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Why do we not, then, use inactivated polio vaccines for routine immunisation in childhood? Parents would not need to be immunised at the same time as their child; and the current inactivated polio vaccines (improved considerably compared with the earliest examples) induce reliable and lasting immunity and are safe. Moreover, in the Netherlands the vaccine has virtually eliminated the disease,9 except in certain antivaccine religious groups. The answer lies in our relatively poor uptake rates for polio vaccine. At present only about 80% of infants, on average, complete a course of live attenuated oral vaccine; and to be effective nationally, inactivated polio vaccine probably needs the high levels of more than 9000 achieved in northern Europe. Therein lies our dilemma with polio vaccination: unless we can increase routine immunisation rates in childhood substantially, we will have to continue to persevere with live attenuated oral vaccine, which has been highly successful in Britain, and to accept the occasional case of vaccine-associated paralytic poliomyelitis that goes with it. NORMAN D NOAH