The inability to vaccinate all children remains at the heart of the problem.
In the global fight against polio, Pakistan has long been a stubborn holdout. In 2024, the situation only got worse. In the outgoing year, the country recorded 67 cases of the crippling virus, more than ten times more than the six cases in 2023. This increase, which has alarmed health officials globally, threatens to undo decades of painstaking progress toward eradication.
The geography of the infection reveals widespread vulnerability in the country’s immunization 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, was not unscathed.
The inability to vaccinate all children remains at the heart of the problem. Approximately 60 percent of affected children in 2024 had not received a single dose of the oral polio vaccine. This indicates large gaps in outreach efforts, particularly in remote and underserved areas. The Independent Monitoring Board revealed in September that more than four million planned vaccinations were missed in 2024 alone. He further revealed that the pressure to meet vaccination targets has encouraged unethical practices such as fake finger marking and hiding unvaccinated children. Such practices compromise the accuracy of immunization data and undermine efforts, particularly in high-risk areas like KP and Balochistan. In addition to this, logistical issues such as maintaining the cold chain for vaccine storage and distribution remain a hurdle in many parts of the country.
Threat of violence
Adding to these challenges is the relentless threat of violence against polio workers. In November, in Balochistan’s Mastung district, a bomb attack targeted a police vehicle on its way to escort polio vaccinators, killing nine people, including five children. Similar incidents occurred in KP where healthcare workers and their security escorts were attacked by militant groups resulting in the death of 20 people. Perpetrators draw strength from conspiracy theories that permeate communities across the country, presenting vaccination campaigns as Western plots.
The inability to vaccinate all children remains at the heart of the problem.
Alarmingly, hostility toward anti-polio workers is not limited to militant groups. In some cases, local families and individuals have also resorted to violence against vaccination teams. In December 2024, an anti-polio team in Karachi’s Korangi district was attacked by a family when they insisted that they must administer the vaccine. The confrontation left three health workers injured. These attacks, although less publicized than those by militants, are equally disturbing and demoralizing for health workers on the ground.
Misinformation remains another formidable obstacle in the fight against polio. In Sindh, more than 43,000 cases of vaccine refusal were reported in a single month. This highlights the critical need for effective communication strategies to counter misinformation and encourage vaccination. In many communities, parents, influenced by unfounded rumors that the vaccine causes infertility or contains ingredients prohibited by religious edicts, deny their children essential protection. While national media campaigns occasionally highlight the importance of immunization, 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 polio program to external global health agencies in 2021 is believed to have worsened the situation, underscoring the need for unified efforts within the country’s health infrastructure.
The government’s efforts to combat polio, although appreciable, appear insufficient. In 2024, multiple vaccination campaigns were launched nationwide, with the goal of vaccinating more than 45 million children. Prime Minister Shehbaz Sharif endorsed the National Polio Emergency Action Plan 2024-2025, which sought to strengthen outreach and improve coordination with international stakeholders. Special attention was paid to cross-border collaboration with Afghanistan to curb the spread of the virus. However, the execution of these initiatives left much to be desired. Safety measures for healthcare workers remained reactive rather than proactive, and logistical deficiencies persisted, especially in the most vulnerable regions of the country.
Way forward
What needs to be done? First and foremost, the safety of healthcare workers must be prioritized. Deploying well-trained security personnel and utilizing technology such as GPS tracking and emergency alert systems could mitigate risks in high-threat areas. Second, combating disinformation requires a nuanced approach. Engaging religious leaders, local influencers, and community elders in awareness campaigns can help counter myths and build confidence in the vaccine. Personalized public service messages that resonate with specific communities are essential to dismantling the barriers of mistrust. Improving vaccination 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 synchronized immunization campaigns in border regions, could significantly reduce cross-border transmission. Furthermore, institutional transparency and accountability are essential. Regular audits and independent evaluations of the polio program can identify weaknesses and drive reforms where necessary.
This crisis presents an opportunity to refine strategy and renew commitment to eradication. The dedication of Pakistan’s health workers, who risk their lives every day, deserves equal political determination and international support. However, the stakes extend beyond Pakistan’s borders. As one of the last reservoirs of the wild poliovirus, the country’s failure threatens global eradication efforts. The world has eliminated smallpox and almost defeated polio. Pakistan’s missteps risk squandering this progress. The resurgence of the virus in 2024 should serve as a wake-up call and we must respond to it.
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