While many state Medicaid programs cover aspects of gender-affirming health services for adults, only Maine and Illinois reported covering five standard gender-affirming services in 2021: hormone therapy, gender-affirming surgery, mental health counseling related to gender-affirming care, voice and communication therapy, and fertility assistance for adult transgender enrollees, according to a KFF survey. Nine states, including Michigan, Connecticut, and Colorado, reported covering four of the five services. Alabama and Texas reported not covering any of these services under Medicaid.

The survey of states on coverage of sexual and reproductive health services for adult enrollees was conducted in Summer 2021. Forty-one states and the District of Columbia responded to the survey.

Despite protections implemented by the Biden administration, several states have recently moved to implement bans or consider actions limiting access to gender-affirming health care, particularly for youth. Coverage of specific services for adults varies and policies like requiring prior authorization can limit access. Additionally, some states do not have policies addressing coverage in their state Medicaid programs, potentially leaving many low-income transgender and nonbinary individuals without a clear path to coverage for medically necessary health services.

Read the brief on the full survey findings

Although COVID-19 fatalities remain much lower than during the peak of last winter’s Omicron surge, deaths among people 65 and older spiked over the summer, more than doubling between April and July 2022, finds a new KFF analysis. The number of deaths topped more than 11,000 people 65 and older in both July and August.

For people younger than 65, deaths have increased more slowly since April, rising by 52 percent to about 1,900 in both July and August 2022. While COVID-19 deaths began declining again in September, they remained higher for those ages 65 and older compared to levels in April and May. For those younger than 65, deaths dropped below April levels.

The numbers illustrate that, despite the determination of many Americans to move on and resume normal activities, COVID-19 continues to exact a toll, especially among older adults. As of the week ending October 1, 2022, the United States had lost nearly 1.1 million lives to COVID-19, including about 790,000 people ages 65 and older. Although people 65 and older are 16 percent of the country’s population, they account for 75 percent of all COVID deaths to date.

In fact, since the summer of 2021, COVID deaths among people 65 and older have been growing as a share of all deaths. The nearly 7,100 deaths among this age group in September of 2022 accounted for 88 percent of all COVID deaths that month – the highest share since the pandemic began. (The absolute number of monthly COVID deaths in this age group peaked at more than 85,000 in January 2021.) The new analysis contains detailed data on the number and share of COVID-19 deaths by age in each month of the pandemic.

The recent rise in deaths is primarily a function of increasing cases due to the more transmissible Omicron variant. Other factors include relatively low booster uptake and waning vaccine immunity, underscoring the importance of staying up to date on vaccination, particularly for older adults. Last month public health authorities began encouraging eligible Americans to get new bivalent booster shots recently authorized by the Food and Drug Administration that target both the original strain of the virus and the more recent Omicron subvariants.

A second analysis released today examines COVID vaccination rates among residents and staff of nursing facilities, where the virus poses a particularly strong threat, and finds that although initial vaccination rates for both groups were quite high, take-up of earlier boosters has been lower. (Sufficient data on take-up of the bivalent boosters is not yet available, however.)

More than 85 percent of residents and staff had completed the primary vaccination series as of September 18, 2022. Only 74 percent of all residents and 51percent of all staff (including those who did not complete the primary series) had received one or more booster shots as of that date. Vaccination and booster rates in nursing facilities also varied considerably across the states, among both residents and staff. In 30 states, fewer than half of all staff had received one or more booster shots as of September 18, 2022.

Recent KFF polling shows that public awareness about the new boosters is modest, although older adults — who tend to be at greater risk of serious illness and death — are most likely to know about the new shots. About a third (32%) of all adults say that they’ve either gotten the new booster (5%) or intend to do so as soon as possible (27%). Among older adults (ages 65 and up), nearly half (45%) say they’ve already gotten the new booster (8%) or plan to get it as soon as possible (37%).

For more data and analyses about Medicare Advantage, visit kff.org

Keeping nursing facility staff and residents current on their COVID-19 vaccines is an important tool for reducing deaths from COVID-19. This is particularly relevant now since KFF analysis found that over one-fifth of all U.S. COVID-19 deaths occurred in long-term care facilities and death rates from COVID-19 are rising for people ages 65 and older, who comprise most nursing facility residents. The number of COVID-19 deaths per month among people 65 and over doubled between April 2022 and July 2022, exceeding 11,000 for the months of July and August.

Although initial vaccination rates for both groups were quite high, take-up of boosters has been lower. Those are troubling numbers because a recent report from the CDC found that receipt of a second COVID-19 booster dose was 90% effective against death and 74% effective against severe COVID-19-related outcomes for nursing facility residents. This data note describes COVID-19 vaccination rates of nursing facility residents and staff between August 2021 and the week ending September 18^th, 2022. We briefly explore how federal policy actions have affected vaccine take-up thus far, and what that might mean for take-up of the new, bivalent boosters. Federal policy may be important to promoting take-up of those boosters as the KFF COVID-19 Vaccine Monitor from September 2022 show half of adults have heard little or nothing at all about the new boosters.

Take-up of the initial vaccine series has been relatively high, with over 85% of residents and staff completing the primary series as of September 18, 2022 (Figure 1). Among nursing facility residents, 87% completed a primary vaccine series, which includes either 2 doses of the Pfizer-BioNTech, Moderna, or Novavax vaccines; or a single dose of the Janssen vaccine. There has been minimal change in that rate over the last year among nursing facility residents – in August 2021, 83% of residents had completed their primary series. Among nursing facility staff, 88% completed a primary vaccine series by September 18, 2022. That rate increased from 62% in August 2021 to 88% in March 2022 and has remained stable since.

Take-up of boosters has been lower: Only 74% of all residents and 51% of all staff had received one or more booster shots as of September 18, 2022. Among the population who completed the initial vaccine series and were eligible for a booster, 86% of residents and 57% of staff had received one or more boosters. The CDC began recommending booster shots for nursing facility residents in September 2021, after data indicated that vaccinations become less effective over time, especially among older adults. Initial take-up among residents was rapid and the percentage of vaccinated residents who had a booster shot increased from 1% in September 2021 to nearly 60% in January 2022. Since then, the percentage of residents who have had a booster has increased but at a much slower rate, rising to 74% in September 2022. Booster take-up has been much lower among nursing facility staff. Between September 2021 and September 2022, the percentage of vaccinated staff who had received a booster grew from 1% to 51%. Any booster dose given to nursing facility residents or staff after September 1, 2022 is the new bivalent booster.

Vaccination and booster rates vary considerably across the states and in 30 states, fewer than half of all staff had received one or more booster shots as of September 18, 2022 (Figure 2). Vaccination rates for nursing facility residents range from 76% in Arizona to 97% in Vermont. Booster rates are lower, ranging from 59% in Arizona to 92% in Vermont. Among staff, the vaccination rate ranges from 78% in Ohio, Idaho, and Missouri to 100% in New York and Maine. The percentages who have received a booster range from 32% in Missouri, Alabama, and Mississippi to 96% in Massachusetts.

Looking forward, both federal policy and local outreach efforts could be important to promoting take-up of the new bivalent boosters among nursing facility residents and staff. One likely reason for the quick initial take-up of vaccines and boosters during 2021 among nursing facility residents and staff was that there were three on-site vaccination clinics held at all long-term care facilities participating in the Federal Pharmacy Partnership for Long-Term Care Program. (Other factors contributing to high take-up rates include very high death rates from COVID-19 among people in nursing facilities and the fact that they were a main focus of the initial vaccine roll-out.) Facilities are still able to request additional clinics, but it’s unclear how many facilities are doing so or how many pharmacy partners continue to participate. Current CDC guidance encourages facilities to let residents and staff know about opportunities to receive vaccines in the community. It is possible that lower take-up of boosters could reflect increased difficulty in getting vaccinated in the community rather than on-site. Among nursing facility staff, initial take-up of COVID-19 vaccines was low until the health care worker vaccination mandate required providers that participate in Medicare and/or Medicaid to be vaccinated. Along with other factors, this mandate led to increased take-up of the primary vaccination series among nursing facility staff and early evidence suggests that it did not increase the frequency of staffing shortages.

Creating new opportunities for on-site vaccinations and updating the health care worker vaccination mandate to reflect current CDC guidance could increase the number of nursing facility residents and staff who are up to date with their COVID-19 vaccinations. The CDC recently updated the definition of “up-to-date” vaccination status for long-term care facilities to align with the definition of “up-to-date” that the CDC rolled out earlier more broadly across the country. Starting on September 2^nd across the country and on September 26^th for long-term care facilities’ reporting/surveillance purposes, the CDC’s new definition of “up-to-date” is having received a bivalent booster or having received a final shot of the original vaccines less than 2 months ago. Nursing facilities may have been subject to this delayed definition of “up-to-date” to align better with quarterly reporting periods. As such, they began reporting the percentage of residents who met the new “up-to-date” standard starting September 26^th, 2022. After there are sufficient data available using the new definition, KFF will update this analysis and provide state-level results on State Health Facts.

As of the week ending October 1, 2022, the United States has lost nearly 1.1 million lives to COVID-19, of which about 790,000 are people ages 65 and older. People 65 and older account for 16% of the total US population but 75% of all COVID deaths to date. Vaccinations, boosters, and treatments have led to a substantial decline in severe disease, hospitalizations, and deaths from COVID-19, but with booster uptake lagging, deaths for older adults rose again during the summer of 2022.

From April to July 2022, the number of deaths due to COVID increased for all ages but rose at a faster rate for older than younger adults and stayed high through August 2022, with deaths due to COVID topping 11,000 in both July and August among people 65 and older. While COVID deaths began to drop again in September, they were still higher for those ages 65 and older than in April or May; for those younger than 65, deaths dropped below their April levels.

The rise in deaths is primarily a function of increasing cases due to the more transmissible Omicron variant. Other factors include relatively low booster uptake, compared to primary vaccination, and waning vaccine immunity, underscoring the importance of staying up to date on vaccination. On September 1^st, CDC recommended a new, updated booster for all those ages 12 and older, but particularly for those who are older.

Vaccination rates among people 65 and older were high for the primary vaccination series (92.4%), but were lower for the first booster (71.1%, among those who received a primary series) and even lower for the second booster dose (43.8%, among those who received a first booster), according to the CDC. Similar trends can be seen in nursing facilities, which are primarily comprised of people 65 and older. Further, CDC data show that, among people 50 and older, those who have received both a primary vaccination series and booster shots have a lower risk of dying from COVID-19 than their non-vaccinated counterparts. Though the uptake in boosters among people 65 and older has been much higher than among people under 65 and they are more likely to say they will get the new booster as soon as possible, booster uptake still remains relatively low compared to primary vaccination among older adults. This, combined with the rise in deaths among adults 65 and older over the summer, raises questions about whether more can be done to encourage older adults to stay up to date on their vaccinations.

The total number of deaths for people 65 and older more than doubled from April to July 2022 and stayed high in August 2022, topping 11,000 in both July and August (Figure 1, Table 1).

• The number of COVID-19 deaths among people 65 and older is now much lower than at the peak of Omicron in early 2022, but deaths more than doubled between April and July 2022 (125%) and topped more than 11,000 in both July and August 2022.
• For people younger than 65, deaths also increased during this time, but more slowly between April and July compared to older adults (52%) to about 1,900 in both July and August 2022.
• While COVID deaths began to drop again in September, they were still higher for those ages 65 and older (~7,100 deaths) than in April (~4,900 deaths) and May (~6,300); for those younger than 65, deaths dropped below their April levels.
• Among all age groups, deaths due to COVID-19 generally declined after the introduction of vaccines in late December 2021, but the number of deaths spiked with the introduction of the more transmissible Delta and Omicron variants, and due to relatively low booster uptake and waning vaccine immunity, as well as loosening COVID-19 mitigation measures.

People 65 and older have consistently accounted for a larger share of COVID-19 deaths than those younger than 65, and represented 88% of all deaths in September 2022 – the highest share since the pandemic began more than two years ago (Figure 2, Table 1).

• With the rollout of vaccinations in the winter of 2020, the share of total deaths due to COVID declined for older adults from a peak of 84% in November 2020 to a low of 58% in August and July 2021.
• Since the summer of 2021, however, COVID deaths among people 65 and older have been growing as a share of all deaths, reaching 88% in September 2022 – similar to the share of COVID-19 deaths accounted for by this group before vaccines were available.
• People 85 and older account for 26% of COVID-19 deaths overall, but since May 2022, have accounted for 38% or more of all COVID-19 deaths (Table 1).

Most Adults Have Not Heard About New 988 National Suicide Prevention Hotline

An overwhelmingly majority (90%) of Americans believe the nation is in the midst of a mental health crisis, and young adults appear to be suffering the most, a new KFF-CNN survey on mental health in America reveals.

A third (34%) of adults under age 30 rate their mental health as “only fair” or “poor,” compared to 19% of those ages 30 and older. Half (52%) say they “always” or “often” felt anxious over the past year (28% for older adults), and about a third say they always or often felt depressed (33%) or lonely (32%) in the past year, also significantly higher than for older adults (18% each among those ages 30 and older).

In addition, about a third (35%) of young adults say they have been unable to work or engage in other activities due to a mental health condition in the past year, a rate significantly higher than older adults.

Featured this week on air at CNN and online at cnn.com, the partnership survey provides an in-depth look at Americans’ views and experiences around mental health, including those who personally report the most difficulty and those with direct family experiences involving severe crises.

The survey reveals how deeply mental health issues affect families, with half (51%) of all adults nationwide saying that their families have experienced a severe mental health crisis. This includes about one in four who say that a family member received in-person treatment because they posed a threat to themselves or others (28%) and that a family member engaged in cutting or other self-harming behaviors (26%).

Significant shares also report that a family member had a drug overdose that required an emergency room visit or hospitalization (21%); experienced homelessness due to mental health problems (16%); died by suicide (16%); or ran away from home due to mental health problems (14%). About one in ten (8%) say that a family member had a severe eating disorder that required hospitalization or in-person treatment.

Among those whose families faced a mental health crisis, nearly half (46%) say it had a major impact on their own mental health, and nearly as many (42%) say it had a major impact on their family relationships. One in five (22%) say it had a major impact on their family’s finances.

One in Five Adults Rate Their Own Mental Health as “Only Fair” or “Poor”

When asked about their own mental health and emotional well-being, most of the public rates their situation positively, though about one in five (22%) rate their situation as “only fair” or “poor.”

In addition to younger adults, lower-income adults (31%); those who identify as lesbian, gay, bisexual or transgender (36%); and those in fair or poor physical health (48%) are more likely than their counterparts to rate their own mental health negatively.

A third (33%) of adults say they “always” or “often” feel anxious, while somewhat smaller shares say they “always” or “often” feel depressed (21%) or lonely (21%). Those who identify as LGBT are among the groups most likely to say they always or often feel anxious (60%), depressed (40%), and lonely (32%). 

When asked about major sources of stress in their lives, four in ten (39%) adults cite their personal finances, making it the top stressor ahead of politics and current events (32%), relationships with family and friends (24%), and work (24%). Personal finances are especially worrisome for those in lower-income households – six in ten (61%) cite them as a major source of stress.

Overall, about a quarter (27%) of all adults say that they did not get mental health care or medication that they thought they needed in the past year. Among those in lower-income families, a third (34%) say they didn’t get needed mental health care in the past year.

Among those who did not get care, equal shares say that the main reason was because they could not afford the cost (20%), they were too busy or could not get the time off work (20%), or they were afraid or embarrassed to seek care (20%). Other main reasons include not being able to find a provider (13%), not knowing how to find services (7%), and their insurance wouldn’t cover it (8%).

Most Adults Have Not Heard About New 988 National Suicide Prevention Hotline

While most people say they know who they would call or how to seek help in a mental health crisis, more than a quarter (27%) do not, including even larger shares of people without health insurance (47%) and Hispanic adults (34%).

In July, the U.S. transitioned the phone number for the National Suicide Prevention Lifeline to a federally mandated three-digit number, 988, that is intended to be easier for people to remember.

One month in, most adults (56%) say they have heard “nothing at all” about the new 988 number with an additional one in five (21%) saying they have heard “a little.” Only about one in four adults say they have heard either “a lot” (7%) or “some” (16%) about the new 988 mental health hotline that will connect people with mental health services.

Despite the low levels of awareness, when informed about the new hotline, a large majority (85%) say that they would be at least “somewhat” likely to call the number if they or a loved one were experiencing a mental health crisis. This includes large majorities of Black, White, and Hispanic adults. 

The public’s interest in 988 may in part reflect mixed perceptions about the usefulness of calling 911 during a mental-health crisis. While about half (52%) think that calling 911 would “help the situation” if they or a loved one was having a mental health crisis, about a quarter (27%) of the public say it would “do more to hurt the situation.”

Other findings include:

• Nearly half of parents (47%) say the COVID-19 pandemic negatively impacted their child’s mental health, including at least four in ten parents across racial and ethnic groups. Almost one in five (17%) say it had a “major” impact.

• Many also are concerned about teenagers’ mental health, with at least eight in ten adults and parents saying they are worried about that depression (85% of adults, 85% of parents), alcohol or drug use (84%, 80%), and anxiety (82%, 83%) are negatively impacting teenagers’ lives.
• Among those who rate their own mental health negatively, most (57%) say they are not comfortable talking to friends and family about it. They cite a range of reasons for their reluctancy, including privacy, shame or stigma, lack of understanding or compassion, and fear of being judged.

The poll was jointly developed and analyzed by CNN and the Kaiser Family Foundation’s polling and survey research group and was conducted July 28-August 9, 2022 among a random national probability-based sample of 2,004 adults ages 18 and older, including 398 parents. Interviews were conducted online and on the phone, in English and Spanish, by SSRS of Media, Pa. The results from the full survey have a margin of sampling error of plus or minus 3 percentage points. Each partner bears responsibility for its editorial content about the poll.

The current MPX outbreak in U.S. appears to be slowing down, following its emergence in May and rapid acceleration in June, with most cases having been reported among gay and bisexual men and other men who have sex with men. Cases peaked in August and have recently begun to decline, largely attributed to the deployment of MPX vaccines and to behavior change among those at higher risk. However, disparities in cases persist among Black and Hispanic people, a pattern also seen with HIV and COVID-19. Indeed, new cases among Black people began to exceed those among White people by early August and, while also trending down, have remained consistently higher. Moreover, although Black and Hispanic people account for a disproportionate share of cases relative to their share of the population, they account for a smaller share of vaccinations, which could pose challenges to addressing MPX in these communities moving forward. Finally, ongoing data limitations may hinder the public health response and efforts to mitigate these disparities.

This analysis examines MPX cases and vaccinations by race/ethnicity based on national data obtained from the Centers for Disease Control and Prevention (CDC). Data on race/ethnicity of people with MPX were available for 68% of cases reported as of September 23 (16,847 of 24,846 cases) in all 50 states, the District of Columbia, and Puerto Rico. Data on race/ethnicity of people who have received a first dose of the two-dose JYNNEOS MPX vaccine were available for 91% of vaccinations reported as of September 27 by 51 jurisdictions (526,692 of 576,420 doses). We find that:

MPX case rates among Black people are over five times those of White people (14.4 vs. 2.6 per 100,000) (Figure 1). Native Hawaiian and Other Pacific Islander (NHOPI) and Hispanic people also have significantly higher rates of reported MPX cases at 10.0 and 8.3 per 100,000, respectively. Rates are lower and similar for Asian (3.0 per 100,000), American Indian and Alaska Native (AIAN) (2.8 per 100,000), and White (2.6 per 100,000) people.

Overall, Black people account for the largest share of MPX cases, and both Black and Hispanic people account for larger shares of cases compared with their shares of the population (Figure 2). Of those with known race/ethnicity, 70% or 11,820 of cases are among people of color, while people of color account for 40% of the U.S. population. Black people account for more than a third (35% or 5,847) of cases, which is almost three times their share of the U.S. population (12%). Hispanic people account for 30% or 4,996 of cases, which is 1.6 times their share of the U.S. population (19%). By contrast, White people account for 30% or 5,027 of cases and 60% of the U.S. population. Asian people represent 3% or 549 of cases, which is smaller than their share of the population. Less than 1% or 117 of reported cases with available race/ethnicity data were among AIAN or NHOPI people, while the remaining 2% or 311 of cases were among individuals reporting other or multiple races.

By late summer 2022, the number of new MPX cases among Black and Hispanic people surpassed the number among White people. Based on the 7-day rolling average of newly reported cases with race/ethnicity data, the number of new cases among Black people first surpassed those among White people on July 21, and, after some fluctuation, has remained consistently higher since August 2 (Figure 3). The 7-day rolling average of new cases reported among Hispanic people surpassed that among White people on August 3 and remained higher until recently. The average number of new cases among Asian, AIAN, and NHOPI people has remained lower than the number among White people over the period examined. While new cases have begun to fall across all racial and ethnic groups, they remain highest among Black people; new cases among Hispanic people have fallen below those among White people.

Black and Hispanic people have received smaller shares of MPX vaccines compared to their shares of cases. The deployment of effective MPX vaccines has been identified as one key factor contributing to the decline in cases. As of September 27, over half (51%) of MPX first doses of vaccinations have gone to White people, although they represent 30% of reported cases (Figure 2). In contrast, despite accounting for more than a third of cases (35%), only 13% of first doses administered went to Black people. Similarly, 22% of first doses have gone to Hispanic people, while they account for 30% of cases. The lower shares of vaccinations among these groups may in part explain why they have had higher numbers of new cases and complicate efforts to address disparities moving forward.

Ongoing data limitations may hinder the public health response and efforts to mitigate these disparities. The ability to monitor MPX cases and vaccination by race/ethnicity provides key measures of where disparities exist and could help to focus outreach and resources to hard hit communities. However, data limitations make tracking these demographic patterns challenging. These include missing race/ethnicity case data for almost a third (32%) of reported cases and for one in ten vaccinations (9%) the lack of available data to allow for intersectional analysis of disparities across multiple factors, such as by race/ethnicity, sex, gender identity, and risk; and the lack of state-level demographic data. Moreover, national-level data by risk factor are increasingly missing from jurisdictional reports to CDC, limiting an assessment of risk for current cases.

Together, these data indicate that there are significant disparities in MPX cases among Black, NHOPI, and Hispanic people, with case rates among Black people more than five times greater than those among White people. Moreover, to date, Black and Hispanic people have received lower shares of vaccinations compared to their shares of MPX cases. These disparities likely result from multiple factors, including structural barriers, which complicate access to information and interventions and contribute to more limited access to health care overall; stigma and homophobia, which may make some reluctant to seek care or be offered services; and data challenges which may delay or obscure recognition of the full scope of the impact of MPX among people of color. These findings highlight the importance of centering intersectional equity in MPX response efforts, including prevention, testing, and treatment. As has been seen with HIV and COVID-19, underlying structural inequities place people of color at increased risk for public health threats and focused efforts will be key to minimizing and preventing further disparities going forward. While the federal government has begun piloting efforts to reach communities of color with MPX vaccines in order to address disparities, it is unclear if such efforts will be enough to stave off further disproportionate impact, and much will also depend on what state and local jurisdictions do.

KFF’s Kaiser Health News (KHN) and the radio program “This American Life” together have won a Loeb Award in the audio category for a deeply reported account of the threats and hate targeted at local public health officials during the covid-19 pandemic.

KHN’s coverage of public health issues will remain a priority beat in the newsroom long after the threat of covid fades. KFF will announce new partnerships and public health reporting plans in the coming months.

In ‘We’re Coming for You’: For Public Health Officials, a Year of Threats and Menace”, the two news organizations chronicled how health officers became the face of local government authority, illustrating through the lens of California’s Santa Cruz county how they became the targets of rage and resentment from loose-knit militia and white nationalist groups. The county, though widely viewed as liberal and progressive, saw an escalating succession of threats, capped by the cold-blooded killing of a sheriff’s deputy, that upended the lives of health leaders trying to navigate the covid response.

KHN senior correspondent Anna Maria Barry-Jester told the story of Dr. Gail Newel, Santa Cruz County’s health officer, and her boss, Mimi Hall, the county’s health services director, who soldiered on as debate over legitimate covid-related public health orders devolved into vitriol and intimidation. Their daily routines changed to incorporate security patrols, surveillance cameras and, in some cases, personal firearms.

This was KHN’s first collaboration with “This American Life.” Listen to the “This American Life” audio story, entitled “The Herd,” here. And read KHN’s companion digital story here.

The Loeb Awards, established in 1957 and considered the most prestigious honor in business and financial journalism, are administered by The G. and R. Loeb Foundation Inc. and the University of California at Los Angeles’s Anderson School of Management. This is KHN’s third Loeb Award.

About KFF and KHN

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis, Polling and Survey Research and Social Impact Media, KHN is one of the four major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

About This American Life

This American Life is an award-winning weekly public radio program and podcast hosted by Ira Glass. It is heard by 2 million listeners each week on over 500 public radio stations in the U.S., with another 2.8 million people downloading each episode as a podcast. The show is produced in collaboration with WBEZ Chicago and delivered to stations by PRX, Public Radio Exchange.

This fact sheet does not reflect recent changes that have been implemented by the Trump administration, including a foreign aid review and restructuring. For more information, see KFF’s Overview of President Trump’s Executive Actions on Global Health.

Key Facts

• Polio, a highly infectious and sometimes deadly disease that has plagued the world since ancient times, is now at very low levels, with 6 reported cases of wild poliovirus (WPV) in 2021.
• Since eradication efforts began in earnest 30 years ago (when cases numbered 350,000 annually), polio has been eliminated in more than 120 countries and remains endemic in only two.
• A global push for polio eradication by 2026 is underway. If polio is eradicated, it would only be the second time in history that a disease affecting humans has been eradicated. Early in the COVID-19 pandemic, global polio immunization campaigns were paused for a few months but then were resumed, and polio efforts now may be benefitting from heightened community awareness of the benefits of vaccinations due to the COVID-19 vaccination effort.
• Eventually, polio efforts will transition from using oral poliovirus vaccine (OPV) to using only inactivated poliovirus vaccine (IPV) through a phased process over several years, which will help to eliminate outbreaks caused by circulating vaccine-derived polioviruses (cVDPV). Type 2 cVDPV (cVDPV2) represents the vast majority of cVDPV cases worldwide, including the case recently found in the United States, and is a major challenge to achieving polio eradication.
• The U.S. government (U.S.) has been engaged in efforts to address polio for decades, as a partner in and the second largest donor to the Global Polio Eradication Initiative and as a supporter of developing countries’ efforts.
• U.S. funding for polio is $253 million in FY 2022, up from $134 million in FY 2009.

Global Situation

Polio, a highly infectious and sometimes deadly disease that has plagued the world since ancient times,¹  is now at very low levels, and today, global polio efforts are focused on sustaining efforts to eradicate the disease, which have already resulted in a 99.9% reduction in cases since 1988 (see Table 1). Progress against the disease has been made possible by the development and expanded use of effective vaccines, particularly the more easily administered and less expensive oral poliovirus vaccine, and mass immunization campaigns (see below).

A global push for polio eradication is underway.⁴  If polio is eradicated, it would only be the second time in history that a disease affecting humans has been eradicated (smallpox being the other),⁵  a “once-in-a-generation opportunity for global public health.”⁶ 

History

The development of effective vaccines against polio in the 1950s and 1960s led to their widespread use in many industrialized countries, including the United States, and resulted in the elimination of polio in a number of countries. These early successes suggested that global polio eradication (through the use of mass immunization campaigns) might be achievable.⁷  Soon thereafter, in 1988, the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) – constituted as a public-private partnership led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), and the Bill & Melinda Gates Foundation – to work toward this goal.⁸  GPEI partners have invested approximately $19 billion globally in eradicating the disease.⁹ 

In 2012, the World Health Assembly stated that successfully eradicating polio was a “programmatic emergency for global public health,” given ongoing challenges that threatened the gains that had already been made.¹⁰  More recently, in 2014, WHO declared the continued spread of polio a “public health emergency of international concern” due to the global risks posed by the disease; under the International Health Regulations, this declaration required certain countries to heighten their efforts against polio.¹¹  See the KFF fact sheet on WHO.

Impact

Since 1988, the global effort to interrupt transmission of wild poliovirus (WPV, the cause of polio) has seen successes and setbacks. The virus was gradually eliminated across the Americas (in 1994), the Western Pacific (in 2000), Europe (in 2002), South-East Asia (in 2014), and Africa (in 2020).¹²  Still, in other regions, it remained endemic in some countries. Today, the virus continues to be endemic in two countries: Afghanistan and Pakistan (see Table 1). In addition, polio-free countries must remain vigilant to prevent reintroduction of the virus, which can lead to re-establishment of polio transmission.¹³  Importation of the virus from another country is a continuing threat, with countries stretching across west Africa to central Africa to the Horn of Africa most often affected.¹⁴ 

Current efforts in endemic countries focus on interrupting transmission of the remaining type of wild poliovirus: WPV 1. (The other WPV types, WPV 2 and WPV 3, have been declared eradicated as of 2015 and 2019, respectively.¹⁵ ) In 1 of 200 persons infected with wild poliovirus, permanent paralysis (usually of the legs) occurs, and of these, 5-10% die when paralysis affects the respiratory muscles.¹⁶  The disease is most prevalent among underserved populations in developing countries, typically striking children under five who live in poverty and who lack access to clean water, good sanitation, immunization and other health services. Young children are more vulnerable to and disproportionately affected by polio.¹⁷ 

Interventions

Several strategies are important in preventing the spread of polio:

• ensuring high levels of routine immunization coverage (greater than 80%) among infants (children under one year old), including multiple doses of oral poliovirus vaccine (OPV) and/or inactivated polio vaccine (IPV) (see Box 1);
• mass immunization campaigns through National Immunization Day campaigns or supplementary immunization activities (SIAs);
• heightened poliovirus surveillance and lab capacity to detect new cases and importations;¹⁸  and
• targeted campaigns (“mop-up” campaigns) to respond to outbreaks in specific areas the virus is known or suspected to be circulating.¹⁹ 

Mass immunization, which is designed to complement the individual protection provided by routine immunization and build herd immunity,²⁰  is intended to immunize children under five who have not been immunized or may only be partially protected, while also boosting the immunity of children who have been immunized. It is only through high levels of sustained herd immunity that virus transmission will stop. A large cadre of volunteers vaccinates thousands, and often millions, of children during these campaigns.

These four main strategies are supported by health worker training, communication campaigns, community outreach, engagement with community and religious leaders, new technological and scientific advances, technical assistance, sharing of best practices, and vaccine production efforts.

Vaccine Transition

To fully achieve eradication, polio vaccination efforts worldwide will eventually transition from OPV to IPV through a phased process over several years. Replacing OPV with IPV will help eliminate outbreaks caused by circulating vaccine-derived polioviruses (cVDPV) (see Table 1) and other VDPV, since OPV includes live, weakened poliovirus (which in very rare cases can mutate and then circulate in communities with low vaccination coverage), while IPV does not.²¹ 

Vaccine Switch. A key step in this transition from OPV to IPV was making a “switch” from OPV that targets all three types of wild poliovirus to OPV that targets the remaining two types of wild poliovirus (WPV 1 and WPV 3). For most countries, this switch occurred beginning in April 2016, preceded by efforts to introduce at least one dose of IPV into routine immunizations in order to maintain immunity against WPV 2.²²  Still, type 2 cVDPV (cVDPV2) represents the vast majority of cVDPV cases and is a major challenge to achieving polio eradication. In countries and areas experiencing outbreaks of cVDPV2, type 2 monovalent OPV (mOPV2) or the next generation version of mOPV2, type 2 novel OPV (nOPV2), is being used to rapidly boost immunity in affected areas to help stem this growing threat.²³ 

Challenges

Although the polio vaccine is relatively inexpensive, challenges persist in delivering the vaccine to the most at-risk populations in endemic regions, as affected areas are often geographically remote and struggle with extreme poverty, conflict, and religious or other social barriers that hamper the ability of health care workers to reach all children who need to be vaccinated. Attacks on health care workers engaged in polio vaccination activities, most recently in Pakistan, have highlighted security concerns that threaten continued progress. To address some of these challenges, approaches have included:

• building political will among national and community leaders,
• mobilizing community support of sustained vaccination efforts,
• retaining public trust in the safety of the vaccine,
• ensuring vaccine supply,
• improving coordination among key players, and
• securing adequate financing.²⁴ 

Global Goals

With the Polio Eradication Strategy 2022–2026, key public and private stakeholders agreed to redouble efforts in the remaining endemic countries and to adopt a strategy for attaining the goal of eradicating polio (specifically, the remaining type WPV1) and validating the absence of cVDPV2 by 2026 that responds to current challenges while also preparing for a post-polio world.²⁵  Although eradication of WPV is still several years away, polio stakeholders have begun to plan for a post-polio world,²⁶  which will require efforts to transition but maintain polio assets (e.g., polio surveillance systems), document lessons learned, and complete the task of eradication by addressing VDPV.

Polio eradication is among the disease-specific goals of Immunization Agenda 2030, the global strategy for expanding access to and coverage of critical vaccines over the next decade.²⁷  Earlier, polio eradication was also a major milestone in the Global Vaccine Action Plan 2011-2020,²⁸  which outlined a vision for delivering universal access to immunization by 2020 as part of the “Decade of Vaccines” effort,²⁹  as first called for by Bill and Melinda Gates in 2010.³⁰  The Gates Foundation is also the largest contributor to the GPEI.³¹ 

U.S. Government Efforts

The U.S. has long been a leader in supporting global polio eradication, with the Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID) engaged in efforts to assist affected countries through bilateral activities as well as the GPEI. In recent years, growing international attention to progress made toward eradication has led the U.S. to emphasize the urgency of sustaining efforts until eradication is achieved and spurred U.S. involvement in new collaborations aimed at better reaching the areas and populations most affected by new cases. In 2009, President Obama launched a new joint effort with the Organization of Islamic Cooperation (an inter-governmental organization with 57 member-states spread over four continents) to eradicate polio globally, bringing high level support to efforts to counter the disease in endemic countries with large Muslim populations.³²  The resulting 2010 joint work plan aimed “to strengthen diplomatic advocacy, technical support and resource mobilization” on the part of the U.S. government and OIC member-states.³³ 

Protecting children from polio by ensuring they are fully immunized is part of the U.S. government maternal and child health strategy.³⁴ 

Organization

CDC and USAID are the major implementing agencies for U.S. global polio efforts, with CDC serving as the U.S. lead agency. The Department of State and the National Institutes of Health (NIH) also play important roles in the U.S. response.

CDC

CDC’s efforts focus on technical and financial assistance for efforts to interrupt WPV transmission. In addition to its polio surveillance expertise,³⁵  it offers field support through the deployment of public health professionals to polio-affected areas who support capacity building of surveillance and laboratory networks, immunization campaign planning and monitoring, social mobilization, and other activities.³⁶  In December 2011, CDC activated its Emergency Operations Center to “support the final push for polio eradication.”³⁷ 

Other U.S. Polio Efforts

USAID provides technical support to country partners in immunization campaign planning and implementation, social mobilization and communications efforts, and strengthening surveillance and monitoring systems.³⁸  The agency’s early polio efforts focused on Latin America in the late 1980s and early 1990s, until the disease was eliminated in the region.³⁹  Since 1996 it has supported and worked with the Global Polio Eradication Initiative.⁴⁰  The Department of State supports U.S. efforts through diplomatic initiatives to engage political and community leaders in affected areas.⁴¹  NIH and CDC efforts also focus on encouraging research into and adoption of new polio vaccines.

Multilateral Engagement

Additionally, the U.S. works closely with international institutions and other partners, including the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and Rotary International. It is also the second largest donor to the Global Polio Eradication Initiative, having contributed almost $4.3 billion since its launch in 1988.⁴² 

Funding

Total U.S. funding for polio has risen from $134 million in FY 2009 to $253 million in FY 2022 (see figure).⁴³ 

Most U.S. funding for polio is provided through CDC’s global immunization program (about 70%). Additional polio funding is provided under the maternal and child health (MCH) program at USAID. See the KFF fact sheet on U.S. MCH efforts.

Key Issues for the U.S.

Increased attention to polio, when coupled with global partnerships and the availability of effective interventions, offer a unique opportunity to eradicate an infectious disease affecting humans for only the second time in history. However, with continued insecurity and difficulty accessing hard-to-reach areas in some of the remaining endemic areas and other ongoing challenges, concerns about how to not only sustain gains made but also eliminate the final reservoirs of the poliovirus exist. For one, in recent years, access to certain areas in Afghanistan has been hampered by security issues, but with Taliban support, nationwide polio vaccination efforts in Afghanistan resumed in November 2021 for the first time in more than three years, allowing polio campaigns to once again reach children in all areas and pushing polio to its lowest levels ever there.⁴⁴  Additionally, there was concern that the coronavirus pandemic would significantly affect these efforts, with global polio immunization campaigns paused for several months in the spring of 2020 and polio assets often made available to support the COVID-19 response while maintaining “critical polio functions.”⁴⁵  Though efforts to stem transmission were stymied by the pause,⁴⁶  polio campaigns resumed in July 2020,⁴⁷  and polio efforts now may be benefitting from heightened community awareness of the benefits of vaccinations due to the COVID-19 vaccination effort.⁴⁸  The spread of VDPV is another major issue on the path to eradication that will be important to monitor and address, including in the United States⁴⁹  and other countries and areas where cVDPV has been found.

Going forward, U.S. support for ongoing global polio efforts and their role in contributing to not only polio eradication efforts but also global health security and emergency response efforts will remain an area to watch as broader discussions about strengthening pandemic preparedness and response continue to evolve.

To achieve the vision of eradicating polio, securing adequate funding for the final stretch of the Global Polio Eradication Initiative will be important.⁵⁰  Additionally, addressing the significant challenge of tackling VDPV will require sustained support and resources even after eradication of WPV is achieved and particularly as efforts to secure a post-polio world get further underway.

1. GPEI, “History of Polio,” webpage, http://polioeradication.org/polio-today/history-of-polio/. ↩︎
2. In 2021, most of these cases occurred in endemic countries (4 in Afghanistan and 1 in Pakistan), with 1 importation case in Malawi. ↩︎
3. In 2021, 647 of these cases occurred in non-endemic countries, while 51 occurred in endemic countries (43 in Afghanistan and 8 in Pakistan). ↩︎
4. Certification of polio eradication occurs after a sustained period of time with no transmission of WPV. Detailed criteria are described at: GPEI, “Certification,” webpage, http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/certification/. ↩︎
5. In 1980, the World Health Assembly (WHA) accepted scientific certification that smallpox had been eradicated worldwide. WHO, The Global Eradication of Smallpox, 1980. Guinea-worm disease (a neglected tropical disease also known as dracunculiasis) could become the second disease eradicated; cases dropped from 3.5 million annually in the mid-1980s to 27 in 2020. WHO, “Dracunculiasis (guinea-worm disease),” fact sheet, Jan. 2022. ↩︎
6. GPEI Independent Monitoring Board, “Letter to Margaret Chan dated Jan. 18, 2013,” http://polioeradication.org/wp-content/uploads/2016/07/Letter_January2013_EN.pdf. ↩︎
7. GPEI, “History of Polio,” webpage, http://polioeradication.org/polio-today/history-of-polio/. ↩︎
8. 41st WHA, “Global eradication of poliomyelitis by the year 2000,” WHA 41.28, 1988; GPEI, “Who We Are,” webpage, http://polioeradication.org/who-we-are/. ↩︎
9. Includes contributions and pledges through 2021. GPEI, “Contributions and Pledges to the Global Polio Eradication Initiative, 1985-2021,” as of Dec. 31, 2021, http://polioeradication.org/financing/donors/historical-contributions/. ↩︎
10. 65th WHA, “Poliomyelitis: intensification of the global eradication initiative,” WHA 65.5, 2012. ↩︎
11. WHO Executive Board, Poliomyelitis, Report by the Secretariat, EB136/21, Jan. 16, 2015; GPEI, “Public Health Emergency Status,” webpage, http://polioeradication.org/polio-today/polio-now/public-health-emergency-status/. ↩︎
12. These years represent the dates of regional certification of eradication. UNICEF, “The Story of the End of Polio,” www.unicef.org/immunization/files/The_Story_of_the_End_of_Polio.pdf; GPEI, “WHO South-East Asia Region Declared Polio-Free,” March 27, 2014, http://polioeradication.org/news-post/who-south-east-asia-region-declared-polio-free/; WHO, “Global polio eradication initiative applauds WHO African region for wild polio-free certification,” Aug. 25, 2020, https://www.who.int/news/item/25-08-2020-global-polio-eradication-initiative-applauds-who-african-region-for-wild-polio-free-certification. ↩︎
13. Sustained poliovirus transmission for over 12 months following importation is classified as re-established transmission. ↩︎
14. GPEI, “Where We Work,” webpage, http://polioeradication.org/where-we-work/. ↩︎
15. WPV 2 was eliminated in 1999 and declared eradicated in 2015, while WPV 3 was eliminated in 2012 and declared eradicated in 2019. WHO, “Poliomyelitis,” fact sheet no. 114, July 2019; Global Certification Commission, “Declaration of WPV2 Eradication,” Sept. 20, 2015; Global Certification Commission, “Declaration of WPV3 Eradication,” Oct. 17, 2019; CDC, “Global Certification of Eradication of Indigenous Wild Poliovirus Type 3,” field stories, https://www.cdc.gov/globalhealth/immunization/stories/global-certification-of-eradication-of-indigenous-wild-poliovirus-type-3.html. ↩︎
16. Most people infected with polio will have no symptoms, and those that do will usually experience minor symptoms that often resolve completely. ↩︎
17. WHO, “Poliomyelitis,” fact sheet no. 114, April 2013 and July 2022. ↩︎
18. Surveillance efforts include monitoring for cases of acute flaccid paralysis (AFP), an early sign of possible polio. ↩︎
19. According to GPEI, “Priority areas include those where polio cases have been found over the previous three years and where access to health care is difficult. Other criteria include high population density, high population mobility, poor sanitation, and low routine immunization coverage.” GPEI, “Targeted Mop-up Campaigns,” webpage, http://polioeradication.org/who-we-are/strategic-plan-2013-2018/targeted-mop-up-campaigns/. ↩︎
20. Herd immunity is the resistance to an infectious agent of an entire group or community (and, in particular, protection of susceptible persons) as a result of a substantial proportion of the population being immune to the agent. See CDC, “Glossary of Epidemiology Terms,” webpage, https://www.cdc.gov/csels/dsepd/ss1978/glossary.html. ↩︎
21. Polio Oversight Board, “Polio Eradication in Reach, with Renewed Commitment,” statement, Sept. 25, 2015. Also see GPEI, ”Vaccine-Derived Polioviruses,” webpage, http://polioeradication.org/polio-today/polio-prevention/the-virus/vaccine-derived-polio-viruses/; WHO, “Poliomyelitis: Vaccine derived polio?,” Online Q&A, April 2017, https://www.who.int/news-room/questions-and-answers/item/poliomyelitis-vaccine-derived-polio; GPEI, “Vaccine-Derived Poliovirus,” fact sheet, Nov. 2019, http://polioeradication.org/wp-content/uploads/2016/07/GPEI-cVDPV-factsheet_March-2017.pdf. ↩︎
22. WHO/GPEI: “Planning for IPV Introduction: FAQs,” March 2014; “Preparing for the withdrawal of all OPVs,” OPV Switch Briefing Note, Feb. 2015. Olen Kew and Mark Pallansch, “Breaking the Last Chains of Poliovirus Transmission: Progress and Challenges in Global Polio Eradication,” July 2018, Annual Review of Virology 2018: 5:7.1-7.25. ↩︎
23. GPEI, GPEI Strategy for the Response to cVDPV2 2020-2021, fact sheet, March 2021; GPEI, “cVDPV2 Outbreaks and the Type 2 Novel Oral Polio Vaccine (nOPV2),” Jan. 2022, https://polioeradication.org/wp-content/uploads/2022/01/GPEI_cVDPV2-nOPV2_Factsheet_13-Jan-2022-EN.pdf. ↩︎
24. The GPEI Independent Monitoring Board monitors progress toward GPEI milestones, examines key challenges, and makes recommendations accordingly; see http://polioeradication.org/who-we-are/governance-and-structure/independent-monitoring-board/. ↩︎
25. GPEI, Polio Eradication Strategy 2022–2026, 2021. ↩︎
26. GPEI, “Transition Planning,” webpage, https://polioeradication.org/polio-today/preparing-for-a-polio-free-world/transition-planning/; GPEI, Polio Post-Certification Strategy: A risk mitigation strategy for a polio-free world, 2018, http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/transition-planning/polio-post-certification-strategy/; WHO, Polio transition planning, Report by the Director-General, EB142/11, Jan 12, 2018, http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_11-en.pdf; WHO, Strategic Action Plan on Polio Transition, Report by the Director-General, May 2018, https://www.who.int/publications/i/item/A71-9; WHO, Polio Transition Programme, webpage, https://www.who.int/teams/polio-transition-programme. ↩︎
27. WHO, Immunization Agenda 2030: A Global Strategy to Leave No One Behind, 2020, https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030. ↩︎
28. WHO, Global Vaccine Action Plan 2011-2020, http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/. ↩︎
29. The secretariat for the Decade of Vaccines Collaboration dissolved in 2012 after the Global Vaccine Action Plan was developed, with the aim that partners’ efforts in support of the plan and global immunization efforts would continue. Decade of Vaccines Collaboration, website, www.dovcollaboration.org/. ↩︎
30. The Decade of Vaccines Collaboration grew out of Bill and Melinda Gates’ initial call for the next ten years to focus on helping “to research, develop, and deliver vaccines for the world’s poorest countries.” See Gates Foundation, media release, 2010, www.gatesfoundation.org/Media-Center/Press-Releases/2010/01/Bill-and-Melinda-Gates-Pledge-$10-Billion-in-Call-for-Decade-of-Vaccines and www.gatesfoundation.org/Media-Center/Press-Releases/2010/12/Global-Health-Leaders-Launch-Decade-of-Vaccines-Collaboration. ↩︎
31. GPEI, “Contributions and Pledges to the Global Polio Eradication Initiative, 1985-2021,” as of Dec. 31, 2021, http://polioeradication.org/financing/donors/historical-contributions/. ↩︎
32. Formerly known as the Organization of the Islamic Conference. Obama Administration/White House, “Remarks by the President on a New Beginning,” June 4, 2009, https://obamawhitehouse.archives.gov/the-press-office/remarks-president-cairo-university-6-04-09. ↩︎
33. Obama Administration/State Department, “United States Support for Polio Eradication,” fact sheet, Oct. 7, 2010, https://2009-2017.state.gov/e/oes/rls/fs/2010/149227.htm. ↩︎
34. USAID: Acting on the Call: Ending Preventable Child and Maternal Deaths, June 2014; Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action, June 2014; Working Toward the Goal of Reducing Maternal and Child Mortality: USAID Programming and Response to FY08 Appropriations (Report to Congress), July 2008; Two Decades of Progress: USAID’s Child Survival and Maternal Health Program, June 2009. ↩︎
35. CDC provides virological surveillance expertise (genetic fingerprinting) to investigate polio cases, identify the strain of poliovirus involved, and pinpoint genetic and transmission linkages. KFF communication with CDC, May 2013. ↩︎
36. CDC, “Polio,” webpage, www.cdc.gov/polio/. ↩︎
37. CDC, CDC Global Health Strategy, 2012-2015, 2012. ↩︎
38. USAID, Global Health and Child Survival: Progress Report to Congress, 2010-2011, 2012; USAID, “Support to Polio Eradication Activities,” fact sheet, Aug. 3, 2015, and webpage updates May 7, 2019 and Oct. 6, 2021, https://www.usaid.gov/global-health/health-areas/maternal-and-child-health/technical-areas/immunization/polio. ↩︎
39. The last case in Latin America occurred in 1991, and the region was certified polio-free in 1994. ↩︎
40. USAID, Polio Eradication Initiative Mission Information Kit, 1999. ↩︎
41. Obama Administration/State Department, “United States Support for Polio Eradication,” fact sheet, Oct. 7, 2010, https://2009-2017.state.gov/e/oes/rls/fs/2010/149227.htm. ↩︎
42. Includes funding through 2022. GPEI, “Contributions and Pledges to the Global Polio Eradication Initiative, 1985-2021,” as of December 31, 2021, http://polioeradication.org/financing/donors/historical-contributions/; KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriations Bills, and U.S. Foreign Assistance Dashboard website, ForeignAssistance.gov. ↩︎
43. KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriations Bills, and U.S. Foreign Assistance Dashboard website, ForeignAssistance.gov. ↩︎
44. GPEI, “Afghanistan makes progress in polio eradication but challenges remain,” Aug. 15, 2022, https://polioeradication.org/news-post/afghanistan-makes-progress-in-polio-eradication-but-challenges-remain/ ; Reuters, “WHO, UNICEF launch Afghan polio vaccine campaign with Taliban backing,” Nov. 8, 2021, https://www.reuters.com/world/asia-pacific/who-unicef-launch-afghan-polio-vaccine-campaign-with-taliban-backing-2021-11-08/; Haroon Janjua, “Afghanistan to restart polio vaccination programme with Taliban support,” Oct. 19, 2021, https://www.theguardian.com/global-development/2021/oct/19/afghanistan-to-restart-polio-vaccination-programme-with-taliban-support. ↩︎
45. GPEI, “Call to Action to Support Covid-19 Response,” Polio Oversight Board Statement, April 2, 2020, http://polioeradication.org/wp-content/uploads/2020/04/POB-COVID-19-Statement-20200402.pdf. ↩︎
46. GPEI, GPEI Strategy for the Response to cVDPV2 2020-2021, fact sheet, March 2021, https://polioeradication.org/wp-content/uploads/2021/03/GPEI-cVDPV2-nOPV2-Factsheet-20210312-EN.pdf. ↩︎
47. GPEI, Latest on COVID-19: GPEI’s Situation Report & Donor Update, Aug. 4, 2020, https://polioeradication.org/wp-content/uploads/2020/08/GPEI-Newsletter-Week32-2020.pdf. ↩︎
48. Mohammad Ali, et al., “COVID-19 vaccination gives hope to eradicate polio,” Nature Medicine, Vol. 27, pp. 1660–1661, correspondence, Oct. 4, 2021, https://www.nature.com/articles/s41591-021-01518-z. ↩︎
49. GPEI, “Updated statement on report of polio detection in United States,” July 29, 2022, https://polioeradication.org/news-post/report-of-polio-detection-in-united-states/. ↩︎
50. GPEI, “Financial Resource Requirements,” webpage, http://polioeradication.org/financing/financial-needs/financial-resource-requirements-frr/; GPEI, Polio Investment Case, 2022-2026, 2022, https://polioeradication.org/wp-content/uploads/2022/04/GPEI-Investment-Case-2022-2026-Web-EN.pdf. ↩︎