high quality in components of Pakistan), and vaccine hesitancy in sure communities (e.g. South KP, Quetta Block, Southeast Afghanistan), all contributing to gaps within the inhabitants immunity.
- Ongoing inhabitants motion between the 2 endemic international locations, together with the returnees from Pakistan to Afghanistan, resulting in continued threat of cross-border WPV1 transmission.
- Inhabitants motion from the 2 endemic international locations to different neighbouring and distant international locations, demonstrating threat of worldwide unfold (latest instance from late 2025: Germany).
Ongoing threat of cVDPV worldwide unfold
Primarily based on the next components, the chance of worldwide unfold of cVDPV seems to stay excessive:
- Continued cVDPV2 transmission in Lake Chad Basin, notably in high-risk areas of Nigeria, with continued potential for amplification of unfold.
- Ongoing cVDPV2 transmission within the Horn of Africa, together with Somalia, Ethiopia, and Yemen. The Horn of Africa international locations proceed to expertise overlapping humanitarian and well being emergencies, making it difficult to implement high-quality vaccination campaigns in a well timed method.
- A big pool of unimmunized and inclined kids within the northern governorates of Yemen (greater than 4.5 million kids aged lower than 5 years), the place a correct OPV response to the continuing cVDPV2 outbreak has not but been applied as a consequence of insecurity and lack of entry. Challenges additionally persist concerning well timed cargo of AFP stool specimens from these areas. Full entry to all kids in Nigeria, southern and central Somalia additionally stays a big problem.
- A widening hole in intestinal mucosal immunity amongst younger kids because the world withdrawal of OPV2 in 2016, in addition to excessive focus of zero dose kids in sure areas.
- Continued low routine immunization and IPV protection in a number of international locations, leading to persistent immunity gaps, signifies an ongoing threat of cVDPV1 and cVDPV3 outbreaks. That is underscored by the cVDPV1 outbreaks reported in 2025 in Algeria, Djibouti, the Lao Folks’s Democratic Republic, and Israel, and in 2026 in South Sudan, in addition to the cVDPV3 outbreaks in Cameroon, Chad, Guinea, and Nigeria.
- Ongoing cross-border transmission, together with unfold into newly re-infected international locations and territories.
Extra Contributing components embrace:
- Sub-optimal routine immunization: Many international locations have weak immunization techniques that may be additional impacted by humanitarian emergencies together with battle, protracted advanced emergencies and lack of political dedication. This rising vulnerability leaves populations in fragile states at elevated threat of polio outbreaks.
- Ongoing insecurity and battle in a number of areas that function persistent supply of cVDPV transmission.
- The present resource-constrained setting additional challenges the total and efficient implementation of vital eradication actions.
Danger classes
The Committee supplied the Director-Normal with the next recommendation aimed toward decreasing the chance of worldwide unfold of WPV1 and cVDPVs, primarily based on the chance stratification as follows:
- States contaminated with WPV1, cVDPV1 or cVDPV3, with or with out proof of native transmission.
- States contaminated with cVDPV2, with or with out proof of native transmission.
- States beforehand contaminated by WPV1 or cVDPV throughout the final 24 months (final detection > 13 months)
Standards to evaluate States as now not contaminated by WPV1 or cVDPV:
- Poliovirus Case: 12 months after the date of onset of the latest case PLUS one month to account for case detection, investigation, laboratory testing and reporting interval OR when all reported AFP circumstances with onset inside 12 months of final case have been examined for polio and excluded for WPV1 or cVDPV, and environmental or different samples collected inside 12 months of the final case have additionally examined adverse, whichever is the longer.
- Environmental or different isolation of WPV1 or cVDPV (no poliovirus case): 12 months after assortment of the latest optimistic environmental or different pattern (reminiscent of from a wholesome youngster) PLUS one month to account for the laboratory testing and reporting interval.
- These standards could also be various for the WPV1 endemic international locations and international locations with longstanding persistent polio outbreaks, the place extra rigorous evaluation is required in reference to surveillance high quality.
As soon as a rustic meets these standards as now not contaminated, the nation will stay on a ‘watch record’ for an additional 12 months as a interval of heightened monitoring. After this era, the nation will now not be topic to Momentary Suggestions.
