The State of Global Vaccinations: What Factors Contribute to the Lack of Eradication of Poliomyelitis and What Solutions Can Be Explored.

Global vaccination efforts have saved millions of lives, yet poliomyelitis remains endemic in a small number of countries and continues to re-emerge through circulating vaccinederived polioviruses (cVDPVs). This scoping review examines the factors contributing to the persistence of polio and identifies strategies to support global eradication. Guided by PRISMA 2020, peer-reviewed and grey literature published between 2000 and 2025 were systematically searched, screened, and synthesized. A total of twelve peer-reviewed studies and twelve grey literature sources met inclusion criteria. Findings indicate that polio persists not due to technical limitations, but because of systemic and social barriers that disrupt consistent vaccination coverage. Key challenges include misinformation and distrust, conflict and political instability, population displacement, economic constraints, geographic inaccessibility, and gaps in health literacy. These barriers are most pronounced in conflict-affected settings, where weakened infrastructure and limited access to care hinder both routine immunization and surveillance. The review highlights several effective and recurring strategies. Community-centered engagement, particularly through trusted local leaders and female health workers, improves vaccine acceptance. Expanding access through mobile and outreach-based delivery reduces logistical barriers. Strengthening routine immunization and integrating polio efforts into broader health systems improves sustainability and continuity of care. Investments in workforce capacity, data systems, and operational infrastructure further support more reliable program implementation. Emerging approaches, including digital communication strategies and more flexible delivery models, offer additional opportunities to address misinformation and reach underserved populations. Ultimately, sustained global coordination, long-term investment, and a renewed focus on equity and health system strengthening will be essential to achieving and maintaining polio eradication.