• Global polio watchdog calls for ‘fresh thinking’ and ‘country ownership’ of eradication efforts
• Responsibility for Pakistan, Afghanistan shifted to WHO’s Eastern Mediterranean region
• Report terms Pakistan’s claims of progress from 2021-23 ‘likely by-product of Covid prevention measures’
ISLAMABAD: As Pakistan reports 26 new polio cases this year, the global polio monitoring board has issued a stark warning that efforts to eradicate the disease are failing.
After 37 years and $22 billion invested, the world has reached an “inflection point” where, traditional methods offer diminishing returns, the Independent Monitoring Board (IMB) on polio said in its latest report.
The ‘glass mountain’ of polio eradication has proven unclimbable through conventional methods, it says, calling for fresh thinking and unambiguous country ownership to achieve success.
In a letter to World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus, IMB Chairman Sir Liam Donaldson said the report, titled ‘The Glass Mountain’ arrives at a critical juncture.
“The confluence of persistent viral transmission, unprecedented geopolitical disruption, and severe financial constraints has created conditions that fundamentally challenge the programme’s survival and success,” Mr Donaldson wrote.
He noted that early optimism in 2023 has been replaced by the “stark reality of resurgence,” as historical reservoirs of the virus — a reference to Pakistan and Afghanistan — have been reinfected.
The IMB, which works on behalf of international donor agencies, said that fresh thinking, institutional courage, strategic realism, and unambiguous country ownership were the only paths to success.
The board identified several “systemic intractable weaknesses” hobbling the programme, including “performance-blind funding mechanisms that provide resources regardless of outcomes; fragmented integration approaches that fail to leverage synergies with essential immunisation; lack of country ownership and transactional behaviour; and accountability systems that generate reports rather than consequences.”
To address these deep-rooted issues, a fundamental shift in strategy and accountability is proposed.
The IMB has suggested moving responsibility for stopping wild poliovirus in Pakistan and Afghanistan to the WHO Eastern Mediterranean Regional (EMRO) Ministerial Polio Subcommittee.
This, Mr Donaldson argued, could combat the persistent “perception that polio eradication is something ‘the West wants’ rather than a regional priority,” potentially reducing community hostility, boycotts, and security threats that have resulted in the deaths of polio workers and police officers, especially in Pakistan.
This proposal has now been formalised, as the polio oversight board adopted the 2026 GPEI Action Plan on Sunday.
In a post on X, Hanan Balkhy, the regional director for WHO-EMRO said the coming low transmission season offers the best chance to stop wild poliovirus in Afghanistan and Pakistan.
Mr Donaldson’s letter also pointed to a dramatically altered geopolitical landscape, citing major disruptions to the Global Polio Eradication Initiative.
“The United States withdrawal from WHO, the dismantling of USAID, and the severe curtailment of CDC’s global health mandate represent the most significant disruption in GPEI history,” Sir Donaldson stated.
It also noted that since the report was finalised, there had been two serious monsoon-related floods in different parts of Pakistan, an earthquake in Afghanistan, a child malnutrition crisis in Borneo and a potential peace settlement in eastern Democratic Republic of the Congo, which have changed the operating landscape for polio.
Pakistan’s claims challenged
The report also challenges Pakistan’s recent claims of progress. While Islamabad asserts it had interrupted polio transmission from 2021 to 2023, the IMB said this was likely an inadvertent result of Covid restrictions, that were “hostile to poliovirus spread”, rather than an outcome of programmatic improvements.
The operating environment for polio is constantly shifting. After the IMB meeting and as the report was being finalised, there were: two serious monsoon-related floods in different parts of Pakistan, an earthquake in Afghanistan, a child malnutrition crisis in Borno and a potential peace settlement in eastern Democratic Republic of the Congo.
A Pakistani polio expert, who spoke on the condition of anonymity, agreed with the IMB’s assessment, highlighting an absence of accountability, innovation, and integration.
“Interestingly, as usual, government’s ownership despite PM’s intense engagement has been questioned,” the expert said. “This IMB report questions the money and time spent against the targets and in midst of virus circulation and resurfacing has questions the viability of the program.”
As a solution, the expert suggested “shifting the management and ownership in real sense to the government, restructuring the program, integrating with EPI and holding the chronic poor performers to account at the high level can address the issues”.
Published in Dawn, September 22nd, 2025