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The areas in particular need of strengthening were national preparedness plans, initial response, plans for securing vaccine supply, and communications. Polio outbreak simulation exercises can be valuable tools to help maintain polio-free status and should be extended to other high-risk countries and subnational areas in the HoA Region and elsewhere. There is also need to standardize the process and methods for conducting POSE for comparability. Polio outbreak simulation exercises can be valuable tools to help maintain polio-fre