The recent confirmation of two more polio cases—one in Tank district of Khyber Pakhtunkhwa (KP) and another in Shikarpur, Sindh—has pushed Pakistan’s 2025 tally to 21, serving as a grim reminder that the fight against this debilitating disease is ongoing and fraught with obstacles.
Just weeks earlier, a case in Lakki Marwat, also in KP, had already heightened concerns, underscoring how polio continues to lurk in vulnerable pockets despite concerted efforts. This ancient virus, which can cause irreversible paralysis in children, remains a public health scourge in Pakistan, one of only two countries—alongside Afghanistan—where wild poliovirus type 1 (WPV1) is still endemic. As we mark over three decades since the launch of global eradication initiatives, Pakistan’s struggle highlights the complex interplay of social, security, and logistical challenges that have allowed the virus to persist.
Polio, or poliomyelitis, has plagued humanity for centuries, but the advent of effective vaccines in the mid-20th century transformed it from a widespread terror to a near-eradicated threat. The Global Polio Eradication Initiative (GPEI), established in 1988 by the World Health Organization (WHO), UNICEF, Rotary International, and other partners, aimed to wipe out the disease worldwide. At its peak in the 1980s, polio paralyzed more than 350,000 children annually across 125 countries. Today, thanks to massive vaccination drives, that number has plummeted by over 99%, with cases confined largely to Pakistan and Afghanistan. In Pakistan, the journey began earnestly in the 1990s, with the government launching the Expanded Programme on Immunization (EPI) and supplementary campaigns to reach every child. Billions of dollars in international aid, including from the Bill & Melinda Gates Foundation, have flowed in, supporting door-to-door vaccinations and surveillance systems.
Yet, despite these investments, Pakistan reported 99 cases in 2024, a sharp rise from just one in 2021, before climbing to 21 so far in 2025. The virus thrives in under-vaccinated areas, particularly the tribal regions of KP and Balochistan, where environmental samples from sewage often detect poliovirus circulation even when no clinical cases are apparent. This “silent transmission” allows the virus to spread undetected, infecting children who miss out on routine immunizations. Factors like poor sanitation, high population density, and cross-border movement with Afghanistan exacerbate the problem, creating a vicious cycle that’s hard to break.
At the heart of the resistance lies a web of misinformation and distrust. In many communities, especially in conservative tribal belts, rumors persist that polio vaccines are a Western plot to sterilize Muslim children or contain harmful substances like pork derivatives, which clash with religious beliefs. These conspiracy theories gained traction during the early 2010s, partly fueled by the CIA’s fake vaccination campaign to track Osama bin Laden, which eroded public confidence. Religious misconceptions, often amplified by local clerics, portray vaccines as un-Islamic, leading to outright refusals. In some areas, parents demand bribes or infrastructure improvements before allowing their children to be vaccinated, viewing campaigns as leverage for unmet needs.
Security threats compound these issues, turning a health mission into a high-stakes operation. Over the past decade, more than 200 polio workers and their security escorts have been killed in targeted attacks by militants, including the Taliban, who view vaccination teams as spies or symbols of government intrusion. Women, who make up a significant portion of the vaccination workforce due to their ability to access households, bear the brunt of this violence. These “lady health workers” traverse rugged terrains, often on foot, to administer oral polio vaccine (OPV) drops, but the constant fear of ambushes has led to hesitancy. In high-risk zones like North and South Waziristan, campaigns are frequently suspended, leaving gaps in coverage. Tragically, some vaccinators resort to “finger-marking” without vaccinating—inking a child’s finger to simulate completion—to evade confrontation, perpetuating the virus’s spread.
The human cost is heartbreaking. Polio primarily affects children under five, causing fever, fatigue, and in severe cases, permanent limb paralysis. Survivors like young Ahmed from Bannu, KP, who contracted polio in 2023, face lifelong disabilities, relying on crutches and facing social stigma. Families endure emotional and financial burdens, with limited access to rehabilitation services in rural areas. Nationally, the disease drains resources, diverting funds from other health priorities and tarnishing Pakistan’s global image. Brain drain among health professionals, wary of the dangers, further weakens the system.
Despite these hurdles, Pakistan’s Polio Eradication Programme has achieved notable successes. Case numbers have dropped dramatically from over 300 in 2014 to the low double digits in recent years, thanks to innovative strategies. High-quality vaccination campaigns, known as Supplementary Immunization Activities (SIAs), target millions of children multiple times a year. The introduction of the injectable inactivated polio vaccine (IPV) alongside OPV has bolstered immunity. Environmental surveillance, monitoring sewage for the virus, has improved early detection, while rapid response teams investigate and vaccinate around every new case. International partners provide technical expertise, funding, and vaccines, with Saudi Arabia and the UAE contributing significantly.
Community engagement has been pivotal in turning the tide. Programs like the Sehat Muhafiz (Health Protectors) initiative recruit local influencers—tribal elders, imams, and teachers—to advocate for vaccinations. In Punjab and Sindh, where cases are fewer (one in Punjab and six in Sindh this year), higher literacy and urban access facilitate better coverage. Success stories abound: Districts once rife with refusals now boast near-100% acceptance after sustained dialogue. In Gilgit-Baltistan, a single case in Diamer this year prompted an intensified drive, demonstrating proactive measures.
Looking ahead, eradicating polio requires a multifaceted approach. Prioritizing worker safety through enhanced police protection and community-led security is essential. Addressing “zero-dose” children—those never vaccinated—demands mobile clinics and integration with routine health services. Combating misinformation calls for media campaigns in local languages, leveraging social media and radio to share testimonials from polio survivors and religious endorsements. Cross-border collaboration with Afghanistan, where 27 cases have been reported in 2025, is crucial to stem importation.
Moreover, tackling root causes like poverty, malnutrition, and weak infrastructure will build resilience. Investing in sanitation and clean water reduces transmission risks, while empowering women through education enhances health outcomes. With political will, as seen in Prime Minister Shehbaz Sharif’s recent pledges, Pakistan can accelerate progress. The GPEI’s goal of a polio-free world by 2026 is ambitious but achievable if the “last mile” challenges are met head-on.
In conclusion, the shadow of polio over Pakistan is persistent but not insurmountable. The 21 cases in 2025, including 13 in KP, reflect setbacks, yet they also galvanize action. By protecting health workers, fostering trust, and sustaining momentum, Pakistan can protect its children and join the ranks of polio-free nations. Every vaccinated child is a step toward victory, ensuring no more families endure the pain of this preventable tragedy. The world watches and supports, but ultimate success lies in unified national resolve.