Pakistan’s Polio Eradication: Reaching Every Child

Pakistan’s polio eradication effort depends on more than polio vaccine campaigns. Build public trust, strengthen routine immunization, protect health workers and reach every child through inclusive healthcare and cross-border cooperation.

PUBLIC HEALTH ECONOMICS

Shama Zahra

11/11/2026

white and green syringe on white surface

In 1988, the world made an ambitious promise: to eliminate polio forever. More than three decades later, that promise remains unfulfilled, with Pakistan and Afghanistan standing as the last countries where wild poliovirus continues to circulate. For Pakistan, a country of more than 240 million people, the persistence of a preventable disease that has disappeared from almost every other part of the world represents a serious public health challenge.

The global campaign has achieved remarkable progress. Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, reported polio cases worldwide have declined by more than 99 per cent, from an estimated 350,000 annually to only a small number. Two of the three wild poliovirus strains have been eradicated: type 2 in 1999 and type 3 in 2012. However, wild poliovirus type 1 remains active in Pakistan and Afghanistan, where population movement across their shared border creates opportunities for continued transmission.

Pakistan’s experience reflects both significant achievements and recurring setbacks. Door-to-door vaccination campaigns began in 1994, targeting children under five. Although cases declined substantially, progress was interrupted by renewed outbreaks. Pakistan reported 147 confirmed cases in 2019, followed by a dramatic reduction to just one case in 2021. This raised hopes that eradication was within reach. However, the country recorded 20 cases in 2022, and new infections reappeared in 2024, including in Dera Bugti, Balochistan, despite nationwide campaigns reaching more than 45 million children.

These setbacks highlight the real difficulty of eradication. Pakistan’s challenge is not simply a shortage of vaccination campaigns or resources. The virus survives in the gaps where children are repeatedly missed, communities resist immunisation, insecurity restricts access and health services remain inadequate. Closing these gaps requires sustained vaccination, community trust and stronger local health systems. Until every child is protected, the threat of polio will remain.

Three Barriers, One Problem

Pakistan’s struggle to eradicate polio is driven by three interconnected barriers: vaccine hesitancy, insecurity and limited access, and weaknesses in campaign delivery. Together, these challenges allow the virus to survive despite repeated vaccination efforts.

The first barrier is vaccine hesitancy and outright refusal, often rooted in religious beliefs, cultural perceptions and mistrust of government-led campaigns. In some communities, vaccines are viewed as part of a foreign conspiracy to sterilise Muslim children. Such suspicions were reinforced by the CIA’s use of a fake hepatitis vaccination campaign during the search for Osama bin Laden in 2011. Religious fatalism, anti-Western sentiment and beliefs in divine healing can further discourage immunisation. Household decision-making also matters. Although mothers usually interact with vaccination teams, fathers often have the final say. Meanwhile, Lady Health Workers, who play a critical frontline role, may encounter hostility, intimidation and even violence.

The second barrier is insecurity and unequal access. In Khyber Pakhtunkhwa, an estimated 400,000–500,000 children are repeatedly missed during nationwide campaigns. Coverage also varies considerably: one survey reported three-dose oral polio vaccine coverage of 94.9 per cent in Punjab, compared with only 45.1 per cent in Balochistan. Security threats further restrict access, while attacks have claimed the lives of more than 70 polio workers since 2012, making vaccination work exceptionally dangerous.

The third barrier concerns campaign quality and weaknesses in routine health services. One analysis found that 29 per cent of children who missed doses were not visited by vaccinators in their assigned areas. Moreover, campaigns often operate separately from everyday healthcare, creating the perception that government teams appear only to administer polio drops while basic needs such as clean water, medicines and electricity remain unmet.

These barriers reinforce one another. Eradication requires not only repeated vaccination but also community trust, secure access, accountable campaign delivery and stronger local health services.

Learning from Global Success: A Coordinated Path to Polio Eradication

Countries that have eliminated wild poliovirus offer important lessons for Pakistan. Nigeria, certified free of wild poliovirus in 2020, achieved this milestone through sustained immunisation, community engagement and coordination across government institutions and development partners. However, the country continues to face vaccine-derived poliovirus outbreaks in underserved communities, demonstrating that surveillance and vaccination must continue even after wild-virus elimination. Germany, which reported its last wild polio case in 1990, also benefited from consistent vaccination and coordinated public health services. These experiences highlight the importance of reliable health systems, public confidence and sustained political commitment.

Pakistan’s progress has also been disrupted by emergencies. The COVID-19 pandemic interrupted vaccination activities in 2020, while the devastating 2022 floods displaced millions of people and disrupted healthcare delivery. Such interruptions leave children without essential doses and create opportunities for the virus to spread. Protecting routine immunisation during emergencies must therefore become a central part of Pakistan’s eradication strategy.

Pakistan has established an extensive institutional framework to address the challenge. Polio was declared a public health emergency in 2011, followed by the creation of a National Emergency Operations Centre and coordination committees at provincial, district and union council levels. These arrangements have strengthened planning, monitoring and accountability. Nevertheless, administrative structures cannot guarantee success if children continue to be missed. The Global Polio Eradication Initiative’s Independent Monitoring Board reported that more than 420,000 children remained unvaccinated during the 2024 campaigns, highlighting the gap between programme planning and implementation.

The way forward must begin with communities. Religious scholars, local leaders and trusted health workers should help address misinformation and explain vaccination through culturally appropriate messages. Female health workers need proper training, recognition and protection. Their engagement is particularly important in households where mothers interact with vaccinators but other family members influence immunisation decisions.

Polio vaccination should also be integrated with routine healthcare, including maternal and child health services, nutrition and sanitation initiatives. When communities receive broader health support, vaccination campaigns become more credible and accessible. Operational weaknesses must be addressed through better-trained vaccinators, timely deployment, reliable supervision, accurate monitoring and improved surveillance. Special attention is needed for remote and conflict-affected areas, where flexible outreach arrangements and community-based security support can help reach vulnerable children.

Finally, regional cooperation is essential. Pakistan and Afghanistan share a border, mobile populations and the continuing risk of poliovirus transmission. Coordinated vaccination campaigns, information sharing, cross-border surveillance and sustained diplomatic engagement are therefore indispensable. Polio eradication will require more than repeated campaigns: it demands public trust, dependable health services, political commitment and cooperation across communities and borders. Pakistan can fulfil the global promise, but only when every child is reached and protected.

Conclusion

Pakistan’s struggle to eradicate polio is no longer simply a question of vaccine availability or campaign frequency; it is a challenge of reaching every child, building public confidence and ensuring reliable healthcare delivery. Vaccine hesitancy, insecurity, missed households and weaknesses in routine health services continue to create opportunities for the virus to survive. International experience demonstrates that sustained immunisation, community participation and strong institutional coordination are essential for success. Pakistan must therefore move beyond campaign-based responses towards a more inclusive and dependable public health system. Engaging religious and community leaders, protecting frontline health workers, integrating vaccination with essential healthcare and improving access in underserved areas should become national priorities. Cooperation with Afghanistan is equally important because poliovirus does not recognise national borders. Eradicating polio will require consistent political commitment, public trust and shared responsibility. Protecting every child is not merely a vaccination target; it is a national obligation and a promise to future generations.

Please note that the views expressed in this article are of the author and do not necessarily reflect the views or policies of any organization.

The writers are affiliated with the Department of Epidemiology and Public Health, University of Agriculture, Faisalabad, Pakistan and can be reached at shamazahra30@gmail.com

Pakistan’s Polio Eradication: Reaching Every Child

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