Billionaire software baron turned philanthropist Bill Gates has warned that violence in Nigeria and Pakistan could set back his goal of eradicating polio by 2018.
Last year, the Bill and Melinda Gates Foundation - a charity that funds medical research and vaccination drives - made wiping out the crippling disease in the next six years its priority.
But the Microsoft founder, who has poured a large part of his fortune, said in an AFP interview on Tuesday that major challenges remain.
India, which once had the world's worst record of polio - a mainly childhood disease that causes the wasting of the limbs - has just celebrated three years free of the disease.
But it remains endemic in Afghanistan, Nigeria and Pakistan.
There are also reinfections in war-torn Somalia and Syria that threaten to break out into areas once free of the scourge.
Gates complained that local conspiracy theories had undermined inoculation drives.
"The vaccine is to help kids. And spreading rumours and attacking the workers on this - those people don't have justice and truth on their side.
"And so we may miss by a year or two if we can't help out with that. The president, the religious leaders and a lot of the supporters of that country are trying to get the truth out."
Hours before Gates spoke, three polio workers were shot dead in the Pakistani city of Karachi, forcing the suspension of vaccination in the southern province of Sindh.
Last week the World Health Organization (WHO) warned that Pakistan's northwestern city of Peshawar was the world's "largest reservoir" of the disease.
Opposition from the Pakistani Taliban to immunisation and an Islamist insurgency in northern Nigeria have also hit hard.
In November the Global Polio Eradication Initiative said Nigeria had 51 of the 328 cases of the disease worldwide in 2013, compared with 121 out of 223 in 2012.
But numbers are up in Pakistan. According to the WHO, Pakistan recorded 91 cases of polio last year compared with 58 in 2012.
"Even in Pakistan it's somewhat of an increase but still small numbers so we're very close," Gates told AFP.
"We'll have the money. I think we've got the will. We need -- on the ground -- to get the truth out," Gates said.
The 58-year-old Harvard dropout, with a net worth of more than $US70 billion ($A79.7 billion), promises to give away all his money within 20 years of the death of either him or his wife.
On Tuesday his Foundation published its annual letter disputing three myths that hinder progress: that poor countries stay poor, foreign aid is pointless and saving lives inflates populations.
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