Achievements and Obstacles in the Late Phase of the Global Polio Eradication Initiative.

Background: The Global Polio Eradication Initiative (GPEI), founded in 1988, has contributed to a drastic reduction in the number of cases of wild poliovirus (WPV) infection. Progress has stalled for years, however, even though the GPEI has become a very costly global health program. Poliomyelitis is caused by WPV types 1, 2, and 3, as well as by mutated vaccine viruses.

Methods: This review is based on publications retrieved by a selective literature search relating to challenges that currently face the GPEI, with an emphasis on the situation in Germany, e.g., the problem of maintaining the high rate of vaccination coverage.

Results: WPV1 remains endemic in Pakistan and Afghanistan. In addition, outbreaks caused by viral mutants of oral live polio vaccines (OPV) have become a problem in countries with low vac cination coverage, with several thousand cases since 2000. Industrialized countries have also had rare cases of poliomyelitis in recent years, caused by mutated vaccine viruses, which often circulate undetected. Aside from the dysfunctionality of the health care systems of many countries, geopolitical tensions, international and civil wars, mass human migration, hesitancy and skepticism of the population about vaccination, and funding fatigue on the part of donor countries, there are a variety of technical problems confronting the GPEI in its quest for success.

Conclusion: Maintaining high polio vaccination rates may be a more realistic solution to the problem of polio than continuing to pursue the GPEI's objective of putting all polioviruses out of existence. Doctors in Germany can actively contribute to the achievement of both these goals by checking the polio vaccination status of their patients, as recommended by the German Standing Committee on Vaccination (STIKO). This is especially important when doctors care for refugees and asylum-seekers who have arrived in Germany from abroad.