India has continued to report cases of wild poliovirus and acute flaccid paralysis throughout the 2000s. Indeed, in 2009 the numbers of both exceeded the totals for 2008, by 26% and 9.5%, respectively. Confirmed wild poliovirus cases are increasingly concentrated amongst Muslim children and localised in western Uttar Pradesh and Bihar. The Pulse Polio Initiative has responded by pressurising parents into complying with the administration of multiple doses of polio vaccine to their children. But almost all new cases occur among children who have been vaccinated many times. The problems inhere in the weaknesses of government health services and in the PPI's inadequacies and errors: a focused top-down programme using the wrong vaccine and with dubious targets. It has lost its way and requires a radical shake-up.