In 1985, the Pan American Health Organization (PAHO) set the goal of regional elimination of polio from the Americas by 1990. At the 41^st World Health Assembly in 1988, the World Health Organization (WHO) adopted the goal to eradicate polio by the end of 2000. In 1991, the last case of wild poliovirus in the Americas was isolated in Peru and by 1994 the WHO declared the Western Hemisphere free of wild poliovirus. Now in the year 1999, polio transmission has been interrupted in the Western Pacific Region, including China, however, three regions continue to serve as global reservoirs.

1. South East Asia Region (SEAR) - Afghanistan, Bangladesh, Democratic People's Republic (DPR) Korea, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Sri Lanka, and Thailand
2. African Continent - West and Central Africa: Democratic Republic of Congo and Nigeria, Horn of Africa: Ethiopia, Somalia, and Sudan
3. Eastern Mediterranean Region (EMR) - Bordering areas of Turkey, Iraq, Iran, and Syria

• High routine immunization with OPV
• Supplementary, additional doses of OPV through National and Sub-National Immunization Days (NIDs and SNIDs)
• Mopping-up (house-to-house) immunization activities
• Enhanced surveillance for all cases of acute flaccid paralysis (AFP) and wild poliovirus

According to a speech given by Dr. Gro Harlem Brundtland, Director - General of WHO, in February 1999, "Thanks to steady progress in vaccination, we are on the brink of eradicating this crippling disease - with an ambitious target of eradication by the end of next year."

Despite major progress in eliminating polio from many regions of the world, global eradication remains a formidable task. The areas of SEAR, Africa, and EMR continue to remain global reservoirs of wild poliovirus because factors including political unrest, armed conflict, civil strife, and economic crisis have caused a breakdown in health infrastructure. As a result, immunization coverage and AFP/wild poliovirus surveillance in these regions continue to remain at extremely low levels. This situation is further complicated by the fact that many of the countries in these regions contain large, remote, refugee populations that are extremely difficult to monitor and administer the three rounds of OPV required to instill lasting immunity.

Moreover, these three regions that serve as global polio reservoirs spread the virus to neighboring countries that already have established good immunization coverage, thus making it extremely difficult for these countries to become polio free.

Due to extremely high operational costs of vaccination programs coupled with the weak economies of these countries, the majority of funding will need to come from external sources. The WHO stated that an estimated US $370 million in addition to funds that have already been secured, is required to complete the polio eradication campaign.

To many of these endemic countries, polio is just one of the many pressing health problems including pneumonia, diarrheal diseases, malaria, AIDS, that are adversely affecting their countries. As a result, polio may be viewed as a disease that now only affects a small number of people and governments must use limited funds to address more prevalent diseases.

The eradication of polio is heavily dependent on environmental factors that influence the countries in these regions. Continued political instability and poor health infrastructure will prolong the process of establishing good immunization coverage and adequate surveillance.

In response to these challenges, the WHO's Technical Consultation Group (TCG) established four specific priorities for the global eradication of polio:

1. Need to conduct additional NIDs and SNIDs in 1999, post dedicated surveillance personnel in major reservoir countries, and strengthen routine Expanded Program on Immunization (EPI).
2. In countries affected by conflict, the formation of 'eradication teams' is imperative to conduct supplementary immunizations (2^nd and 3^rd doses of OPV) and to establish alternative supplemental surveillance for AFP.
3. In remaining endemic countries, increased and expanded surveillance, mopping-up, and supplementary activities are needed to eliminate final chains of transmission of wild poliovirus.
4. Advocacy for full funding of eradication activities

Ultimately, as in the case with small pox eradication, enormous external human and financial resources are necessary to effectively implement these strategies. If sufficient funds can be obtained from WHO, UNICEF, Rotary International, and the governments of Australia, Canada, Denmark, Japan, UK, the US, and other agencies, then sufficient doses of OPV, personnel, laboratories, and logistics can be obtained. With these resources, an increased immunization and surveillance can begin in these endemic areas. Depending on how soon these resources are acquired will determine when polio will be eradicated. Many believe that this goal will be realistically accomplished by 2005, however, it remains to be seen. If polio is eradicated, the world would save an estimated US $1.5 billion annually in vaccination costs.