Europe faces growing risk of polio despite ongoing vaccination efforts

An unusually high amount of poliovirus detections in several European countries in recent months has underscored the importance of keeping Europe polio-free, according to an editorial by European Centre for Disease Prevention and Control (ECDC) Director Pamela Rendi Wagner and World Health Organization (WHO) Regional Director for Europe Hans Kluge, which was published on Eurosurveillance. 'A future without polio remains our goal, but it is by no means a certainty', warn Rendi-Wagner and Kluge.

'Every country must remain vigilant to detect the presence of polioviruses through sensitive surveillance systems, prepared to act quickly if any circulation is detected, and committed to sustain high vaccination coverage in every community every year until global polio eradication has been achieved,' said Kluge and Rendi-Wagner. This reiterates the path laid out in the European Immunization Agenda 2030, the GPEI Polio eradication strategy, and the Global Polio Surveillance Action Plan.

Ongoing risk highlighted by recent detections

While polio has been a threat to the health and wellbeing of children for centuries, it is a mostly forgotten disease for the vast majority of people in Europe. Thanks to successful vaccination programmes, extensive surveillance and outbreak response, Europe has been polio-free since 2002.

However, the virus will continue to be imported into Europe as long as it circulates globally. Pathogenic poliovirus has been detected in at least one country in Europe every year from 2015 through 2022. More worryingly, vaccine-derived poliovirus type 2 was detected in 2024 in the wastewater systems of 14 cities in 5 countries, namely in Spain, Poland, Germany, the United Kingdom, and Finland.

These viruses are linked to a lineage that was first detected in Nigeria in 2020, and which has travelled to other 21 countries in Africa, causing outbreaks in 15 of them. Genetic sequencing analysis indicates that before it had been detected in Europe, the virus had been circulating for a year elsewhere.

There is no evidence that there has been widespread circulation of the virus in Europe due to these importations. However, these may and do lead to outbreaks if people who are unvaccinated are exposed to the virus, as recently seen in Tajikistan, Ukraine, Israel and the United Kingdom.

Public health action urgently needed

Therefore, Rendi-Wagner and Kluge emphasise the need to maintain high national vaccination coverage across all populations. While the five countries that detected polio virus in 2024 have maintained high immunization levels, they have also reported disparities in some communities, which remain vulnerable to infection as a result. ECDC estimates that 2.4 million children in the EU/EEA may not have received the course of vaccinations required for protection between 2012-2021, with an additional 600 000 children who may have missed their vaccinations in 2022-2023.

ECDC has published a Rapid Risk Assessment on these detections recommending priority actions to be urgently taken to prevent and curb possible transmission of polioviruses. WHO Europe has also published guidance to help countries identify, address and track disparities in vaccination levels.

Kluge and Rendi-Wagner have also underlined their commitment to cooperate closely to support national and local public health authorities in their efforts to curb the virus. This support includes technical guidance and resources for surveillance and outbreak response, facilitating data exchange and genetic sequencing of virus strains, and assisting in targeted risk communication and community engagement strategies to improve vaccination coverage. 'Europe remains committed to do its part in the context of all relentless global efforts in this direction and has full capacity to do so successfully,' said Kluge and Rendi-Wagner.