Polio eradication in Africa: overcoming the final hurdles

Abstract

Africa's 2020 certification as free of wild poliovirus was a historic milestone and a testament to the Expanded Programme on Immunization (EPI), now marking its 50th year. Yet, as the EPI reflects on five decades of progress, circulating vaccine-derived poliovirus type 2 (cVDPV2) continues to threaten vulnerable populations. This perspective argues that Africa's polio endgame is not only about stopping cVDPV2 transmission but about reimagining eradication as a platform for resilient, equity-centered immunization systems for all vaccine-preventable diseases (VPDs). We highlight emerging challenges, including insecurity, mobility, vaccine hesitancy, COVID-19 disruptions, and climate-linked shocks that mirror broader weaknesses of the EPI, as seen in the resurgence of measles and other VPDs. We propose innovations that accelerated nOPV2 deployment, AI- and genomic-enabled surveillance, and equity-driven outreach to zero-dose children, not just as polio tools, but as models for the next 50 years of immunization in Africa. Through reframing polio eradication as a lever for system-wide resilience, Africa can deliver on its promise of a polio-free future while strengthening health security across the continent.