Polio IHR Emergency Committee Holds 44th Meeting

The 44th 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 January 2026 with eight out of nine Committee members and the adviser meeting 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, Angola, Germany, Lao People's Democratic Republic, Namibia, Pakistan and Papua New Guinea.

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.. Key amendments to the IHR include, inter alia, broader poliovirus notification requirements; the introduction of the determination of "pandemic emergency" , 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 on 1 October 2025, nine new WPV1 cases have been reported from the two endemic countries, Afghanistan (5) and Pakistan (4). 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 2025 to date, 40 WPV1 cases have been reported: nine in Afghanistan and 31 in Pakistan. This compares to 99 WPV1 cases reported in all of 2024. For environmental surveillance, a total of 673 WPV1 positive samples have been reported so far in 2025 (64 from Afghanistan, 608 from Pakistan and one from Germany). This compares to 741 positive environmental samples reported during all of 2024 (113 from Afghanistan and 628 from Pakistan). It is important to note that land border closures between Afghanistan and Pakistan have disrupted the shipment of AFP and environmental surveillance samples to the Regional Reference Laboratory in Islamabad, Pakistan since 12 October 2025. As a result, a substantial backlog of untested samples has accumulated. Efforts are underway by WHO and Global Polio Eradication Initiative (GPEI) to resume shipments and accelerate testing, noting that results from pending samples may lead to changes in the current epidemiological assessment.

The Committee noted with concern the ongoing WPV1 transmission in both endemic countries, particularly along the southern (South Afghanistan – Quetta Block) and central (Northwest Pakistan/South Khyber Pakhtunkhwa – Southeast Afghanistan) cross-border epidemiological corridors.

In Pakistan, WPV1 continues to be detected in environmental samples across all the four major provinces. Transmission remains most intense in South Khyber Pakhtunkhwa (KP), as indicated by continued reporting of WPV1 cases and positive environmental isolates. Although Karachi in Sindh Province has not reported any WPV1 cases in 2025, ongoing detections in environmental samples, which are mostly genetically linked, indicate continued transmission within the city. A decline in both WPV1 cases and environmental detections has been observed in 2025 in the Quetta and Peshawar blocs. Active WPV1 transmission is also being detected in 2025 in Lahore, Punjab Province, and several districts within the Central Pakistan epidemiological block. In Afghanistan, intense transmission continues in the southern region, detected through both acute flaccid paralysis (AFP) and environmental surveillance. WPV1 transmission in Afghanistan's eastern region has declined significantly in 2025, indicating improvement in population immunity.

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. 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 September 2025.

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. Afghanistan implemented two nationwide and five sub-national polio vaccination rounds in 2025. 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 in 2025. Moreover, bOPV 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. 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 the consistently high reported coverage and Lot Quality Assurance Sampling (LQAS) pass rates at the national and provincial levels. However, the Committee observed 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 more than 250,000 children reportedly unreached, primarily due to access constraints driven by insecurity. The Committee noted the continued detection of WPV1 in Karachi despite high reported vaccination coverage during recent campaigns. The recently conducted programme audit in Karachi concluded that the current systems and the quality of available programme data do not provide a sufficiently accurate picture of campaign quality to identify problems and guide programme decisions, and that more children are being missed than programme data currently indicate. The potential scale of missed children and the over estimation of coverage are sufficient to explain the persistence of WPV1 transmission in the Karachi Bloc.

The Committee noted that the low transmission season from December 2025 to May 2026 presents an important opportunity to consolidate the gains achieved in the Peshawar Bloc and Quetta Bloc of Pakistan, as well as in Eastern Afghanistan. Substantial and sustained efforts will be required during this period to reverse the concerning epidemiological situation in South KP and Karachi in Pakistan, and in Southern Afghanistan. The Committee reinforced that full access to all children in both countries, particularly in key high-risk geographies, and the implementation of high-quality polio vaccination campaigns during the low transmission season will be critical to stopping WPV1 transmission in Afghanistan and Pakistan. The Committee emphasized that Afghanistan, ideally, should implement nationwide house to house campaigns to accelerate progress towards stopping WPV1 transmission. However, in the current context where such campaigns are not being implemented, the programme must maximize the reach and effectiveness of site-to-site campaigns through robust operational planning and strengthened social mobilization strategies. Stopping WPV1 transmission in Pakistan will require translating strong political and programmatic commitment at the national level into functional access to all children everywhere, and high-quality implementation of vaccination plans, in line with the recommendations of the Technical Advisory Group, during the low transmission season. Particular focus will be needed on core reservoirs and areas of persistent transmission.

The Committee reinforced that Afghanistan and Pakistan constitute a single epidemiological bloc for the purposes of polio eradication. Despite an apparent reduction in cross border WPV1 transmission in 2025, associated with decreased population movement, the risk of shared transmission remains high. It therefore remains essential that both country programmes, with support from the GPEI, maintain strong cross border coordination at national and subnational levels and continue efforts towards synchronized programme implementation, particularly in border areas. Both countries should also maintain coordination on reaching and vaccinating populations moving across the border, including undocumented migrants returning from Pakistan to Afghanistan, which compound the programme's operational challenges.

On 10 November 2025, the GPEI confirmed the detection of wild poliovirus type 1 (WPV1) in an environmental sample collected through routine surveillance in Hamburg, Germany, on 7 October 2025. Genetic sequencing indicates that this WPV1 detection is linked to WPV1 previously identified in Kandahar, Afghanistan, in August 2025, suggesting a recent importation into Germany. An environmental sample collected from the same site on 13 October 2025 also showed the presence of WPV1. No further WPV1 detections have been reported in subsequent environmental samples collected after 13 October 2025. This event underscores that, until polio is eradicated globally, all countries remain at risk of poliovirus importation. It highlights the critical importance of maintaining high vaccination coverage, strong disease surveillance, and international cooperation to achieve and sustain a polio free world.

In summary, available data indicate that global WPV1 transmission remains geographically confined to the two endemic countries. However, during 2024 and 2025, there has been geographic spread alongside continued transmission within core reservoir areas in both the endemic countries. There has also been detection of WPV1 in wastewater in Germany (October 2025), underscoring the ongoing risk of wider international spread.

Circulating vaccine derived polioviruses (cVDPV)

In 2025 (as of 31 December), a total of 202 cVDPV cases and 218 environmental detections were reported globally across 27 countries. Of the 202 cVDPV cases, 192 are cVDPV2, seven are cVDPV3, and three are cVDPV1 cases. Of the 218 positive environmental samples in 2025, 12 tested positive for cVDPV1, 197 for cVDPV2 and nine environmental samples that tested positive for both cVDPV1 and cVDPV2. This compares to 463 cVDPV cases (448 cVDPV2, 11 cVDPV1, and four cVDPV3) and 293 environmental detections of cVDPV from 38 countries during all of 2024. Nigeria in the African Region reported the highest number of cVDPV2 cases in 2025 (53), representing 28% of the global cVDPV2 case load. This is followed by Ethiopia in the African Region with 40, and Yemen in the Eastern Mediterranean Region with 30 cVDPV2 cases. Together, these three countries constitute 64% of the global cVDPV2 case load in 2025. Algeria, Djibouti, Israel, and Democratic Republic of Congo have reported co-circulation of cVDPV1 and cVDPV2 in 2025, while Guinea, Chad, and Cameroon reported co-circulating cVDPV2 and cVDPV3. Since the last Emergency Committee meeting, Lao People's Democratic Republic (PDR) reported a cVDPV1 outbreak, and Namibia reported a cVDPV2 outbreak. Response is underway in both these countries.

A total of 30 unique cVDPV2 emergence groups have been detected in 2025 (as of 31 December), compared with 31 in 2024 and 28 in 2023. Of the 30 emergence groups identified in 2025, 13 are newly detected in 2025; 12 derived from novel OPV2, while the origin of one remains under investigation. 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 2025 (as of 31 December), three cVDPV1 cases have been 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). Three countries, Cameroon, Chad, and Guinea, reported cVDPV3 outbreaks in 2025. Cameroon and Chad were affected by co-circulation of cVDPV types 2 and 3. Notably, the same cVDPV3 emergence caused the outbreaks in both countries, indicating cross-border transmission.

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

1. 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.
2. 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.
• Geographical expansion and established transmission of WPV1 in epidemiologically critical areas, including Central Pakistan and parts of Punjab Province, particularly Lahore.
• 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: 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 and Chad, 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.
• New cVDPV1 outbreaks in Algeria, Djibouti, Lao People's Democratic Republic, and Israel, and cVDPV3 outbreaks in Cameroon, Chad and Guinea indicate continued low routine immunization and IPV coverage in several countries and associated immunity gap. The risk of new and expanding cVDPV1 and cVDPV3 outbreaks appears to have increased in 2025.
• Ongoing cross-border transmission, including spread into newly re-infected countries and territories, with Lao People's Democratic Republic and Namibia reporting new cVDPV1 and cVDPV2 outbreaks, respectively.

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.
• Lack of access: Inaccessibility remains a major risk, particularly in northern Yemen and Somalia, where sizable populations have remained unreached with polio vaccine for extended periods of more than a year.
• 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:

1. States infected with WPV1, cVDPV1 or cVDPV3.
2. States infected with cVDPV2, with or without evidence of local transmission.
3. 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.

Temporary recommendations

States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread

(as of data available at WHO HQ on 31 December 2025)

These countries should:

• Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
• Ensure that all residents and long­term visitors (> four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
• Ensure that those undertaking urgent travel (within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
• Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in accordance with the Model International Certificate of Vaccination or Prophylaxis (ICVP), contained in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination. It is noted that, in accordance with resolution WHA77.17, ICVP issued after 19 September 2025 (date of entry into force of the amendments) by States Parties to which the amendments apply shall conform to the amended Model ICVP contained in Annex 6.
• Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of transport (road, air and/or sea).
• Further enhance cross­border efforts by significantly improving coordination at the national, regional, and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross­border populations. Improved coordination of cross­border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
• Further intensify efforts to increase routine immunization coverage, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication. Countries which have not yet introduced a second dose of IPV into their routine immunization schedules should urgently implement this. Once available, countries should also consider introducing the hexavalent vaccine, now approved by Gavi.
• Ensure a high-quality surveillance network that provides equitable coverage of all populations, enabling timely detection of new poliovirus isolates and effective monitoring and response to evolving epidemiological trends.
• Ensure that both routine and supplementary immunization activities reach all geographies and populations equitably, aiming to achieve uniformly high population immunity and protect all children from poliovirus paralysis. The GPEI and other relevant international health partners should support countries in ensuring fair and timely access to recommended polio vaccines through established global mechanisms.
• Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high-quality eradication activities in all infected and high-risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
• Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.

States infected with cVDPV2, with or without evidence of local transmission:

(as of data available at WHO HQ on 31 December 2025)

States that have had an importation of cVDPV2 but without evidence of local transmission should:

• Officially declare, if not already done, at the level of head of state or government, that the prevention or interruption of poliovirus transmission is a national public health emergency.
• Undertake urgent and intensive investigations and risk assessment to determine if there has been local transmission of the imported cVDPV2, requiring an immunization response.

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• Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, States should request vaccines from the global novel OPV2 stockpile, as required.
• Further intensify efforts to increase routine immunization coverage, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication. Countries which have not yet introduced a second dose of IPV into their routine immunization schedules should urgently implement this. Once available, countries should also consider introducing the hexavalent vaccine, now approved by Gavi.
• Intensify surveillance for polioviruses and strengthen regional cooperation and cross-border coordination to ensure the timely detection of poliovirus.
• Ensure a high-quality surveillance network that provides equitable coverage of all populations, enabling timely detection of new poliovirus isolates and effective monitoring and response to evolving epidemiological trends.
• Ensure that both routine and supplementary immunization activities reach all geographies and populations equitably, aiming to achieve uniformly high population immunity. The GPEI and other relevant international health partners should support countries in ensuring fair and timely access to recommended polio vaccines through established global mechanisms.

States with local transmission of cVDPV2, with risk of international spread, in addition to the above measures, should:

• Encourage residents and long­term visitors (> four weeks) to receive a dose of IPV four weeks to 12 months prior to international travel.
• Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
• Intensify regional cooperation and cross­border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and cross­border populations.

For both sub-categories:

• Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a 'state no longer infected'.
• At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
• Provide to the Director-General a regular report on the implementation of the Temporary Recommendations.

States no longer polio infected, but previously infected by WPV1 or cVDPV within the last 24 months(as of data available at WHO HQ on 17 September 2025)

WPV1

cVDPV

These countries should:

• Urgently strengthen routine immunization to boost/maintain population immunity.
• Enhance surveillance quality, including considering introducing or expanding supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high-risk and vulnerable populations.
• Intensify efforts to ensure vaccination of mobile populations, including populations moving across national borders, internally displaced persons, refugees, and other vulnerable groups.
• Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high-risk population groups.
• Maintain these measures with documentation of full application of high-quality surveillance and vaccination activities.

Additional considerations and recommendations

The Committee noted the overall decline in the number of WPV1 and cVDPV cases reported in 2025 compared with 2024. However, this trend is subject to some important considerations. For WPV1, a complete epidemiological picture is not yet available for Afghanistan, as testing of stool specimens from AFP cases and environmental samples from Afghanistan has been suspended since early October 2025. The Committee urged that arrangements be expedited as a matter of highest priority to enable the prompt testing of specimens from Afghanistan. The Committee further proposed the development of contingency plans to address and mitigate similar challenges in the future. The Committee noted that the population immunity remains low in key high-risk areas, including the Southern Region of Afghanistan and specific geographies in Pakistan, particularly South KP and Karachi having ongoing transmission. In Afghanistan, the absence of house-to-house vaccination campaigns throughout 2025 has led to suboptimal campaign quality, especially in the Southern Region, where intense WPV1 transmission persists. For cVDPV outbreaks, a significant backlog of AFP stool specimens from Yemen awaits testing. Transmission of cVDPV2 continues to be driven primarily by countries around Lake Chad Basin, with Nigeria remaining a major contributor. The Committee expressed deep concern regarding the lack of progress in northern Yemen towards implementing an effective immunization response to the ongoing cVDPV2 outbreak and ensuring the regular shipment of AFP stool specimens for testing. The Committee urged the GPEI to explore all feasible options and to intensify advocacy efforts to facilitate meaningful progress in Yemen. The recent outbreaks reported towards the end of 2025 in Namibia (cVDPV2) and the Lao People's Democratic Republic (cVDPV1) further underscore the persistent risks of poliovirus transmission globally.

The Committee noted that its previous recommendation to infected States to declare polio transmission a national public health emergency has not been implemented consistently. The Committee urges all countries currently affected by polio outbreaks or high-risk events to give due consideration to issuing such a declaration.

The Committee noted that the GPEI has developed, through a consultative process, an Action Plan to sustain and enhance programme operations in pursuit of the objectives set out in the GPEI Strategy, within the constraints of available resources. The Committee remains concerned that the current financial shortfall estimated at nearly 30% poses a substantial risk to all programme components, including the maintenance of sensitive poliovirus surveillance. These risks are exacerbated by concurrent funding constraints affecting WHO, international partners, and national governments, reflecting broader fiscal pressures in the global health sector. The Committee recommended that WHO and GPEI surveillance teams at global, regional, and national levels should establish robust mechanisms for monitoring surveillance quality, particularly in high-risk countries, in order to identify any emerging gaps promptly and facilitate timely remedial action. The Committee further urged donor countries and partner organizations to increase their financial support, underscoring that the consequences of under-funding could be substantial and far-reaching. The Committee also called upon national governments to prioritize polio eradication within their domestic financing frameworks to safeguard the gains made and sustain momentum towards global eradication.

The Committee noted that WPV1 transmission persisted with a generally high force of infection in the two endemic countries during the last high transmission season, driven primarily by core reservoirs and persistent transmission zones, particularly South KP and Karachi in Pakistan, and the Southern Region of Afghanistan. The Committee recognized that the current momentum in the Pakistan programme, combined with the ongoing low transmission season, offers an opportunity to fast-track progress towards stopping WPV1 transmission during the first half of 2026, with success hinging on progress in South KP, Karachi, and Southern Afghanistan. The Committee urged the Afghanistan polio programme to explore feasible options for transitioning to house-to-house vaccination, as site-to-site campaigns have generally not achieved the coverage and quality for eradication. The Committee emphasized the urgent need for a comprehensive, whole-of-government approach in both endemic countries, extending to district level, to deliver the high-quality activities required to stop WPV1 transmission and sustain global confidence and support for polio eradication.

The Committee noted the continued transmission cVDPV2 in the African Region, particularly in the Lake Chad Basin and the Horn of Africa. Although the overall number of cVDPV2 cases has declined in 2025, cVDPV2 transmission persists with significant intensity in Algeria, Angola, Chad, Ethiopia, Nigeria, and Yemen. The Committee, in particular, expressed deep concern about the situation in Nigeria and Yemen, where the access and quality of response remains majorly sub-optimal for significantly long period of time. The Committee noted the continued transmission of cVDPV2 in the African Region, particularly in the Lake Chad Basin and the Horn of Africa. Although, the overall number of cVDPV2 cases has declined in 2025, transmission persists with significant intensity in Algeria, Angola, Chad, Ethiopia, Nigeria, and Yemen. The Committee expressed deep concern about the situation in Nigeria and Yemen, where access challenges and suboptimal response quality have persisted for an extended period. Ongoing challenges have not allowed implementing any immunization response in the northern governorates of Yemen, where cVDPV2 transmission continues. In Somalia, an emerging downward trend in cVDPV2 detections requires cautious interpretation due to persistent access challenges in south and central regions, leaving more than 450,000 children unreached during vaccination campaigns.

The risk of international spread remains considerably lower for circulating vaccine-derived poliovirus types 1 and 3 (cVDPV1 and cVDPV3) than for cVDPV2. Nevertheless, the Committee expressed concern regarding the cVDPV1 outbreaks in Algeria, Djibouti, the Lao People's Democratic Republic, and Israel, as well as the cVDPV3 outbreaks in Cameroon, Chad, and Guinea. These events require sustained vigilance. Such outbreaks indicate the presence of population subgroups with suboptimal immunity to poliovirus types 1 and 3 and highlight the importance of improving routine immunization. The Committee recommended that high-quality outbreak response measures be implemented to stop these outbreaks and prevent further geographic spread. The Committee noted that, given the current financial limitations facing the GPEI, preventive vaccination campaigns using bOPV cannot be supported in countries that have no active transmission of poliovirus type 1 or type 3. The Committee encouraged countries where population immunity to types 1 and/or 3 is very low to consider conducting catch-up activities within routine immunization programmes, and where justified by a careful risk assessment, to implement supplementary immunization activities with bOPV using domestic resources.

The Committee recognized the critical role of mobile and migrant populations in sustaining WPV1 transmission in the two endemic countries, as well as cVDPV transmission in the African Region and elsewhere globally. The Committee urged that vaccination of populations on the move be accorded the highest priority. The Committee emphasized the need to identify and differentiate the various categories of mobile populations and to reach them through country-specific, tailored strategies, drawing on current guidance from WHO and the GPEI.

The Committee noted that conflict and insecurity continue to affect many countries and sub-national experiencing WPV1 and cVDPV outbreaks, disrupting both routine immunization services and supplementary polio vaccination campaigns. Moreover, concurrent health emergencies and other disease outbreaks in several of these countries compound the difficulties in mounting timely and effective vaccination responses. Recognizing the highly diverse and often complex operating environments at national and sub-national levels, the Committee emphasized the critical importance of tailoring operational strategies and social mobilization efforts to local contexts in order to achieve high-quality campaign implementation and ultimately interrupt transmission. The Committee also underscored the need for coordinated sub-regional approaches and strengthened cross-border collaboration to address the challenges arising from porous borders and shared operational constraints among polio-affected countries.

The Committee noted ongoing cross-border transmission of polioviruses, predominantly in the African and Eastern Mediterranean Regions. In-depth genetic analyses indicate at least eight documented cVDPV global importation events from January to September 2025. Notable recent events include the detection of WPV1 in wastewater in Germany, multiple detections of cVDPV2 in some countries of the European Region, cVDPV2 in Papua New Guinea linked to the 2024 transmission in Indonesia, cVDPV2 in Namibia associated with the outbreak in Angola, and shared cVDPV3 transmission between Chad and Cameroon. These events reaffirm that polio continues to pose a global threat until complete eradication is achieved. The Committee emphasized the vital importance of sustaining highly sensitive surveillance in all polio-affected and high-risk countries. The Committee recommended that the GPEI provide full support to implement the Global Polio Surveillance Action Plan. The Committee further underscored the need to preserve the operational capacity of the Global Polio Laboratory Network to ensure timely and accurate poliovirus detection in support of eradication efforts. The Committee particularly highlighted the importance of maintaining robust surveillance in high-income countries, given the ongoing risk of importation, as evidenced by recent detections in the European Region. Strong surveillance remains essential for the early identification of and rapid response to both imported viruses and newly emerging outbreaks. The Committee recommended that communication and programme messaging concerning the international spread of polioviruses be carefully tailored to the specific epidemiological and socio-political context of each setting, including high-income countries, in order to promote greater understanding and sustained commitment to the global polio eradication effort.

The Committee noted that novel OPV2 continues to demonstrate greater genetic stability compared to Sabin OPV2. However, the risk of new cVDPV2 emergences increases when the interval between outbreak response campaigns exceeds four weeks or when vaccination quality is suboptimal, underscoring the need for timely and high-quality immunization efforts.

Based on the current situation regarding WPV1 and cVDPVs, and the reports provided by affected countries, the Director-General accepted the Committee's assessment, and on 01 March 2026 determined that the poliovirus situation continues to constitute a public health emergency of international concern (PHEIC) with respect to WPV1 and cVDPV. He further followed the advice of the Committee that the poliovirus situation does not constitute a pandemic emergency.

The Director-General endorsed the Committee's recommendations for countries meeting the definition for 'States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread', 'States infected with cVDPV2 with potential risk for international spread' and for 'States previously infected by WPV1 or cVDPV within the last 24 months' and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of polioviruses, effective, 01 March 2026.