In an October 2011 report, the Independent Monitoring Board (IMB), an oversight body for the Global Polio Eradication Initiative, said that GPEI may never eradicate polio without fundamental changes in a culture and management style the board characterized as insular, stuck in old habits, averse to criticism, and resistant to innovation. The report jolted a program that for 2 decades has struggled to rid the world of poliovirus. Most agree that the report was instrumental in reinvigorating a program that was years behind schedule and billions of dollars over budget. In June 2012, with polio cases at an all-time low, IMB said "the Programme has broken free of its decade-long stagnation." But, the board warned, these gains were fragile, and failure was still possible.

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