Overview
Global donors used a pledging event in Abu Dhabi on 8 December 2025 to commit US$1.9 billion to the Global Polio Eradication Initiative (GPEI), temporarily stabilizing a flagship global health campaign that is facing a 30% budget cut in 2026 and a multi‑year funding gap. The largest pledges — US$1.2 billion from the Bill & Melinda Gates Foundation and US$450 million from Rotary International — narrow the shortfall in GPEI’s 2022–2029 strategy to roughly US$440 million but do not fully close it. The event comes as wild poliovirus transmission has resurged in Afghanistan and Pakistan and vaccine‑derived polio continues to spark outbreaks in under‑immunized communities worldwide.
The Abu Dhabi pledges highlight a stark tension: the technical feasibility of eradicating polio versus an accelerating collapse in global health and development aid, driven by donor retrenchment in the United States, Germany, the United Kingdom and others. GPEI’s revised 2022–2029 plan requires US$6.9 billion to interrupt remaining wild poliovirus transmission by 2027 and eliminate type 2 variant poliovirus by 2029, yet donors had only provided about two‑thirds of that before Abu Dhabi. The coming years will test whether the world finishes the job of eradication or slips into a lower‑ambition, chronically underfunded model of “control” that risks future resurgences.
Key Indicators
People Involved
Organizations Involved
A public–private partnership launched in 1988 after the World Health Assembly resolved to eradicate poliomyelitis, coordinating global surveillance, vaccination campaigns and technical strategy.
The United Nations specialized agency for health, coordinating international responses to infectious diseases, setting standards and providing technical support to countries.
A major private foundation focused on global health, development and education, with polio eradication as a flagship priority.
A global network of 1.2 million members that has made polio eradication its top humanitarian priority since the 1980s.
A UAE-based philanthropic vehicle associated with President Sheikh Mohamed bin Zayed Al Nahyan, focused on humanitarian and global health initiatives.
Timeline
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Abu Dhabi pledging event secures US$1.9B for polio eradication amid looming budget cuts
FundingAt Abu Dhabi Finance Week, hosted by the Mohamed bin Zayed Foundation for Humanity, governments, philanthropies and global health leaders pledge US$1.9 billion to GPEI. Major contributions include US$1.2 billion from the Gates Foundation and US$450 million from Rotary. The pledges reduce GPEI’s 2022–2029 funding gap to about US$440 million, but the programme still faces a projected 30% budget cut in 2026 due to wider aid retrenchment.
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Gates Foundation warns of first rise in child deaths this century due to aid cuts
ContextThe Gates Foundation projects that under‑five deaths will increase by about 200,000 in 2025 compared with 2024, attributing the reversal to a roughly 27% drop in development assistance for health and warning that long‑term cuts could yield millions of additional child deaths.
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Pakistan launches campaign to vaccinate 57 million children against measles, rubella and polio
Operational ResponseIn response to rising polio and measles cases, Pakistan begins a nationwide campaign to vaccinate more than 57 million children, including administering oral polio drops to over 23 million, supported by WHO and other partners.
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Germany reverses polio funding cuts after virus found in Hamburg wastewater
Policy ReversalAfter detecting traces of wild poliovirus in Hamburg wastewater — the first such finding in Europe since 2010 — Germany partially reverses planned cuts to GPEI, adding €4 million to its 2026 contribution and citing the global nature of disease threats.
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WHO Europe warns of variant poliovirus in wastewater across six countries
WarningOn World Polio Day, WHO’s European office reports that type 2 variant poliovirus has been detected in wastewater in Finland, Germany, Israel, Poland, Spain and the United Kingdom since 2024, and vaccination coverage has declined, leaving over 450,000 babies unprotected in 2024 alone.
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Mid‑2025 data show continued environmental transmission despite limited cases
Public Health AssessmentThe 42nd IHR Emergency Committee notes 13 wild polio cases reported globally in the first half of 2025 but 275 positive environmental samples, mostly in Pakistan, indicating persistent transmission even as case counts fluctuate.
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WHO Emergency Committee flags four‑ to twelve‑fold rise in wild polio cases
Public Health AssessmentThe 41st IHR Emergency Committee on polio reports that wild poliovirus cases in 2024 increased more than four‑fold in Afghanistan and over twelve‑fold in Pakistan compared with 2023, with hundreds of positive environmental samples, and urges sustained vaccination and travel measures.
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Saudi Arabia confirms US$500M commitment to GPEI
FundingSaudi Arabia reaffirms a US$500 million pledge to GPEI, originally made in 2024, targeted at interrupting wild polio transmission in Afghanistan and Pakistan and controlling variant poliovirus outbreaks.
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Pakistan’s polio cases surge to 50 amid militant attacks on vaccinators
OutbreakBy November 2024, Pakistan reports 50 wild polio cases — up from six in 2023 — concentrated in conflict‑affected areas of Khyber Pakhtunkhwa and Balochistan. Militant attacks on polio workers and their security escorts, alongside large‑scale Afghan repatriations, complicate vaccination coverage.
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GPEI extends eradication deadline and expands budget to US$6.9B
Strategy ShiftFacing persistent wild poliovirus transmission and widespread vaccine‑derived outbreaks, GPEI announces that its eradication targets are pushed back to 2027 for wild polio and 2029 for variant type 2. The revised 2022–2029 strategy carries a budget of US$6.9 billion, of which about US$4.5 billion has been pledged, leaving a multi‑billion‑dollar shortfall.
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Polio Emergency Committee records rising 2024 wild polio cases
Public Health AssessmentWHO’s 39th IHR Emergency Committee notes an increase in wild poliovirus cases in Afghanistan and Pakistan in 2024, alongside continued spread of vaccine‑derived strains in parts of Africa, underscoring that eradication by 2026 is unlikely.
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Sharp rise in Pakistan environmental detections foreshadows resurgence
WarningThe 37th IHR Emergency Committee reports a large increase in wild poliovirus detected in Pakistan’s environmental surveillance in late 2023, despite only six reported human cases, raising concern that transmission is expanding under the radar.
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WHO polio Emergency Committee notes low case counts but warns of persistent risk
Public Health AssessmentThe 36th meeting of the IHR Emergency Committee on polio reviews data showing very low numbers of wild poliovirus cases in 2023 but rising environmental detections in Pakistan. The committee recommends maintaining the PHEIC status and strengthening vaccination in Afghanistan and Pakistan.
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Vaccine-derived polio detected in New York wastewater and paralytic case confirmed
OutbreakAn unvaccinated adult in Rockland County, New York develops paralytic polio caused by vaccine-derived poliovirus type 2. Wastewater surveillance in New York City and surrounding counties detects sustained circulation of related strains, highlighting the risk of importation into under‑vaccinated communities in high‑income countries.
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Berlin pledging moment secures US$2.6 billion for 2022–2026 polio strategy
FundingAt the World Health Summit in Berlin, Germany and WHO co-host a pledging event where governments and philanthropies commit over US$2.6 billion toward GPEI’s 2022–2026 strategy, including US$1.2 billion from the Gates Foundation and US$150 million from Rotary.
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Global polio burden reduced by more than 99%
MilestoneBy around 2000, the annual number of polio cases falls from an estimated 350,000 in 1988 to roughly 1,000–2,000, with endemic transmission eliminated from the Americas and most other regions.
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World Health Assembly launches Global Polio Eradication Initiative
Policy DecisionWHO’s World Health Assembly passes a resolution to eradicate poliomyelitis globally, leading to the creation of the Global Polio Eradication Initiative (GPEI), a partnership between WHO, Rotary International, CDC, UNICEF and others.
Scenarios
Gap Closed, 2027/2029 Targets Largely Met
Discussed by: GPEI leadership, WHO technical experts, pro‑eradication advocates in major media and policy forums
In this scenario, the remaining roughly US$440 million gap is closed over 2026–2027 through a mix of restored bilateral aid (e.g., partial reversals of cuts by European donors), increased Gulf and emerging‑market contributions, and additional philanthropic pledges. GPEI implements its 2026 Action Plan, focusing resources on high‑risk districts in Afghanistan and Pakistan and outbreak zones in Africa, while integrating polio campaigns with broader health services to build community trust. Wild poliovirus transmission is interrupted by around 2027, and type 2 variant poliovirus outbreaks are brought under control by 2029. The polio PHEIC is lifted in the late 2020s, and attention shifts to containment and legacy planning rather than crisis fundraising.
Chronic Underfunding Forces Triage and Further Delays
Discussed by: Independent public health researchers, some donor‑country officials, investigative reporting on polio programme weaknesses
Here, Abu Dhabi’s pledges prove to be a high‑water mark. Fiscal pressures and domestic politics in major donor countries prevent full closure of the gap, and the projected 30% budget cut in 2026 largely materializes. GPEI responds by concentrating staff and campaigns in a smaller number of ‘core’ districts while scaling back surveillance and outreach in lower‑priority areas. This triage limits explosive outbreaks but leaves many communities with thin immunization coverage and patchy wastewater monitoring. Wild polio cases in Afghanistan and Pakistan decline but do not reach zero by 2027, and variant poliovirus continues to spark sporadic outbreaks into the early 2030s. Eradication deadlines are quietly pushed back again, and fatigue grows among donors and affected populations alike.
Strategic Pivot From Eradication to Long‑Term ‘Control’
Discussed by: Skeptical global health economists, critics of the eradication paradigm, some donor finance ministries
If funding constraints worsen and political appetite for open‑ended commitments declines sharply, influential donors could push WHO and GPEI to formally reframe polio from an eradication campaign to a long‑term control programme, echoing the shift that ended the Global Malaria Eradication Programme in 1969. Under this model, the goal becomes minimizing disease burden rather than eliminating transmission everywhere. Polio activities are folded into routine immunization and primary care, with fewer dedicated campaigns and less intensive surveillance. This saves money in the short term but accepts a continuing trickle of cases, periodic outbreaks and the risk of major resurgences if coverage slips — particularly in fragile states. The move would be controversial within the global health community and could be seen as a betrayal of commitments made to frontline workers and affected countries.
High‑Profile Outbreak in a Wealthy Country Triggers Emergency Re‑Investment
Discussed by: Risk modelers, WHO and CDC officials referencing past New York and UK wastewater events
In this scenario, a sustained vaccine‑derived polio outbreak or a case of wild polio emerges in a high‑income country with pockets of low vaccination, similar to the 2022 paralytic case in New York State but on a larger scale. Widespread media coverage and political pressure in that country reframes polio from a distant problem to an immediate domestic threat. Governments that had cut back on WHO and GPEI contributions scramble to restore or exceed prior funding, and parliaments rapidly approve emergency appropriations. The financial picture for GPEI improves quickly, but only after costly and politically damaging outbreaks that could have been prevented with steadier funding and vigilance.
Historical Context
Smallpox Eradication Campaign
1967–1980What Happened
In 1967, WHO launched an intensified global smallpox eradication programme that combined mass vaccination with targeted ‘ring vaccination’ around detected cases. Over about a decade, coordinated surveillance and response removed smallpox from one region after another, and in 1980 the World Health Assembly certified the world free of smallpox after what WHO has described as a 10‑year effort involving half a billion vaccinations and relatively modest funding by today’s standards.
Outcome
Short term: Smallpox cases plummeted in the 1970s, and the last naturally occurring case was detected in Somalia in 1977. Eradication was formally certified in 1980, ending a disease that had killed an estimated 300 million people in the 20th century.
Long term: The programme became a template for later eradication efforts, including polio, demonstrating that a concerted, time‑bound global campaign can eliminate a human pathogen and yield massive economic benefits compared with indefinite control.
Why It's Relevant
Smallpox shows that eradication is achievable when technical tools, political will and predictable funding align — and that the final years of a campaign can be both the most fragile and the most cost‑effective. Proponents of finishing polio often cite smallpox’s relatively low programme cost and large annual savings as an argument against retreating now.
Global Malaria Eradication Programme (GMEP)
1955–1969What Happened
Encouraged by the success of DDT in reducing malaria, WHO launched the Global Malaria Eradication Programme in 1955, emphasizing standardized, vertically managed spraying campaigns. While malaria was eliminated in parts of Europe, North America and some other regions, many endemic countries faced operational challenges, vector and parasite resistance, and inadequate health infrastructure. As progress slowed and financial support from key donors — particularly the United States — waned in the 1960s, resurgences occurred and WHO formally suspended the eradication campaign in 1969, pivoting back to long‑term control.
Outcome
Short term: Malaria rebounded in many areas after spraying campaigns were scaled back, contributing to major epidemics in the 1970s and 1980s. International support for malaria programmes declined sharply during the same period.
Long term: The failure of GMEP led to a more cautious approach to eradication and underscored the importance of adaptable strategies, community engagement and resilient health systems. It remains a cautionary tale about the risks of over‑centralized campaigns and premature withdrawal of funding.
Why It's Relevant
Critics of continued polio eradication spending point to GMEP as evidence that eradication campaigns can become costly and unsustainable. Supporters of polio eradication counter that the lesson is not to retreat at the ‘last mile’ but to ensure that financing, governance and community engagement are robust enough to sustain gains, avoiding the kind of resurgence seen with malaria.
Guinea Worm (Dracunculiasis) Eradication Effort
1986–presentWhat Happened
Led by The Carter Center, WHO and national governments, the Guinea worm eradication campaign has reduced global cases from an estimated 3.5 million annually in the mid‑1980s to just a handful of human cases each year in the 2020s. Despite this success, the final phase has been described as the ‘most difficult,’ with residual transmission in a small number of African countries complicated by conflict, remote populations and animal reservoirs.
Outcome
Short term: By 2023–2024, global human cases number in the low double digits, but maintaining surveillance and community‑level interventions remains essential to prevent recrudescence.
Long term: Guinea worm is poised to become the next human disease eradicated after smallpox, but only if sustained funding and political attention persist until transmission is fully interrupted and certification achieved.
Why It's Relevant
Guinea worm illustrates how eradication campaigns can reach very low case numbers yet still require intense, long‑duration effort and funding to deal with ‘last mile’ challenges. It underscores the argument that cutting support just because incidence is low can jeopardize decades of investment — a risk directly analogous to today’s debates over polio financing.