The Lancet Infectious Disease
Feb 2012  Volume 12  Number 2  p89 – 166
http://www.thelancet.com/journals/laninf/issue/current

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Inactivated polio vaccine and global polio eradication
John F Modlin

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2012 will mark the 24th year of WHO’s Global Poliomyelitis Eradication Initiative.1 Eradication has proven more difficult than originally envisioned because of geopolitical events, such as war, social disruption, and political indifference; social and cultural issues, such as distrust of poliovirus vaccines and vaccinators; and the unanticipated emergence of virulent vaccine-derived polioviruses in many locations. Few of these obstacles have bewildered the scientific community as much as the low efficacy of the major weapon in the arsenal, trivalent oral polio vaccine (OPV) in regions with dense populations, high birthrates, and poor sanitation resulting from diarrhoea due to enteric pathogens, particularly rotaviruses, and perhaps nutritional deficiencies and other factors.