USAID and CDC Halt of Support to Global Polio Eradication Threatens Worldwide Campaign
Infectious Diseases 07/02/2025 •
A Pakistani health worker administers a polio vaccine at a girl’s home. Door-to-door campaigns are critical to eradicating poliovirus in under-vaccinated regions.

The disengagement of both USAID and the US Centers for Disease Control (CDC) from the WHO-led global polio eradication initiative, threatens efforts in the world’s poorest countries with about  $233 million more in a year in budget shortfalls, WHO’s Regional Director for the Eastern Mediterranean Region, Hanan Balkhy, said on Friday. 

This, in a year when polio cases increased by 283% in Afghanistan and by 550% in Pakistan in 2024, as compared to 2023. Vaccine-derived polio cases also were reported in 35 other African, Asian and Middle Eastern countries, as well as in Spain in 2024. The US also reported 31 cases in 2022.

Distribution of polio cases around the world as of July 2024.

“The disengagement of CDC and USAID is costing us already with the loss of their technical, strategic and functional support,” Balkhy told the WHO Executive Board in a session on Friday, devoted to progress on polio eradication, led by WHO jointly with the Global Polio Eradication Initiative (GPEI).

“In financial terms, this [the US suspension of support] means a loss of $133 million to the GPEI, and a loss of $100 million for the WHO each year,” said Balkhy.  She noted that the GPEI already faces a funding shortfall of $2.4 billion for its current five-year strategic plan that has been extended to 2029 – the new target date for wild poliovirus eradication. 

While it remains unclear if the US pause in funding for GPEI, a public-private partnership with heavy US involvement, will become permanent, prospects are not bright, in light of the oft-expressed vaccine skepticism of Robert F Kennedy Jr, the nominee for US Secretary of Health and Human Services. Although Kennedy declared in December he is “all for the polio vaccine”, he has a long history of expressing unsubstantiated doubts about the vaccine – and vaccines more generally.   

And as secretary of HHS, Kennedy would also oversee the US CDC’s engagements in global health. Kennedy’s nomination by US President Donald Trump is likely to come before the full Senate next week for approval, after he cleared the Senate Finance committee on Tuesday.   

GPEI, which was launched in 1988 as a semi autonomous programme, is co-led by WHO with Rotary International and the US CDC, along with UNICEF, the Gates Foundation, and Gavi, The Vaccine Alliance.  

Conflict and political instability – other factors 

Hanan Balkhy, WHO Director of the Eastern Mediterranean region, describes polio eradication challenges at the WHO EB on Friday.

WHO’s Eastern Mediterranean Region, which extends from North Africa to Pakistan,  is the only remaining region with endemic wild poliovirus still being transmitted amongst young children who have not been reached by vaccines. 

“As 2024 began, we were on the verge of eradicating wild poliovirus in Afghanistan and Pakistan, the last two polio endemic countries,” said Balkhy. 

“But then came a resurgence, alongside outbreaks of variant poliovirus in Somalia, Sudan, Yemen and the Gaza strip,” she observed, referring to vaccine-derived poliovirus strains that may be accumulate and mutate in untreated waste, and then be transmitted to children in populations with low-levels of background vaccine immunity.  

As of September 2024, a total of 40 wild poliovirus cases had been reported (21 cases from Pakistan and 19 from Afghanistan) as compared with only 12 cases in 2023, according to the WHO report before the EB.  By the end of the year, a total of 64 cases had been reported in the two nations.     

“This represents a 283% increase in paralytic cases in Afghanistan and a 550% increase in Pakistan compared to all of 2023,” stated WHO in December, 2024.

Endemic transmission is concentrated in high-risk districts of the southern area of Khyber Pakhtunkhwa province in Pakistan, and bordering areas of Afghanistan’s eastern region. 

While the “genetic diversity of wild poliovirus type 1” remains at a historic low, the increased detection of the virus outside the endemic districts points to a “heightened risk of re-establishment of poliovirus transmission in historic reservoirs, notably the southern region of Afghanistan, and the Karachi, Peshawar-Khyber and Quetta blocks in Pakistan,” the WHO reported added, noting that virus spread is exacerbated by population movements in border areas.

USAID cutbacks hit at female health workers in Afghanistan

Snapshot of USAID fact sheet on its work in Afghanistan before it was removed last week.

“I was privileged to visit Afghanistan and Pakistan twice last year, and Gaza as well,” Balkhy said. “I saw amazing work by the front line health workers in Afghanistan and Pakistan. We need to strengthen their capacity so they can do even more.”

In both countries, one of the most effective tactics in polio eradication in that region is house-to-house vaccination campaigns, the WHO report also notes. 

But the same USAID program cuts have also hit hard at US initiatives training female health workers in countries such as Afghanistan. Women are particularly critical to polio outreach in cultures where mothers of young children cannot receive male health workers in their homes. 

According to one USAID factsheet, published in January 2025, the agency had supported some 2,396 health facilities, employing over 10,000 female health workers over the past year.  

But the publication has now been removed from the agency’s website in the mass shutdown of USAID data by the new Trump administration, and replaced with the USAID  notice placing 95% of its employees worldwide on leave.

Blackout notice that has replaced thousands of USAID webpages and documents on its global health activities, including to combat poliovirus in Afghanistan

Gaza shows it can be done

Polio campaign gets unmderway in northern Gaza on 10 September, the third phase of the staged outreach.

The successful poliovirus vaccine campaign that took place last year in Gaza, during an active conflict, is evidence that ‘zero-dose’ children can be reached through poliovirus outreach can succeed when funding and political support exist, Balkhy added. Both Hamas and Israeli authorities cooperated in the campaign with humanitarian pauses to ensure healthworkers could reach children under the age of 10, who were targeted in the campaign. 

“Our strategy remains straightforward, vaccinate every child and keep up a robust search of poliovirus to stop further spread. Achieving this is far from simple. Afghanistan and Pakistan face immense geopolitical infrastructure, environmental and security challenges, but none of these challenges are insurmountable,” Balkhy said. 

“In Gaza, during a humanitarian pause, last year, over 560,000 children were vaccinated against polio thanks to who led multi actor, multi level coordination and the courage of communities and health workers. If we did it in Gaza, we can do it anywhere.

“At this crucial stage for the eradication efforts with diminishing resources, we are doing our part….We need the international community’s steadfast support to help us across the finish line. Let us make sure that every last child is vaccinated, only then will polio be eradicated.” 

Image Credits: Pakistan Polio Eradication Program , GPEI, USAID , WHO.

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