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The OPV has another problem. If coverage declines (as is bound to happen in Pakistan), vaccine viruses will spread to children who are not vaccinated, back-mutate, de-attenuate and become virulent. Such viruses are called circulating vaccine-derived polioviruses (cVDPV). They can cause polio outbreaks. Thus Pakistan will soon be at risk of polio outbreaks by both WPV1 and cVDPV.

It is to avoid the emergence of cVDPV that India strives to maintain high OPV coverage through routine immunisation, Mission Indradhanush and annual national pulse campaigns.

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pulse campaigns since its efficacy is poor. On the other hand, the IPV is highly efficacious and needs to be given just two-three times as part of routine immunisation. Risk of polio outbreaks <span>The OPV has another problem. If coverage declines (as is bound to happen in Pakistan), vaccine viruses will spread to children who are not vaccinated, back-mutate, de-attenuate and become virulent. Such viruses are called circulating vaccine-derived polioviruses (cVDPV). They can cause polio outbreaks. Thus Pakistan will soon be at risk of polio outbreaks by both WPV1 and cVDPV. It is to avoid the emergence of cVDPV that India strives to maintain high OPV coverage through routine immunisation, Mission Indradhanush and annual national pulse campaigns. In 2018, Papua New Guinea developed a cVDPV polio outbreak as OPV coverage fell to 60%. In 2017, as OPV coverage fell to 53%, Syria had an outbreak of cVDPV polio. There is yet another


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