The 43rd meeting of the Emergency Committee under the International Health Regulations (IHR or Regulations) on the international spread of poliovirus was convened by the WHO Director-General on 01 October 2025 with eight out of nine Committee members and the adviser meeting via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029. Technical updates were received about the situation in the following countries: Benin, Cameroon, Chad, Germany, Israel, and Pakistan. The Committee reviewed detailed written updates on the situation in Afghanistan.
Amendments to the IHR, adopted by the Seventy-seventh World Health Assembly, through resolution WHA77.17 in June 2024, entered into force on 19 September 2025 for 182 of 196 States Parties.[1] The 43rd meeting of the IHR Emergency Committee on polioviruses, held on 01 October 2025, was the first under the amended Regulations. Key amendments to the IHR include, inter alia, broader poliovirus notification requirements; the introduction of the determination of “pandemic emergency”[2], a higher level of global public health alert with respect to a public health emergency of international concern (PHEIC); measures to strengthen equitable access to relevant health products; and recognition of health documents in non-digital and digital formats.
Wild poliovirus
Since the last Emergency Committee meeting (18 June 2025), 15 new WPV1 cases have been reported from the two endemic countries, Afghanistan (2) and Pakistan (13). The cases in Afghanistan were reported from the South and East Regions of the country, while in Pakistan the cases were reported from Khyber Pakhtunkhwa and Sindh provinces. In 2025 (as of 17 September), 28 WPV1 cases have been reported: 4 in Afghanistan and 24 in Pakistan. This compares to 99 WPV1 cases reported in all of 2024. For environmental surveillance, a total of 443 WPV1 positive samples have been reported so far in 2025 (53 from Afghanistan and 390 from Pakistan), compared to 741 positive samples reported during all of 2024 (113 from Afghanistan and 628 from Pakistan).
The Committee noted with concern the ongoing WPV1 transmission in both endemic countries, particularly along the southern (South Afghanistan – Quetta Block) and central (Northwest Pakistan/South KP – Southeast Afghanistan) cross-border epidemiological corridors.
In Pakistan, WPV1 continues to be detected in environmental samples across all four major provinces. Transmission remains most intense in South Khyber Pakhtunkhwa (KP), as indicated by continued reporting of WPV1 cases and positive environmental isolates. Although Karachi in Sindh Province has not reported any WPV1 cases in 2025, ongoing detections in environmental samples indicate continued transmission within the city. A decline in both WPV1 cases and environmental detections has been observed in the Quetta Block and Peshawar. Active WPV1 transmission is also being detected in 2025 in Lahore, Punjab Province, and several districts within the Central Pakistan epidemiological block. In Afghanistan, intense transmission continues in the southern region, detected through both acute flaccid paralysis (AFP) and environmental surveillance. WPV1 transmission in Afghanistan’s eastern region has declined significantly in 2025, indicating improvement in population immunity levels.
Regarding molecular epidemiology, there has been an overall decrease in genetic biodiversity between 2020 and 2023. However, an increase in the genetic biodiversity was observed in 2024, necessitating a split of two genetic clusters into eight genetic clusters, three of which are active in 2025. The remaining chains of transmission continue to circulate in populations and geographies with persistently low immunization coverage, including the bordering districts of the southern and northern epidemiological corridors across the two endemic countries.
Afghanistan and Pakistan continue to implement an intensive and mostly synchronized campaign schedule, with a focus on achieving high vaccination coverage in core reservoirs and ensuring timely, effective response to WPV1 detections in other areas of each country. Afghanistan implemented two nationwide and three sub-national vaccination rounds while Pakistan implemented three nationwide and one sub-national vaccination during the first half of 2025.
In Afghanistan, campaigns are being conducted using the site-to-site strategy, with focused efforts to strengthen operational and communication approaches to maximize coverage of target children under this modality. House-to-house campaigns are not being implemented since October 2024 due to security concerns, limiting full campaign access to all the children. The Committee expressed concern that site-to-site campaigns often fail to reach all children, particularly younger children, which could contribute to further geographic spread within Afghanistan and beyond. In Pakistan, the programme is facing challenges in consistently and effectively reaching all target children in South KP, the area currently experiencing the most intense WPV1 transmission in the country; more than 250 000 children remain unreached, primarily due to access constraints caused by insecurity.
The Committee noted with appreciation the strong leadership and high-level commitment to polio eradication in Pakistan at all levels, including the direct engagement of the Prime Minister, the Federal Minister for Health, and the Prime Minister’s Focal Person for Polio Eradication. The Committee also acknowledged the consistently high reported coverage and Lot Quality Assurance Sampling (LQAS) pass rates at the national and provincial levels. However, the Committee observed variability in campaign quality at the district and sub-district levels, attributed to operational challenges and prevailing insecurity, particularly in Khyber Pakhtunkhwa, and Balochistan provinces. The Committee also noted the continued detection of WPV1 in Karachi despite high reported vaccination coverage during recent campaigns. Stopping WPV1 transmission will require translating Pakistan’s strong political and programmatic commitment into high-quality implementation of vaccination plans, in line with the recommendations of the Technical Advisory Group, during the upcoming low-transmission season. Particular focus will be needed on core reservoirs and areas of persistent transmission.
In addition to seasonal population movement within and between the two endemic countries, the ongoing return of undocumented migrants from Pakistan to Afghanistan continues to compound the programme’s operational challenges. This population displacement increases the risk of cross-border and internal poliovirus transmission in both countries. The Committee noted that this risk is being mitigated through vaccination at border crossing points and by updating micro-plans in areas of origin and return. The Committee also recognized the strong coordination mechanisms between the Afghanistan and Pakistan programmes at both national and subnational levels and encouraged the continuation of these collaborative efforts. It will be essential to maintain synchronized campaigns between Afghanistan and Pakistan and to achieve uniformly high vaccination coverage in border areas of both countries to interrupt WPV1 transmission in a comprehensive manner.
In summary, available data indicate that global WPV1 transmission remains geographically confined to the two endemic countries. However, during 2024 and 2025, there has been geographic spread alongside continued transmission within core reservoir areas in both the endemic countries.
Circulating vaccine derived polioviruses (cVDPV)
In 2025, a total of 143 cVDPV cases have been reported (as of 17 September), 136 of which are cVDPV2, five are cVDPV3 and two are cVDPV1 cases. Additionally, 141 environmental samples have tested positive for cVDPV, including 11 cVDPV1, 121 cVDPV2 and nine environmental samples that tested positive for both cVDPV1 and cVDPV2. In 2024, a total of 463 cVDPV cases were reported, including 448 cVDPV2, 11 cVDPV1, and 4 cVDPV3 cases. During the same year, 291 environmental samples tested positive for cVDPV, 288 cVDPV2 and three cVDPV3. Since the last Emergency Committee meeting, new cVDPV1 outbreaks have been reported in Algeria, Djibouti, and Israel. Recently, Cameroon and Chad have reported cVDPV3 outbreaks, while the 2024 cVDPV3 outbreak in Guinea has continued into 2025.
Nigeria and Chad in the Lake Chad Basin, along with Yemen and Ethiopia in the Horn of Africa, are the major contributors to the global cVDPV2 caseload in 2025. The Democratic Republic of the Congo and Somalia, which previously experienced intense cVDPV2 transmission, have shown a significant decline in transmission intensity in 2025. However, challenges persist in ensuring operational quality and reaching all children during polio vaccination campaigns.
A total of 20 circulating cVDPV2 emergence groups have been detected so far in 2025, compared to 31 in 2024, and 27 in 2023. Of the 20 emergence groups identified in 2025, five are newly detected this year: two derived from the novel OPV2 vaccine, while the origin of the other three is under investigation. Since its introduction in 2021, approximately 2 billion doses of nOPV2 have been administered and a total of 32 cVDPV2 emergences have been associated with nOPV2. The Committee noted that nOPV2 continues to demonstrate significantly greater genetic stability and a substantially lower risk of reversion to neurovirulence compared to Sabin OPV2.
In 2025, two cVDPV1 cases have been reported to date, one each from Algeria and the Democratic Republic of the Congo (DR Congo). In addition, cVDPV1 outbreaks have been confirmed in Djibouti and Israel, based on environmental surveillance detections (nine from Djibouti and ten from Israel).
Cameroon and Chad reported co-circulation of type 2 and type 3 cVDPV in 2025. The same cVDPV3 emergence caused outbreaks in both countries, with one cVDPV3 case in Cameroon (paralysis onset in May 2025) and two in Chad (onsets in June and July 2025). The cVDPV3 outbreak in Guinea, first detected in 2024, has continued into 2025. In total, Guinea reported six cVDPV3 cases during 2024–2025.
The Committee noted that although global transmission of cVDPV1 and cVDPV3 remains at lower levels compared to cVDPV2, the upward trend observed in 2025 is a concern. This underscores the critical importance of sustaining high population immunity against type 1 and type 3 polioviruses through robust routine immunization, as well as ensuring timely and high-quality response activities in the event of any detections.
The Committee noted that the risk of cVDPV outbreaks is largely driven by a combination of inaccessibility, insecurity, high concentrations of zero-dose and under-immunized children, and ongoing population displacement.
Conclusion
- The Committee unanimously concluded that the risk of international spread of poliovirus continues to constitute a Public Health Emergency of International Concern (PHEIC) and recommended extending the Temporary Recommendations for a further three months.
- The Committee, after a thorough review of the epidemiological and programmatic situation, unanimously concluded that the event does not constitute a pandemic emergency.
In reaching the conclusion that the risk of international spread of poliovirus continues to constitute a PHEIC, the Committee considered the following factors:
Ongoing risk of WPV1 international spread
The Committee noted that the risk of international spread of WPV1 persists due to the following factors:
- Re-established and intense WPV1 transmission in the core reservoirs, particularly in the southern region of Afghanistan and Karachi and South KP in Pakistan.
- Geographical expansion and established transmission of WPV1 in epidemiologically critical areas, including Central Pakistan and parts of Punjab Province.
- Persistent inconsistencies in campaign quality and a substantial number of unimmunized and under-immunized children in some key areas, driven by access constraints due to insecurity (e.g. South KP), sub-optimal operational performance (e.g. site-to-site vaccination modality in Afghanistan and uneven quality in parts of Pakistan), and vaccine hesitancy in certain communities (e.g. South KP, Quetta Block, Southeast Afghanistan), all contributing to gaps in the population immunity.
- Ongoing population movement between the two endemic countries, including the returnees from Pakistan to Afghanistan, leading to cross-border WPV1 transmission.
- Population movement from the two endemic countries to other neighbouring and distant countries, constituting risk of international spread.
Ongoing risk of cVDPV international spread
Based on the following factors, the risk of international spread of cVDPV appears to remain high:
- Continued cVDPV2 transmission in Lake Chad Basin, particularly in high-risk areas of Nigeria, with continued potential for amplification of spread.
- Intense cVDPV2 transmission in the Horn of Africa, especially in Ethiopia. The Horn of Africa countries continue to experience overlapping humanitarian and health emergencies, making it challenging to implement high-quality vaccination campaigns in a timely manner.
- A large pool of unimmunized and susceptible children in the northern governorates of Yemen, where a proper OPV response to the ongoing cVDPV2 outbreak has not yet been implemented due to insecurity and lack of access. Challenges also persist regarding timely shipment of AFP stool specimens from these areas. Full access to all children in southern and central Somalia also remains a significant challenge.
- A widening gap in intestinal mucosal immunity among young children since the global withdrawal of OPV2 in 2016, as well as high concentration of zero dose children in certain areas.
- New cVDPV1 outbreaks in Algeria, Djibouti, and Israel, and cVDPV3 outbreaks in Cameroon, Chad and Guinea indicate continued low routine immunization and IPV coverage in several countries and associated immunity gap. The risk of new and expanding cVDPV1 and cVDPV3 outbreaks appears to have increased in 2025.
- Ongoing cross-border transmission, including spread into newly re-infected countries and territories — with Cameroon and Chad reporting new cVDPV3 outbreaks, and Algeria, Djibouti, and Israel reporting new cVDPV1 outbreaks.
Additional contributing factors include:
- Sub-optimal routine immunization: Many countries have weak immunization systems that can be further impacted by humanitarian emergencies including conflict and protracted complex emergencies. This growing vulnerability leaves populations in fragile states at increased risk of polio outbreaks.
- Ongoing insecurity and conflict in several areas that serve as persistent source of cVDPV transmission.
- Lack of access: Inaccessibility remains a major risk, particularly in northern Yemen and Somalia, where sizable populations have remained unreached with polio vaccine for extended periods of more than a year.
- The current resource-constrained environment further challenges the full and effective implementation of critical eradication activities.
Risk categories
The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:
- States infected with WPV1, cVDPV1 or cVDPV3.
- States infected with cVDPV2, with or without evidence of local transmission.
- States previously infected by WPV1 or cVDPV within the last 24 months (last detection > 13 months).
Criteria to assess States as no longer infected by WPV1 or cVDPV:
- Poliovirus Case: 12 months after the date of onset of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
- Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period.
- These criteria may be varied for the WPV1 endemic countries and countries with longstanding persistent polio outbreaks, where more rigorous assessment is needed in reference to surveillance quality.
Once a country meets these criteria as no longer infected, the country will remain on a ‘watch list’ for a further 12 months as a period of heightened monitoring. After this period, the country will no longer be subject to Temporary Recommendations.
Temporary recommendations
States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread
(as of data available at WHO HQ on 04 June 2025)
WPV1
Afghanistan most recent detection 24 Aug 2025
Pakistan most recent detection 07 Aug 2025
cVDPV1
Algeria most recent detection 17 Mar 2025
DR Congo most recent detection 25 Jun 2025
Djibouti most recent detection 04 May 2025
Israel most recent detection 09 Jul 2025
cVDPV3
Cameroon most recent detection 30 May 2025
Chad most recent detection 22 Jul 2025
Guinea most recent detection 07 Mar 2025
These countries should:
- Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
- Ensure that all residents and longterm visitors (> four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
- Ensure that those undertaking urgent travel (within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
- Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in accordance with the Model International Certificate of Vaccination or Prophylaxis (ICVP), contained in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination. It is noted that, in accordance with resolution WHA77.17, ICVP issued after 19 September 2025 (date of entry into force of the amendments) by States Parties to which the amendments apply shall conform to the amended Model ICVP contained in Annex 6.
- Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of transport (road, air and/or sea).
- Further enhance crossborder efforts by significantly improving coordination at the national, regional, and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk crossborder populations. Improved coordination of crossborder efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
- Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication. Countries which have not yet introduced a second dose of IPV into their routine immunization schedules should urgently implement this. Once available, countries should also consider introducing the hexavalent vaccine, now approved by Gavi.
- Ensure a high-quality surveillance network that provides equitable coverage of all populations, enabling timely detection of new poliovirus isolates and effective monitoring and response to evolving epidemiological trends.
- Ensure that both routine and supplementary immunization activities reach all geographies and populations equitably, aiming to achieve uniformly high population immunity and protect all children from poliovirus paralysis. The GPEI and other relevant international health partners should support countries in ensuring fair and timely access to recommended polio vaccines through established global mechanisms.
- Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high-quality eradication activities in all infected and high-risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
- Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.
States infected with cVDPV2, with or without evidence of local transmission:
(as of data available at WHO HQ on 17 September 2025)
- Algeria most recent detection 21 Jul 2025
- Angola most recent detection 17 Jul 2025
- Benin most recent detection 12 Jun 2025
- Burkina Faso most recent detection 30 Mar 2025
- Cameroon most recent detection 07 Apr 2025
- Central African Republic most recent detection 21 Jun 2025
- Chad most recent detection 05 Aug 2025
- Côte d’Ivoire most recent detection 06 Feb 2025
- Democratic Republic of the Congo most recent detection 16 May 2025
- Djibouti most recent detection 04 May 2025
- Ethiopia most recent detection 05 Jun 2025
- Finland most recent detection 19 Nov 2024
- Germany most recent detection 28 Jul 2025
- Ghana most recent detection 20 Aug 2024
- Israel most recent detection 11 Feb 2025
- Niger most recent detection 18 Apr 2025
- Nigeria most recent detection 24 Jul 2025
- occupied Palestinian territory (oPt) most recent detection 05 Mar 2025
- Papua New Guinea most recent detection 11 Jul 2025
- Poland most recent detection 21 Jan 2025
- Senegal most recent detection 05 Mar 2025
- Somalia most recent detection 04 Aug 2025
- South Sudan most recent detection 03 Dec 2024
- Spain most recent detection 16 Sep 2024
- Sudan most recent detection 16 Apr 2025
- The United Kingdom of Great Britain
and Northern Ireland most recent detection 20 Jan 2025 - United Republic of Tanzania most recent detection 18 Aug 2025
- Yemen most recent detection 27 Jul 2025
States that have had an importation of cVDPV2 but without evidence of local transmission should:
- Officially declare, if not already done, at the level of head of state or government, that the prevention or interruption of poliovirus transmission is a national public health emergency.
- Undertake urgent and intensive investigations and risk assessment to determine if there has been local transmission of the imported cVDPV2, requiring an immunization response.
- Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, Members States should request vaccines from the global novel OPV2 stockpile.
- Further intensify efforts to increase routine immunization coverage, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication. Countries which have not yet introduced a second dose of IPV into their routine immunization schedules should urgently implement this. Once available, countries should also consider introducing the hexavalent vaccine, now approved by Gavi.
- Intensify surveillance for polioviruses and strengthen regional cooperation and cross-border coordination to ensure the timely detection of poliovirus.
- Ensure a high-quality surveillance network that provides equitable coverage of all populations, enabling timely detection of new poliovirus isolates and effective monitoring and response to evolving epidemiological trends.
- Ensure that both routine and supplementary immunization activities reach all geographies and populations equitably, aiming to achieve uniformly high population immunity and protect all children from poliovirus paralysis. The GPEI and other relevant international health partners should support countries in ensuring fair and timely access to recommended polio vaccines through established global mechanisms.
States with local transmission of cVDPV2, with risk of international spread, in addition to the above measures, should:
- Encourage residents and longterm visitors (> four weeks) to receive a dose of IPV four weeks to 12 months prior to international travel.
- Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
- Intensify regional cooperation and crossborder coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and crossborder populations.
For both sub-categories:
- Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.
- At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
- Provide to the Director-General a regular report on the implementation of the Temporary Recommendations.
States no longer polio infected, but previously infected by WPV1 or cVDPV within the last 24 months(as of data available at WHO HQ on 17 September 2025)
WPV1
country last virus date
cVDPV
country last virus date
- Egypt cVDPV2 01 Aug 2024
- Equatorial Guinea cVDPV2 26 Mar 2024
- France (French Guiana) cVDPV3 06 Aug 2024
- Gambia cVDPV2 15 Feb 2024
- Guinea cVDPV2 12 Jun 2024
- Indonesia cVDPV2 10 Jul 2024
- Kenya cVDPV2 31 Jul 2024
- Liberia cVDPV2 08 Jun 2024
- Mali cVDPV2 02 Jan 2024
- Mauritania cVDPV2 13 Dec 2023
- Mozambique cVDPV1 17 May 2024
- Sierra Leone cVDPV2 28 May 2024
- Republic of Congo cVDPV2 07 Dec 2023
- Uganda cVDPV2 07 May 2024
- Zimbabwe cVDPV2 25 Jun 2024
These countries should:
- Urgently strengthen routine immunization to boost/maintain population immunity.
- Enhance surveillance quality, including considering introducing or expanding supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high-risk and vulnerable populations.
- Intensify efforts to ensure vaccination of mobile and crossborder populations, Internally Displaced Persons, refugees, and other vulnerable groups.
- Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high-risk population groups.
- Maintain these measures with documentation of full application of high-quality surveillance and vaccination activities.
Additional considerations and recommendations
The Committee noted that the Global Polio Eradication Initiative (GPEI) has developed an Action Plan aimed at sustaining and enhancing programme operations to achieve the goals of the GPEI Strategy, within the limits of available resources. The Committee appreciated the comprehensive and consultative process undertaken by the GPEI in formulating the plan. However, the Committee expressed concern that the current financial shortfall, estimated at nearly 30%, poses a significant risk to all components of the programme, including the ability to maintain sensitive poliovirus surveillance. These risks are further compounded by concurrent funding constraints across WHO, international partners, and national governments, reflecting wider fiscal pressures across the global health landscape. The Committee therefore urged donor countries and partner organizations to strengthen their financial support, emphasizing that the consequences of underfunding could be substantial and far-reaching. The Committee also called on national governments to prioritize polio eradication within their domestic frame mechanisms to safeguard the gains made and sustain progress toward global eradication.
The Committee emphasized the critical importance of robust monitoring of the implementation of the GPEI Action Plan to enable early identification and timely mitigation of emerging risks and gaps. This monitoring should comprehensively cover all programme components, including immunization activities as well as field and laboratory surveillance.
The Committee noted that WPV1 transmission has persisted with a generally high force of infection in the two endemic countries during the high transmission season. While transmission remains widespread, it continues to be driven by core reservoirs and persistent transmission zones—particularly South Khyber Pakhtunkhwa and Karachi in Pakistan, and the Southern Region of Afghanistan. The Committee recognized that the current momentum of the Pakistan programme, together with the forthcoming low transmission season, presents a critical opportunity to interrupt WPV1 transmission during the first half of 2026. Achieving this goal will depend heavily on progress in South Khyber Pakhtunkhwa, Karachi, and Southern Afghanistan. The Committee urged the Afghanistan polio programme to explore feasible options for transitioning to house-to-house vaccination, noting that site-to-site campaigns have not yet achieved the level of coverage and quality required for eradication.
The Committee emphasized the need for a comprehensive, whole-of-government approach in both endemic countries, extending to the district level, to achieve the quality required in polio eradication activities to stop WPV1 transmission. Such an approach is more critical than ever to sustain global confidence and continued support for the polio eradication effort.
The Committee noted the continued transmission of cVDPV2 in the African Region, particularly in the Lake Chad Basin and the Horn of Africa. While the overall number of cVDPV2 cases has declined over the past two years, the Committee expressed concern about ongoing transmission in Algeria, Angola, Chad, Ethiopia, and Nigeria. Although Nigeria has recently reported a decrease in cVDPV2 cases, transmission persists in several critical areas, posing a risk to the progress achieved elsewhere in the country. In Somalia, a downward trend in cVDPV2 detections appears to be emerging; however, given the persistent challenges in accessing children in south and central Somalia, this must be interpreted with caution, and heightened vigilance must be maintained. The Committee also acknowledged the ongoing difficulties in implementing immunization responses in the northern governorates of Yemen, where cVDPV2 transmission continues.
The Committee noted the initiation of vaccination activities in response to the cVDPV2 outbreak in Papua New Guinea. Given the very low population immunity against type 2 poliovirus, the Committee emphasized the need to ensure high-quality implementation of the vaccination response. The Committee stressed that urgent measures are required to strengthen surveillance, including addressing silent areas for acute flaccid paralysis (AFP) surveillance, to minimize the risk of undetected cVDPV2 circulation and to effectively monitor progress.
Although the risk of international spread of cVDPV1 and cVDPV3 is considerably lower than that of cVDPV2, the Committee expressed concern over the recent cVDPV1 outbreaks in Algeria, Djibouti, and Israel, and the cVDPV3 outbreaks in Cameroon, Chad, and Guinea, which warrant continued vigilance. These outbreaks highlight the existence of population pockets with low immunity to type 1 and type 3 polioviruses and underscore the need to strengthen routine immunization. The Committee recommended ensuring high-quality response to these outbreaks to prevent further geographical spread.
The Committee noted that many countries affected by cVDPV continue to experience conflict and insecurity, disrupting both routine immunization services and polio vaccination campaigns. The Committee also noted that concurrent health emergencies and disease outbreaks in several countries further complicate the timely and effective implementation of vaccination response. Acknowledging the diverse and often complex operating environments at national and sub-national levels, the Committee emphasized the importance of context-specific operational and social mobilization interventions to ensure high-quality campaign delivery and ultimately interrupt cVDPV transmission. The Committee also highlighted the need for coordinated sub-regional strategies and strengthened cross-border collaboration to overcome challenges posed by porous borders and shared operational constraints across the polio outbreak affected countries.
The Committee noted the continued cross-border spread of cVDPV2 in the African and Eastern Mediterranean Regions, the detection of cVDPV2 in multiple countries of the European Region, and the detection of cVDPV2 in Papua New Guinea linked to the 2024 transmission in Indonesia. The Committee also noted the shared cVDPV3 transmission in Chad and Cameroon. These developments underscore that polio remains a global threat until eradication is fully achieved. The Committee emphasized the critical importance of maintaining sensitive surveillance systems in polio-affected and high-risk countries and recommended that the GPEI provide all necessary support under the Global Polio Surveillance Action Plan. The Committee underscored the importance of preserving the capacity of the Global Polio Laboratory Network to continue supporting eradication efforts through timely and accurate detection of polioviruses. The Committee noted the need for high-income countries to sustain high-quality poliovirus surveillance, given the persistent risk of importation, as recently demonstrated by detections in the European Region. Robust surveillance remains essential for early detection and timely response to both importations and newly emerging outbreaks. The Committee recommended that programme messaging on the international spread of polioviruses be tailored to the specific context and setting, including ensuring appropriate communication in high-income countries, with the aim of fostering understanding and sustained support for global polio eradication efforts.
The Committee recognized the critical role that mobile and migrant populations play in sustaining WPV1 transmission in endemic countries, as well as cVDPV transmission in the African Region and globally. The Committee urged that vaccinating populations on the move be treated as a top priority, emphasizing the importance of identifying different categories of mobile populations such as seasonal, economic, and agricultural migrants, and reaching them through country-specific, tailored strategies and approaches.
The Committee noted that novel OPV2 continues to demonstrate greater genetic stability compared to Sabin OPV2. However, the risk of new cVDPV2 emergences increases when the interval between outbreak response campaigns exceeds four weeks or when vaccination quality is suboptimal, underscoring the need for timely and high-quality immunization efforts.
The Committee noted that the amendments to the IHR, adopted by the Seventy-seventh World Health Assembly through resolution WHA77.17, entered into force on 19 September 2025 for 182 of the 196 States Parties. The Committee took the amended International Health Regulations into account during its deliberations and in reviewing and advising on the Temporary Recommendations.
Based on the current situation regarding WPV1 and cVDPVs, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment, and on 10 November 2025 determined that the poliovirus situation continues to constitute a public health emergency of international concern (PHEIC) with respect to WPV1 and cVDPV. The poliovirus situation, however, does not constitute a pandemic emergency.
The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States previously infected by WPV1 or cVDPV within the last 24 months’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective, 10 November 2025.
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[1] The text of the International Health Regulations (2005), as amended in 2014, 2022 and 2024 is available at https://apps.who.int/gb/bd/pdf_files/IHR_2014-2022-2024-en.pdf [accessed on 21 October 2025].
[2] Under amended Article 1 of the IHR, “pandemic emergency” is defined as “a public health emergency of international concern that is caused by a communicable disease and:
(i) has, or is at high risk of having, wide geographical spread to and within multiple States; and
(ii) is exceeding, or is at high risk of exceeding, the capacity of health systems to respond in those States; and
(iii) is causing, or is at high risk of causing, substantial social and/or economic disruption, including disruption to international traffic and trade; and
(iv) requires rapid, equitable and enhanced coordinated international action, with whole-of government and whole-of-society approaches.