Statement of the Forty-sixth Meeting of the Polio IHR Emergency Committee

The 46^th 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 30 September 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, Central African Republic, Democratic Republic of Congo, Ethiopia, Pakistan, South Sudan, and Sudan.

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

Wild poliovirus

Since the last Emergency Committee meeting in May 2026, 25 new WPV1 cases have been reported from the two endemic countries, Afghanistan (22) and Pakistan (3). 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 (KP) province. In 2026 to date, 29 WPV1 cases have been reported: 25 in Afghanistan and four in Pakistan. In 2025, 52 WPV1 cases were reported: 21 in Afghanistan and 31 in Pakistan. A total of 99 WPV1 cases were reported in 2024. For environmental surveillance, a total of 204 WPV1 positive samples have been reported so far in 2026 (76 from Afghanistan and 128 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.

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, 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 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 due to low population immunity. Southern Khyber Pakhtunkhwa continues to present significant operational and security challenges that impede implementation of high-quality vaccination activities. The Committee was encouraged to note a reduction in the number of children remaining unvaccinated following the two most recent vaccination campaigns in the South KP and emphasized the need to ensure consistent and full access to all children in upcoming vaccination rounds. Karachi, despite a significant decline in environmental surveillance positivity in 2026, continues to show local WPV1 transmission in some geographies. This indicates the presence of substantial population pockets with low immunity in these geographies, placing the wider epidemiological block at continued risk.

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. However, the recent slight increase in WPV1 detections in Peshawar, together with the upward trajectory of detections in the East Region of Afghanistan over the last six months, indicates that the gains made remain fragile. The detections in the East Region of Afghanistan mostly indicate introductions from the South Region of the country. The Committee emphasized the need to sustain high population immunity, particularly among vulnerable and high-risk population groups, and sensitive surveillance across the epidemiological corridor to protect and consolidate the gains achieved.

The Committee also noted encouraging progress in the Quetta Block, particularly the decline in positive environmental samples. 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 genetic biodiversity was observed in 2024, necessitating a split of two genetic clusters into eight genetic clusters, seven of which were active in 2025, and four remain active in 2026. The remaining chains of transmission continue to circulate in populations and geographies with persistently low immunization coverage, particularly in districts along the central and southern cross-border epidemiological corridors between the two endemic countries. Evidence of shared cross-border transmission between the two WPV1-endemic countries was documented as recently as mid-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 and effective responses to WPV1 detections in other areas of both countries. In Afghanistan, two nationwide and five sub-national vaccination campaigns were conducted in 2025, while two sub-national and one nationwide campaign have been conducted in 2026 so far. Additionally, targeted fractional-dose IPV campaigns were implemented in high-risk areas of the East, South and Southeast Regions in 2025, and in high-risk areas of the East Region in 2026. In Pakistan, five nationwide and one sub-national vaccination campaign were conducted in 2025, while two nationwide and two sub-national campaigns have been conducted in 2026 so far. Targeted fractional-dose IPV campaigns were also implemented in Karachi, Quetta Bloc and Lahore in 2025 and 2026.

In Afghanistan, campaigns continue to be 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 the continued implementation of its recommendation for all-age vaccination at border crossing points between Afghanistan and Pakistan and emphasized the importance of sustaining these efforts to minimize the risk of cross-border poliovirus transmission. In addition, the Committee emphasized the critical importance of achieving and sustaining consistently high levels of population immunity in both countries, particularly in border areas, to effectively prevent cross-border transmission.

The Committee noted with appreciation the strong leadership and high-level commitment to polio eradication in Pakistan at all levels, including the engagement of the Prime Minister’s Office. 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, due to operational challenges, vaccine hesitancy is certain communities, and prevailing insecurity, particularly in Khyber Pakhtunkhwa and Balochistan provinces. The programme in Pakistan continues to face 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. The recent improvements in Karachi, though encouraging, do not yet reflect eradication-level programme quality, as local transmission persists in some areas of the cosmopolitan city.

In summary, available data indicate that global WPV1 transmission remains geographically confined to the two endemic countries. While epidemiological progress during the last 12 months has been encouraging, it remains uneven across geographies. Measurable progress has been noted in several key geographies including the East Region of Afghanistan and the Peshawar, Quetta and Karachi Blocs of Pakistan. However, recent increase in WPV1 detections in Eastern Afghanistan and Peshawar, including polio cases and positive environmental samples, constitute a significant risk. Notwithstanding the improvements, WPV1 transmission remains intense in South KP of Pakistan as well as in the Southern Region of Afghanistan, with continued reporting of WPV1 cases and positive environmental samples. 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 the Technical Advisory Group and Karachi programme audit conducted in late 2025, 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 15 September), a total of 155 cVDPV cases and 61 environmental detections were reported globally across 20 countries. Of the 155 cVDPV cases reported in 2026, 118 were cVDPV2, 24 were cVDPV1, and 13 were cVDPV3. Of the 61 positive environmental samples reported in 2026, 55 were cVDPV2, five were cVDPV1, and one was cVDPV3. In 2025, a total of 246 cVDPV cases and 249 confirmed cVDPV environmental detections were reported globally across 30 countries. The Democratic Republic of the Congo and Nigeria together reported 88 cVDPV2 cases in 2026, 52 and 36 respectively, accounting for about 75% of the global cVDPV2 caseload as of mid-September. In 2025, Algeria, Djibouti, and the Democratic Republic of the Congo reported co-circulation of cVDPV1 and cVDPV2, while Nigeria, Chad, and Cameroon reported co-circulation of cVDPV2 and cVDPV3. In 2026, Nigeria and Chad reported co-circulation of cVDPV2 and cVDPV3, while South Sudan reported co-circulation of cVDPV1 and cVDPV2.

As of 15 September, 23 unique cVDPV2 emergence groups have been detected in 2026, compared with 35 in 2025, 31 in 2024 and 28 in 2023. Of the 23 cVDPV2 emergences detected in 2026, nine were new emergences (all nOPV2 derived). Since its introduction in 2021, more than 2 billion doses of nOPV2 have been administered and a total of 53 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. 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.

In 2026 (as of 15 September), 24 cVDPV1 cases have been reported, 10 from South Sudan, nine from Ethiopia, three from Lao People’s Democratic Republic and two from Madagascar. 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).

In 2026 (as of 15 September), 13 cVDPV3 have been reported, including 11 from Nigeria, one each from Niger and Chad. Nigeria is affected by outbreaks of both cVDPV2 and cVDPV3 in 2026. In 2025, 15 cVDPV3 cases were reported, eight from Nigeria, four from Chad, two from Guinea, and one from Cameroon.

Although global transmission of cVDPV1 and cVDPV3 remains at lower levels compared to cVDPV2, the Committee noted with concern the rising trend in the numbed of cVDPV1 and cVDPV3 cases in 2026, indicating low population immunity, especially among the vulnerable population groups, due to low routine immunization and compounded by the lack of preventive bOPV campaigns due to lack of resources. 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.
• 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 (most recent example: international spread to Germany in late 2025).

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 of spread.
• Intensifying cVDPV2 transmission in the Democratic Republic of the Congo during the last six months, including in provinces neighbouring Angola.
• 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.
• Eighteen countries, including some in the African Region, have yet to introduce a second dose of IPV into their routine immunization schedules, while coverage with the first dose of IPV (IPV1) remains low in several African countries.
• 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 rising number of cVDPV1 and cVDPV3 cases in 2026.
• Ongoing cross-border transmission in the African region, including spread into newly re-infected countries and territories.
• 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:

1. States infected with WPV1, cVDPV1 or cVDPV3, with or without evidence of local transmission.
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 or without evidence of local transmission
(as of data available at WHO HQ on 15 September 2026)

States that have had an emergence or importation of cVDPV1 or cVDPV3, or importation of WPV1 but without evidence of local transmission should:

• Officially declare, if not already done, at the level of head of state or government, that the risk 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.
• Undertake urgent and intensive investigations and risk assessment to determine if there has been local transmission, requiring an immunization response.
• 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. However, consideration of future hexavalent vaccine introduction should not delay the introduction of IPV2 in countries that are ready to proceed, particularly where introduction of the hexavalent vaccine is not imminent.
• 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 cVDPV1, cVDPV3 or WPV1 with risk of international spread, in addition to the above measures, should:

• 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.

For both sub-categories

• Maintain these measures until the following criteria have been met: (i) at least six months have passed without new detections 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’.
• Provide to the Director-General a regular report on the implementation of the Temporary Recommendations, including vaccination of international travelers, as appropriate.
• At the end of 12 months without evidence of transmission, provide a situational review report to the Director-General, including the measures taken to maintain high population immunity.

States infected with cVDPV2, with or without evidence of local transmission:
(as of data available at WHO HQ on 15 September 2026)

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 risk 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.
• Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, States should ensure preparedness to 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 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.
• Enhance 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 cVDPV2 detection 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’.
• Provide to the Director-General a regular report on the implementation of the Temporary Recommendations, including vaccination of international travelers, as appropriate.
• At the end of 12 months without evidence of transmission, provide a situational review report to the Director-General, including the measures taken to maintain high population immunity.

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 15 September 2026)

WPV1

cVDPV

These countries should:

• Strengthen routine immunization to boost/maintain population immunity, particularly among high-risk and vulnerable populations.
• Ensure high quality surveillance, 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.
• Maintain efforts to ensure vaccination of mobile populations, including populations moving across national borders, internally displaced persons, refugees, and other vulnerable groups.
• Maintain regional cooperation and cross border coordination to ensure early detection of WPV1 or 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 paid tribute to the health workers who lost their lives in the course of supporting polio vaccination activities and extended its deepest condolences to their families, friends and colleagues. The Committee strongly condemned attacks against health workers and security personnel supporting them and underscored the importance of ensuring their safety and security as they carry out their critical work towards global polio eradication.

While noting the overall decline in the number of WPV1 cases during the last 12 months, the Committee emphasized that the upcoming low transmission season presents an important opportunity to consolidate gains achieved in the Peshawar and Quetta Blocs of Pakistan, as well as in Eastern Afghanistan. Substantial and sustained efforts will be required to address the concerning epidemiological situation in South KP (Pakistan) and Southern Afghanistan, while further consolidating the recent gains achieved in Karachi (Pakistan).

The Committee acknowledged the political commitment in Pakistan and noted that the current high-level momentum in the country programme, if translated into high quality operational implementation and access to all children, provides an opportunity to fast-track progress towards stopping WPV1 transmission, with success primarily dependent on progress in South KP and Karachi. The Committee also acknowledged the operational and social mobilization related adjustments made to maximize reach through site-to-site campaigns in Afghanistan, which have resulted in encouraging vaccination quality in the East Region of the country. However, the Committee urged the Afghanistan polio programme to explore feasible options for transitioning to house-to-house vaccination throughout the country, as site-to-site campaigns have generally not achieved the consistent high levels coverage and quality required for eradication, particularly in the South Region.

The Committee appreciated the continued high-level engagement and support of the GPEI leadership, as demonstrated by the recent visit of the Polio Oversight Board to Afghanistan and Pakistan. The Committee was also encouraged by the strong support and commitment expressed by Member States towards achieving polio eradication during the 79th World Health Assembly in May 2026. The Committee emphasized the heightened importance of sustained engagement and support for polio eradication efforts at regional and global levels, including through appropriate diplomatic channels and the constructive involvement of Member States with established relationships in the region. The Committee encouraged continued efforts through these channels to seek greater support for the restoration of house-to-house vaccination campaigns in Afghanistan, particularly in high-risk areas, recognizing that this remains critical to reaching all eligible children and achieving the stopping of WPV1 transmission.

For cVDPV outbreaks, the Committee expressed deep concern about the situation in Democratic Republic of the Congo, Nigeria and Yemen, where the access and the quality of response remain significantly sub-optimal over a long period of time. In Nigeria, both routine immunization and supplementary immunization activities have not been able to reach all children, particularly in the high-risk northern states, due to a combination of operational quality and access challenges, despite the GPEI having made available most of the essential resources required to support the outbreak response. The Committee urged that all necessary steps be considered at the national, state and local government levels to improve routine immunization and enhance the quality of vaccination campaigns to stop the cVDPV2 and cVDPV3 outbreaks in Nigeria. This is critical to success in the African Region and globally since Nigeria is among the largest contributor to the global cVDPV caseload. Similarly, ongoing challenges have not allowed the implementation of any immunization response in the northern governorates of Yemen, where cVDPV2 transmission continues. Moreover, a significant backlog of AFP stool specimens from Yemen awaits testing. The Committee urged the GPEI to explore all feasible options and intensify advocacy efforts to facilitate meaningful progress in Yemen. The Committee also called for an investigation into the underlying factors contributing to the recent upsurge in cVDPV2 transmission in the Democratic Republic of the Congo and for appropriate measures to address identified gaps and safeguard the gains achieved in the country over the last 12 to 18 months.

The Committee noted that conflict and insecurity continue to affect many countries and sub-national areas experiencing WPV1 and cVDPV outbreaks, adversely affecting both routine immunization and supplementary polio vaccination campaigns. In addition, concurrent health emergencies and other disease outbreaks in several of these countries pose additional challenges to implementing timely and effective vaccination responses. Recognizing the diversity and complexity of operating environments at national and sub-national levels, the Committee emphasized the critical importance of adapting operational strategies and social mobilization efforts to local contexts to achieve high-quality campaign implementation and ultimately interrupt transmission. The Committee also highlighted the continued need for coordinated sub-regional approaches and cross-border collaboration to address the challenges posed by porous borders and shared operational constraints among polio-affected countries.

The Committee noted that the successful interruption of cVDPV2 transmission in several countries of the WHO African Region demonstrates the critical importance of strong political commitment, particularly when translated into high-quality, effective and sustained programme implementation at the operational level. The Committee expressed concern that some countries experiencing polio outbreaks have not declared these outbreaks national public health emergencies and emphasized the importance of such declarations in demonstrating high-level political commitment, mobilizing national resources and facilitating a coordinated and effective outbreak response.

The Committee remains concerned that the ongoing financial shortfall poses a substantial risk to all programme components, including the ability to maintain sensitive poliovirus surveillance. These risks are compounded by concurrent funding constraints affecting WHO, international partners, and national governments, reflecting broader fiscal pressures in the global health sector. The Committee appreciated the efforts of partners who have increased their financial contributions or optimized their funding approaches to help sustain poliovirus surveillance and other essential programme functions. The Committee recognized that the increasingly complex geopolitical environment continues to pose challenges to programme implementation in several countries. The Committee noted that these operational and financial pressures, including rising transportation and fuel costs and broader resource constraints, are placing additional strain on the delivery of essential programme activities. The Committee emphasized the need for WHO and GPEI surveillance teams at global, regional, and national levels to maintain robust mechanisms for monitoring surveillance quality, particularly in priority countries, to promptly detect emerging gaps and enable timely corrective action. The Committee further called upon donor countries and partner organizations to strengthen their financial support, underscoring that the consequences of insufficient funding could be substantial and far-reaching. The Committee also called on national governments to prioritize polio eradication within their domestic financing frameworks to protect the progress achieved and sustain momentum towards global eradication. The Committee recognised the importance of integrating polio activities with other immunisation activities or appropriate health programmes, the EPI programme being the most relevant.

The Committee noted with appreciation the ongoing collaboration between the GPEI and Gavi, recognizing its potential to generate mutual benefits for polio eradication and routine immunization. The Committee encouraged both partners to further build on this collaboration and explore opportunities to maximize its benefits. The Committee also encouraged Gavi to explore feasible approaches to facilitate broader access to hexavalent vaccines at an affordable cost, particularly for countries with limited financial resources, to support sustainable introduction into national immunization programmes.

The Committee noted that the risk of international spread of WPV1 remains significant due to ongoing transmission in the two endemic countries, Afghanistan and Pakistan. Similarly, the risk of international spread of cVDPV2 remains significant due to intense transmission in parts of the African Region. Ongoing population movements, including across international borders, contribute to the risk of international spread of both WPV1 and cVDPV2. Though the risk of international spread remains considerably lower for circulating vaccine-derived poliovirus types 1 and 3 (cVDPV1 and cVDPV3) than for cVDPV2, the increase in the number of cVDPV1 and cVDPV3 cases in 2026 is concerning, indicating the presence of population subgroups with suboptimal immunity to poliovirus types 1 and 3 and underscoring the importance of improving routine immunization. The Committee recommended the implementation of high-quality outbreak response measures to stop the cVDPV1 and cVDPV3 outbreaks and prevent further geographic spread. The Committee noted that, given the ongoing financial constraints facing the GPEI, preventive vaccination campaigns using bOPV cannot be financially supported in countries without 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 vaccination activities through routine immunization programmes and, where justified by a careful risk assessment, conducting supplementary immunization activities with bOPV using domestic resources.

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 12 November 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’, ‘States infected with cVDPV2’ 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, 12 November 2026.

¹ The text of the International Health Regulations (2005), as amended in 2014, 2022 and 2024 is available at https://apps.who.int/gb/bd/pdf_files/IHR_2014-2022-2024-en.pdf [accessed on 2106 October 2026]