Characterization of environmental and clinical surveillance inputs to support prospective integrated modeling of the polio endgame

National, regional, and global poliovirus surveillance needs continue to expand and evolve. The 1988 global resolution to eradicate polio necessitated the creation and support for a global poliovirus surveillance system able to identify poliovirus transmission anywhere and everywhere. Clinical surveillance of patients that present with acute flaccid paralysis (AFP) became an essential tool, and the need for standardized laboratory methods to detect polioviruses isolated from stool samples of AFP patients led to the development of the Global Poliovirus Laboratory Network (GPLN) in 1990. Relatively recently, the GPLN expanded to include environmental surveillance to obtain additional information about poliovirus transmission in some geographies and to increase confidence about the absence of poliovirus transmission after successful eradication and/or the cessation of use of live-attenuated oral poliovirus vaccines (OPVs). Historical polio eradication strategic plans anticipated that successful global poliovirus eradication would lead to reduced requirements for financial investments for a poliovirus-specific surveillance system, and consequent transition of capacity and resources into integrated national disease surveillance systems. However, given the state of the polio endgame with ongoing transmission in several geographies, current global strategic plans include poliovirus-specific surveillance for the foreseeable future. In addition, the development and expansion of genetic testing technologies create new opportunities for poliovirus surveillance system designs. The expected growth (instead of decline) of poliovirus surveillance needs as of 2024, as well as innovations in laboratory technologies and expansion wastewater sampling, raise questions about the tradeoffs of different options and the future of poliovirus surveillance. This descriptive review of poliovirus surveillance evidence as of late 2024 aims to provide national, regional, and global decision makers with an understanding of prospective tradeoffs and uncertainties and to support prospective assumptions relevant for integrated policy, poliovirus transmission, and economic modeling for 2024–2035.