Nepal recognized childhood immunization as a cost effective health intervention and established the National Immunization Program. Nepal introduced the Expanded Program on Immunization in 1979 starting with three antigens in three districts, later expanding nationwide to include six antigens including polio vaccines by 1988-89. Wild polio cases in Nepal declined from 1999 to 2009 according to UNICEF. India reported the majority of polio cases in the South East Asia Region (SEAR) in 2009 and 2008, concentrated in Uttar Pradesh and Bihar. Currently, only four countries including Nigeria, India, Pakistan and Afghanistan remain polio endemic areas, down from over 125 countries in 1988 when the Global Polio Eradication Initiative was established.