Review of: "Integrated Determinants of Persistent Wild Poliovirus Transmission in Pakistan and Afghanistan: The Roles of Cross-Border Mobility, Hard-to-Reach Populations, and Micro-Transmission Hotspots, 2010-2025"

This paper is a strong and important review that looks at why wild poliovirus type 1 is still spreading in Pakistan and Afghanistan.The topic is highly relevant because these two countries are the last places in the world where polio has not been eliminated.The authors clearly explain that polio continues not because of one single problem, but because several issues happen together.These include frequent movement of people across the border, groups of children who are repeatedly missed by vaccines, and small areas where the virus continues to spread quietly.The review brings together evidence from many sources, such as genetic studies, environmental surveillance, vaccination data, and program reports, which makes the conclusions convincing and easy to follow.The paper also does a good job explaining what this means for polio eradication efforts.It shows that high national vaccination numbers can hide local gaps where children are not protected.The authors suggest practical solutions, such as better coordination between Pakistan and Afghanistan, focusing more on mobile and hard-to-reach communities, improving environmental surveillance, and strengthening routine immunization services.Overall, the study is well-written, thoughtful, and suitable for publication, and it can be very useful for policymakers and public health workers working to nally end polio.A few areas could be improved, such as being clearer about when ndings show association rather than cause and simplifying some repeated points like Qeios qeios.com