85% of polio-affected children in 2023 lived in conflict-affected zones - UNICEF

Of the 541 children affected by polio globally in 2023, 85 per cent live in the 31 fragile, conflict-affected, and vulnerable countries, according to a new UNICEF analysis on World Polio Day.

Polio cases in these settings have more than doubled in the past five years, while routine childhood immunization has dropped from 75 to 70 per cent – well below the 95 per cent needed for community immunity.

The data issue a stark warning that the life-threatening disease continues to thrive in areas where life is most precarious, and where conflict, natural disasters, humanitarian crises, other destabilizing factors make it difficult to deliver critical healthcare.

“In conflict, children face more than bombs and bullets; they are at risk of deadly diseases that should no longer exist,” said UNICEF Executive Director Catherine Russell.

“In many countries, we are witnessing the collapse of healthcare systems, destruction of water and sanitation infrastructure, and the displacement of families, triggering a resurgence of diseases like polio. Children are being left paralyzed, unable to walk, play, or attend school."

A global decline in childhood immunization has also led to an increase in polio outbreaks, including in countries that had been polio-free for decades.

Nowhere is this more evident than in conflict-affected areas, with 15 out of 21 such countries – including Afghanistan, Democratic Republic of Congo, Somalia, South Sudan, and Yemen – currently battling polio.

In recent months, UNICEF and partners have intensified emergency responses to surges in polio outbreaks. In Gaza, for example, UNICEF, in partnership with WHO, reached nearly 600,000 children under 10 years during the first round of a polio vaccination campaign in mid-September.

The second and final round has been successfully implemented in south and central Gaza, but renewed mass displacement and bombings have delayed the process in the north. The campaign follows the return of polio to Gaza for the first time in 25 years.

In Sudan, national childhood vaccination coverage plummeted from 85 per cent before the war to 53 per cent in 2023, while in active conflict zones, the coverage has dropped to just 30 per cent.

In response, UNICEF and partners have led two emergency polio campaigns in recent months, reaching 2.9 million children under 5 years through house-to-house vaccinations.

Successful polio vaccination campaigns in fragile, conflict-affected, and vulnerable countries are critical to stopping further cases and protecting children who are already vulnerable.

Humanitarian pauses are essential to ensure healthcare workers can reach children and deliver vaccines safely.

The battle against polio is hardest in the most challenging places, but eradication is within reach. UNICEF, which delivers over 1 billion doses of polio vaccines annually – the largest share of its global vaccine deliveries – urges governments, partners, and donors to:

• Prioritize vaccination of all children against polio, especially in conflict and humanitarian settings and in countries with low immunization coverage across Africa and parts of Asia. 
• Strengthen immunization systems to ensure all children receive essential, lifesaving vaccines.
• Protect humanitarian and healthcare workers delivering vaccines, and respect essential humanitarian pauses needed for campaign success.
• Provide critical resources to the Global Polio Eradication Initiative and Gavi, the Vaccine Alliance, to quickly halt outbreaks and ensure children are vaccinated.
• Elevate polio eradication on political agendas at all levels, prioritizing innovative solutions and coordinated actions to enhance the quality of immunization campaigns.

“The spread of polio not only puts children in affected countries at immediate risk but also poses a growing threat to neighbouring countries,” added Russell.

“The final push is the hardest, but now is the time to act. We cannot rest until every child, in every corner of the world, is safe from polio – once and for all.”

The current polio outbreak in Kenya is being driven by a combination of factors: the COVID-19 pandemic halted many routine vaccination services, and  the health system is still recovering.

Immunization programmes in Kenya are also impacted by climate change, with cyclical drought and flooding displacing of children and their families, and destroying health centres where routine immunization services are delivered.

Population movement and immigration from the long-lasting conflicts in Somalia and South Sudan, together with congestion in refugee camps such as Dadaab and Kakuma, lead to the prolonged circulation of polio.

Poor hygiene and sanitation in the camps make this worse since the virus is spread through oral and nasal secretions and contact with contaminated feces.

These interconnected factors all mean that the virus is much more able to spread, and there is a potential risk for it to keep spreading even further to other high-risk, under-immunised communities.

On World Polio Day, UNICEF Kenya Representative Shaheen Nilofer said UNICEF is fully committed to supporting the Government of Kenya’s National Immunisation Programme, which has maintained an average vaccine coverage rate of 85 % to reach the 88% vaccination target.

“We have made great strides in Kenya towards eradicating polio, but we must do more. We must reach the last 1%. No one is safe unless everyone is safe. We have a plan to address the threat of polio, and the plan is simple and safe: We must vaccinate all children against polio,” said Ms. Nilofer.