Effective vaccine delivery to isolated endemic regions: a remaining obstacle to global eradication of poliomyelitis

Poliomyelitis was considered historically to be a major infectious disease of humans. Over the past few decades the implementation of widespread, effective vaccination programs in most countries has reduced the global burden of this potentially fatal and often severely debilitating viral disease to a minimally low level. However, polio-endemic regions remain in Afghanistan, Pakistan and Nigeria, where polio eradication has never eventuated. These isolated pockets pose a serious threat of the re-emergence of the disease and its dissemination to distant locations worldwide that are currently deemed to be polio-free. The recently increased awareness and improved surveillance by public health monitoring bodies of endemic regions in these three countries has facilitated tangible progress towards successful cessation of polio clinical cases. Nevertheless, logistical challenges remain that are yet to be addressed on a priority basis. These are inextricably linked to political, cultural and societal issues that hinder the pace of eradication. How action may be taken to resolve the complex, localized situations is discussed in this article.