Persistent Poliovirus Transmission: A Hierarchical Consilient One Health Framework

Despite decades of eradication efforts, poliovirus transmission persists and may re-emerge in settings where biological, environmental, infrastructural, institutional and social vulnerabilities converge. This persistence reflects not only gaps in vaccination or surveillance, but also the interaction between structural conditions and the intrinsic biological strategies that support poliovirus survival, replication and silent circulation, including acid stability, immune-response modulation and IRES-dependent translation of uncapped RNA. We propose a hierarchical consilient framework within the One Health approach that organises established determinants according to causal depth: primary structural drivers, psychosocial and institutional mediators, surveillance signals and dependent epidemiological outcomes. By linking these interacting levels primarily to the persistence of poliovirus transmission, the model clarifies why interventions targeting isolated components may achieve only temporary control without modifying the wider causal system. The framework supports coordinated, context-specific combinations of vaccination, environmental surveillance, sanitation measures, risk communication and community engagement. As a conceptual proposal, it requires local validation, calibration and operational testing before implementation.