Overview

• Internal WHO audits over the past decade uncovered falsified vaccination records, untrained vaccinators and frequent cold-chain breaches in both countries.
• Experts caution that the live oral vaccine’s rare risk of paralysis and mutation can spark outbreaks where immunization coverage lags.
• Door-to-door campaigns continue to face deep cultural resistance, widespread misinformation and endemic poverty that hinder vaccination rates.
• The initiative’s roughly $1 billion annual budget is under pressure as donor patience wanes without clear progress in endemic regions.
• Health leaders and independent reviewers are demanding a shift to injectable vaccines, stronger accountability measures and a comprehensive strategy overhaul.