Collateral damage from violent incidents: human costs of polio immunization.

OBJECTIVE

To provide observational statistics on reported violent incidents, deaths and injuries associated with polio immunization activities in the context of global polio eradication efforts.

METHODS

We made a systematic search of registries dedicated to documenting violence against health workers, as well as online news reports related to targeted attacks against polio immunization activities.

FINDINGS: We identified 362 violent incidents between 1998 and 2024 that reported 359 deaths, 358 non-fatal injuries and 179 kidnappings associated with polio immunization activities. Incidents included attacks on immunization facilities, workers, support staff (for example, security and transportation) and/or vaccine recipients, which also sometimes involved family members of vaccinees or uninvolved bystanders. The reported incidents occurred in 14 countries. The two countries still endemic for wild poliovirus transmission as of 2025 accounted for 85% (607/717) of the total deaths and injuries: Pakistan 69% (497/717) and Afghanistan 15% (110/717). Of the deaths and injuries reported, 47% (404/857) were vaccine delivery personnel, including individuals identified as volunteers, workers or staff and 28% (236/857) were security personnel. The total number of violent incidents peaked in 2014 (51 incidents, 64 deaths and 56 injuries), followed by 2024 (42 incidents, 40 deaths and 63 injuries), which are double the average of the preceding 5 years.

CONCLUSION

We found substantial human costs associated with the polio immunization activities conducted to achieve the goal of global polio eradication. Efforts are needed to find effective solutions to protect individuals on the frontline of polio immunization activities, particularly in places where the risks are highest.