IN the global fight against polio, Pakistan has long been a stubborn holdout. In 2024, the situation only worsened. In the outgoing year, the country recorded 67 cases of the paralytic virus — more than a tenfold increase from 2023’s six cases. This surge, that has global health officials alarmed, threatens to unravel decades of painstaking progress toward eradication.

The geography of infection reveals a widespread vulnerability in the country’s immunisation infrastructure. Balochistan, Pakistan’s largest and least developed province, reported 27 cases. Khyber Pakhtunkhwa and Sindh followed with 19 each. Punjab, despite its better infrastructure, recorded one case. Even Islamabad, the relatively prosperous capital, did not escape unscathed.

The inability to vaccinate every child remains at the core of the problem. Approximately 60 per cent of the children affected in 2024 had not received even a single dose of the oral polio vaccine. This points to big gaps in outreach efforts, particularly in remote and underserved areas. The Independent Monitoring Board revealed in September that over four million planned vaccinations were missed in 2024 alone. It further revealed that the pressure to meet vaccination targets has fostered unethical practices such as fake finger-marking and concealing unvaccinated children. Such practices compromise the accuracy of immunisation data and undermine efforts, particularly in high-risk areas like KP and Balochistan. On top of this, logistical issues, such as maintaining the cold chain for vaccine storage and distribution, are still a hurdle in many parts of the country.

Threat of violence

Adding to these challenges is the unrelenting threat of violence against polio workers. In Balochistan’s Mastung district, a bomb attack in November targeted a police vehicle on its way to escort polio vaccinators, killing nine people, including five children. Similar incidents occurred in KP, where health workers and their security escorts were targeted by militant groups leading to the deaths of 20 people. The perpetrators draw strength from conspiracy theories that permeate communities across the country, casting vaccination campaigns as Western plots.

The inability to vaccinate every child remains at the core of the problem.

Alarmingly, hostility towards polio workers is not limited to militant groups. In some instances, local families and individuals have also resorted to violence against vaccination teams. In December 2024, a polio team in Karachi’s Korangi district was attacked by a family when they insisted they must administer the vaccine. The confrontation resulted in injuries to three health workers. These attacks, though less publicised than those by militants, are equally disruptive and demoralising for the health workers on the ground.

Misinformation remains another formidable obstacle in the fight against polio. In Sindh, over 43,000 cases of vaccine refusal were reported in a single month. This highlights the critical need for effective communication strategies to counteract false information and encourage vaccination. In many communities, parents, influenced by baseless rumours that the vaccine causes infertility or contains ingredients forbidden by religious edicts, deny their children the essential protection. While national media campaigns occasionally highlight the importance of immunisation, these efforts often fail to engage local influencers or address the cultural nuances that drive vaccine hesitancy. As a result, polio continues to find refuge in areas where ignorance outweighs scientific evidence.

Coordination between the federal and provincial governments also remains a pressing issue without which the effectiveness of vaccination campaigns and the overall strategy remain compromised. The decision to delegate the anti-polio programme to external global health agencies in 2021 is believed to have worsened the situation, underscoring the necessity for unified efforts within the country’s health infrastructure.

The government’s efforts to combat polio, while appreciable, appear insufficient. In 2024, multiple nationwide immunisation campaigns were launched, aiming to vaccinate over 45m children. PM Shehbaz Sharif endorsed the National Emergency Action Plan for Polio 2024-2025, which sought to strengthen outreach and improve coordination with international stakeholders. Special focus was placed on cross-border collaboration with Afghanistan to curb the virus’s spread. However, the execution of these initiatives left much to be desired. Security measures for health workers remained reactive rather than proactive, and the logistical shortcomings persisted, especially in the country’s most vulnerable regions.

Way forward

What is to be done? First and foremost, the safety of health workers must be prioritised. Deploying well-trained security personnel and utilising technology such as GPS tracking and emergency alert systems could mitigate risks in high-threat areas. Secondly, the fight against misinformation requires a nuanced approach. Engaging religious leaders, local influencers, and community elders in awareness campaigns can help counteract myths and build trust in the vaccine. Tailored public service messages that resonate with specific communities are essential to dismantle the barriers of mistrust. Improving vaccine coverage must also be a priority. Investing in cold chain infrastructure and training health workers to navigate remote terrain can ensure that no child is left unvaccinated. Joint efforts with Afghanistan, including synchronised immunisation campaigns in border regions, could significantly reduce cross-border transmission. Additionally, institutional transparency and accountability are critical. Regular audits and independent evaluations of the polio programme can identify weaknesses and drive reforms where needed.

This crisis presents an opportunity to refine strategy and recommit to eradication. The dedication of Pakistan’s health workers, who risk their lives daily, deserves matching political resolve and international support. Yet the stakes extend beyond Pakistan’s borders. As one of the last reservoirs of wild poliovirus, the country’s failure threatens global eradication efforts. The world has eliminated smallpox and nearly vanquished polio. Pakistan’s stumbles risk squandering this progress. The virus’s resurgence in 2024 should serve as a wake-up call and we must answer it.

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