In 1998, the World Health Assembly passed a resolution to eradicate polio, launching the Global Polio Eradication Initiative. In October of the same year, the Regional Committee for the Eastern Mediterranean passed a resolution adopting the global target. A regional plan was prepared and adopted by the Regional Committee in 1999.
The number of cases and of endemic countries has continued to decrease rapidly from an estimated 35 000 cases in 1988, reported from 22 countries, to only 113 virologicaly-confirmed cases in 2004 reported from the only three endemic countries.
The Region has always been subject to importations resulting in a limited number of cases and they were quickly controlled. However, the importation in 2004 from Chad resulted in an epidemic in Sudan, which reached Yemen in 2005 and Somalia in 2006. Importations continued from neighbouring countries but their outcome in the Region has been limited through proper preparedness and response. One importation to southern Sudan in 2008 resulted in an outbreak which spread to the rest of Sudan, neighbouring Kenya and Uganda. This outbreak ended in June 2009.
The situation in Pakistan started to deteriorate in 2007 due to a combination of factors, including insecurity, natural disasters and weak performance of immunization campaigns.
In Afghanistan, the deteriorating security situation is behind continued circulation in the south.