"We're not done but we're certainly in by far the best situation we've ever been in," Gates told reporters in Islamabad on the possibility of eliminating polio in Pakistan and globally.

The Bill & Melinda Gates Foundation, of which Gates is co-chair, is part of the Global Polio Eradication Initiative (GPEI), a major project between governments and international organisations.

Pakistan, along with neighbouring Afghanistan, is one of two countries in the world where polio continues to circulate.

Gates, with Pakistan's Special Assistant to the Prime Minister on Health, Faisal Sultan, told reporters that the two neighbouring countries' polio eradication efforts were interlinked.

They said there was a real possibility of eliminating polio in practice in the next few years, but the outcome was uncertain, particularly given the situation in Afghanistan where the Taliban took control in August.

"I think the steps taken in Pakistan during 2022 will probably set us up to finish polio eradication," Gates said.

"Afghanistan is a little bit of a question mark because that's a more complex situation," he said, but noted vaccination rates had gone up this year after dropping off since 2018, though needed to be higher.

Sultan said Pakistan was engaging with the Taliban administration health authorities.

"We ... have ongoing conversations to make sure that a synchronised campaign for eradication ... because when you look at our two countries (they) are adjacent to each other and ... tightly linked," he said.

No children have been paralysed by wild polio in Pakistan in more than a year, according to the Gates Foundation, but the virus was detected in December in sewerage samples in Khyber Pakhtunkhwa province.

Four wild polio cases were reported in Afghanistan in 2021 and one this year, according to GPEI.

Pakistan President Arif Alvi conferred the award of Hilal-e-Pakistan, the country's second-highest civilian award, to Gates at an investiture ceremony.

(Reporting by Charlotte Greenfield; Editing by David Holmes)

By Charlotte Greenfield