A child reacts as he receives an injection during the nationwide vaccination campaign against measles, rubella and polio…
A child reacts as he receives an injection during the nationwide vaccination campaign against measles, rubella and polio targeting all children younger than 15 in Nkozi town, about 84 km from the capital Kampala, Uganda, Oct. 19, 2019.

WASHINGTON - Ending polio has been a long haul. The global campaign to eradicate the virus has been going on since 1988, and while it’s close, it’s not over. Sometime in 2020, Africa may be declared polio-free. But the disease is hanging on stubbornly in Pakistan and Afghanistan, and as long as it hangs on, it can spread around the globe.

The effort to end polio started more than 30 years ago. It’s been a massive program that relies on global funding, countless volunteer vaccinators, negotiations with political and religious leaders and parents. Vaccinators sometimes work in conflict zones, all to save lives and prevent lifelong disability.

Polio cases down 99.9%

In Kenya, facts about polio and the vaccine are taught in schools. Children are even taught what to tell their parents.

The international effort has seen the polio cases drop by 99.9%. Nigeria had its last case more than three years ago. It’s possible that next year Nigeria, and all of Africa, will be declared polio free.

Another victory: There used to be three strains of the virus. As of this week, there is now only one.

Afghan women wearing burqas from a polio immunization team walk together during a vaccination campaign in Kandahar, Oct. 15, 2019. Polio immunization is compulsory in Afghanistan, but distrust of vaccines is rife.

Pakistan-Afghanistan border

It is here, at the border between Pakistan and Afghanistan where the wild polio virus spreads. People are constantly crossing from one country to another, mostly to visit family members. Both countries saw cases increase in 2019 from the previous year. Oliver Rosenbauer is a spokesman for the World Health Organization. He spoke to VOA by Skype.

“The reality is that both countries are essentially one epidemiological block, and there is so much population movement. The same virus family is being ping-ponged back and forth across the border with population movements,” he said.

A second challenge concerns restrictions the Taliban have placed on vaccinators. The vaccine can only be given at immunization centers. Door-to-door immunizations are now banned.

WATCH: Another Partial Victory in Ending Polio

Program’s success

Still another challenge is a result of the program’s success. There are so very few cases in the two countries, the global program now has to address other urgent needs like access to clean water and better nutrition.

Carol Pandak, head of the PolioPlus program at Rotary International, says the partners in the Global Polio Eradication Initiative have always been able to adapt.

“UNICEF, in particular, has a strategy for both Afghanistan and Pakistan to provide these complimentary services, and Rotary, for many years now, has been working with Coca Cola in Pakistan, providing water filtration systems in some of these highest risk areas,” she said.

Those involved in the Global Polio Eradication Initiative have traveled a road that is longer and harder than was expected in 1988, when the program began. It’s far from over, but Rotary International, UNICEF, the World Health Organization, the Centers for Disease Control and Prevention, and the Bill and Melinda Gates Foundation, along with countless local and federal governments, and the vaccinators themselves have not given up.