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A public health catch-22 In 2016, the serotype 2 component of the oral poliovirus vaccine given to children was withdrawn. This measure was taken to prevent vaccine-associated disease outbreaks caused by mutation in the live attenuated vaccine. Children around the world now have poor immunity to serotype 2 poliovirus because the inactivated vaccine is far less effective and a new oral vaccine is not yet ready. Using a statistical model, Macklinet al. discovered that most current outbreaks of polio in several countries across Asia and sub-Saharan Africa are likely associated with the serotype 2 vaccine strain (see the Perspective by Donlan and Petri). To block transmission when poliovirus outbreaks occur requires deployment of the only tool in the box: the existing live attenuated serotype 2 oral vaccine, which increases the risk of vaccine-derived disease.Science , this issue p.401 ; see also p.362

Evolving epidemiology of poliovirus serotype 2 following withdrawal of the serotype 2 oral poliovirus vaccine