A plan to rid the world of polio by the end of next year is "off track", say international experts.
India is praised for having had just one case of polio in the first six months of this year.
But the report by independent monitors warns that Pakistan "risks becoming the last global outpost of this vicious disease". It has also resurfaced in four other countries.
There were around 1,000 cases of polio worldwide last year.
The virus remains present in Afghanistan, India, Nigeria and Pakistan and in the countries where it has resurfaced, there have been twice as many cases - 162 - as there were in the endemic countries.
The experts are particularly concerned about new cases in the Democratic Republic of Congo and Chad.
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Tackling the remaining 1% of polio is the greatest challenge yet.”
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Sir Liam Donaldson
Independent Monitoring Board
'Vicious disease'
England's former chief medical officer, Sir Liam Donaldson, is leading the board monitoring the efforts of the Global Polio Eradication Initiative, which works to support the goal set in 1988.
Sir Liam said: "Polio is a very resilient disease. There was a big impact in tackling it in the first two decades since the goal.
"But we still have this very big rump of cases left behind. Tackling the remaining 1% of polio is the greatest challenge yet.
"India has done something simple - it's run very high quality vaccination campaigns. They have public health leaders who are meticulous in making sure every child is vaccinated.
"If they can do it, why can't other countries?"
Polio is highly infectious - and tends to strike children aged under five. It invades the nervous system, leading to irreversible paralysis.
There is no cure, but a vaccine of mouth droplets can give good protection.
Untrained vaccinators
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It is alarming and bad for morale that there are still surprise outbreaks.”
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Independent Monitoring Board
Sir Liam and his colleagues say strong political and community leadership is important in the countries with polio outbreaks. They also identify a funding gap of £366m.
The report highlights problems that occur within some vaccination programmes. In one part of Pakistan, paid vaccinators had sub-contracted their tasks to untrained children.
And in another campaign, the vaccinators stood passively at their post in the town square, rather than mingling with the crowds and encouraging immunisation.
The monitoring board said: "Our view remains that stopping polio transmission needs to be treated as a global health emergency.
"Fourteen countries have had polio outbreaks since the start of 2010. It is alarming and bad for the programme's morale that there are still these surprises.
"Polio eradication is still possible in the near-term if there is enhanced political commitment, secure funding and strengthened technical capacity."
Rotary International, which is part of the Eradication Initiative, said: "We welcome this frank assessment of the programme.
"We will work with our members in countries affected by polio to follow the board's recommendation of creating a checklist, to enhance the impact of the immunisation teams and ensure standardisation."
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