Pakistan, Afghanistan, and Nigeria are all states where Islamist extremists operate, interrupting processes of governance and challenging or blocking polio vaccination programs. The countries where polio has re-emerged are also areas of high Islamist activity, and the link between Islamism and polio often appears overt. Because of this correlation with religious extremism, it is easy to blame religion for the failure to eradicate polio in countries beset by Islamist violence. The correlation has also induced advocates of vaccination to look for religious solutions to the problem. But religion is not always at the heart of the problem. Just as much of an issue, if not more of one, is geopolitics.