Health infrastructure poses another big hurdle, says Grassly. Delivering the vaccine in clinics instead of door to door will pose a challenge for Nigeria, which has one of the lowest rates of routine immunization in the world. Less than 50% of children receive a complete schedule of childhood vaccinations, and in parts of northern Nigeria that figure is around 10%.
“We as a global community have to do a much better job of integrating polio and routine immunization,” says Zulfiqar Bhutta, an immunization expert at Aga Khan University in Karachi, Pakistan, and a member of the WHO committee that issued the new vaccination policy. He sees the eventual switch to inactivated vaccines as an opportunity to align polio eradication with routine immunization. “We should have done this a lot earlier,” he says.