Global efforts to eradicate polio have led to the elimination of two of the three wild poliovirus (WPV) serotypes, leaving only WPV type 1 (WPV1) endemic in Afghanistan and Pakistan. From January 2022 to December 2023, 12 WPV1 cases were reported in these two countries, a decrease from 22 in 2022. Environmental surveillance detected WPV1 in 13 provinces in 2023, compared to seven in 2022. Circulating vaccine-derived polioviruses (cVDPVs) decreased from 881 in 2022 to 524 in 2023, with outbreaks occurring in 32 countries, including eight that did not experience outbreaks in 2022. Despite reductions in paralytic polio cases, cVDPV and WPV1 cases were more geographically widespread in 2023. Continued efforts to vaccinate persistently missed children, strengthen routine immunization programs, and improve cVDPV outbreak responses are necessary for further progress toward global polio eradication. In 2023, 119 supplementary immunization activities (SIAs) were conducted in 30 countries, with over 675 million doses of bivalent oral poliovirus vaccine (bOPV) administered. However, production by a single manufacturer led to vaccine supply shortages. Environmental surveillance (ES) detected poliovirus in sewage samples, supplementing AFP surveillance. In 2023, 15,886 ES samples were tested, an increase from 14,498 in 2022. WPV1 cases were detected in 13 provinces in 2023, compared to seven in 2022. cVDPV cases decreased by 41%, with outbreaks reported in 32 countries, including eight new countries. Despite planned outbreak responses, 24 countries with cVDPV detections in 2022 failed to stop outbreaks, indicating persistent missed children during SIAs. The Global Polio Eradication Initiative (GPEI) has not yet interrupted all poliovirus transmission. Continued efforts to increase immunization coverage, improve surveillance, and ensure vaccine supply are critical to achieving polio eradication. Challenges include ongoing security issues in Afghanistan and Pakistan, and vaccine supply shortages for cVDPV2 outbreaks. Alternative strategies are needed in areas with prolonged outbreaks and access issues. Improving vaccine supply and outbreak response is essential to interrupting poliovirus transmission and achieving global eradication.Global efforts to eradicate polio have led to the elimination of two of the three wild poliovirus (WPV) serotypes, leaving only WPV type 1 (WPV1) endemic in Afghanistan and Pakistan. From January 2022 to December 2023, 12 WPV1 cases were reported in these two countries, a decrease from 22 in 2022. Environmental surveillance detected WPV1 in 13 provinces in 2023, compared to seven in 2022. Circulating vaccine-derived polioviruses (cVDPVs) decreased from 881 in 2022 to 524 in 2023, with outbreaks occurring in 32 countries, including eight that did not experience outbreaks in 2022. Despite reductions in paralytic polio cases, cVDPV and WPV1 cases were more geographically widespread in 2023. Continued efforts to vaccinate persistently missed children, strengthen routine immunization programs, and improve cVDPV outbreak responses are necessary for further progress toward global polio eradication. In 2023, 119 supplementary immunization activities (SIAs) were conducted in 30 countries, with over 675 million doses of bivalent oral poliovirus vaccine (bOPV) administered. However, production by a single manufacturer led to vaccine supply shortages. Environmental surveillance (ES) detected poliovirus in sewage samples, supplementing AFP surveillance. In 2023, 15,886 ES samples were tested, an increase from 14,498 in 2022. WPV1 cases were detected in 13 provinces in 2023, compared to seven in 2022. cVDPV cases decreased by 41%, with outbreaks reported in 32 countries, including eight new countries. Despite planned outbreak responses, 24 countries with cVDPV detections in 2022 failed to stop outbreaks, indicating persistent missed children during SIAs. The Global Polio Eradication Initiative (GPEI) has not yet interrupted all poliovirus transmission. Continued efforts to increase immunization coverage, improve surveillance, and ensure vaccine supply are critical to achieving polio eradication. Challenges include ongoing security issues in Afghanistan and Pakistan, and vaccine supply shortages for cVDPV2 outbreaks. Alternative strategies are needed in areas with prolonged outbreaks and access issues. Improving vaccine supply and outbreak response is essential to interrupting poliovirus transmission and achieving global eradication.