The Global Polio Eradication Initiative, the largest public health campaign ever launched, began in 1988 with the ambition of achieving its goal by the year 2000. In the decade since this deadline was missed, the initiative has suffered a number of setbacks, notably in the tropical world. Four major types of problems have impeded the eradication effort: operational, biological, political and religious. Northern Nigeria offers a case study of all of these factors, with domestic political and religious conflict, unsanitary conditions, and suspicion of Western medicine all undermining the anti-polio campaign. One of the questions raised by the campaign’s struggle is whether or not eradication is itself a realistic public health goal, and to what extent smallpox furnishes a model precedent or a potentially misleading dream scenario.