A seven-month-old boy in Mastak Union Council, Bara tehsil of Khyber district, has become Pakistan’s ninth polio case this year. When the Global Polio Eradication Initiative began in 1988, wild poliovirus paralysed an estimated 350,000 children annually across more than 125 countries. Today, only Pakistan and Afghanistan remain endemic. Nearly four decades later, Pakistan has failed to protect every child from a disease preventable with a few drops of vaccine. This child’s infection is more than a statistic. It exposes the state’s persistent failure to turn decades of effort into lasting success.
The numbers suggest progress, but the gains remain fragile. Pakistan reported 74 cases in 2024, 31 in 2025 and nine so far in 2026, seven in Khyber Pakhtunkhwa and two in Sindh. In 2021, it recorded just one case, bringing eradication seemingly within reach. Yet declining transmission is not eradication. The virus survives wherever vaccination coverage is uneven, communities remain inaccessible and children are repeatedly missed. All three cases reported from Khyber district this year are genetically linked to Afghanistan, which has recorded 50 cases in 2026. The WHO treats both countries as a single epidemiological zone. Poliovirus recognises neither borders nor diplomatic tensions. It travels wherever immunity leaves an opening.
Why does a disease with a free and effective vaccine continue to threaten Pakistani children? Misinformation is part of the answer. Rumours that polio drops contain pork or alcohol, cause infertility or serve a Western conspiracy to sterilise Muslim children have circulated for years. Such claims gain traction when repeated by trusted community figures. History has further weakened public confidence. In 2011, the CIA used a fake hepatitis vaccination programme in Abbottabad to gather intelligence on Osama bin Laden, damaging the credibility of genuine immunisation campaigns. A year later, militant commander Hafiz Gul Bahadur banned vaccination in North Waziristan until drone strikes stopped, making children’s health a bargaining tool in the war on terror.
Religious opposition has also lost much of its credibility. Scholars and clerics have repeatedly endorsed immunisation, while local imams have challenged misinformation and urged parents to cooperate with vaccination teams. A study of refusals in Quetta found that misconceptions accounted for 56.4 percent of reported reasons, compared with 16 percent for religious objections. Religion alone, therefore, cannot explain vaccine refusal. Nor can government advertisements and occasional public appeals overcome deeply rooted mistrust. That requires sustained engagement with communities and the people they trust.
A more difficult problem lies beneath the visible resistance: the growing use of vaccination campaigns as an instrument of protest against an absent state. A review of Pakistan’s polio programme by the US Centres for Disease Control and Prevention found that repeated community boycotts were often driven by demands unrelated to vaccination, including clean water and electricity. In parts of southern Khyber Pakhtunkhwa, communities have withheld cooperation to press the government over neglected services and unresolved grievances. The frustration is difficult to dismiss. Why does the state repeatedly find its way to a household to administer two drops, but rarely arrive with a doctor, a functioning health facility, clean drinking water or reliable electricity?
The coverage figures expose the inequality behind this failure. A 2021 survey found that not a single district in Khyber Pakhtunkhwa, Sindh or Balochistan had achieved 80 percent coverage for three routine doses of oral polio vaccine among children aged 12-23 months. In Punjab, 31 of 36 districts had crossed that threshold. A five-month-old child in Lakki Marwat who tested positive last year had received no routine immunisation. Insecurity, restricted access and shortages of female vaccinators further weaken coverage in southern districts. These are more than operational failures. They reflect unequal access to one of the most basic obligations of citizenship.
There is evidence that public confidence can be rebuilt. During its October 2025 campaign, Khyber Pakhtunkhwa reported vaccinating 99 percent of its 7.15 million targeted children, while refusals fell to 0.3 percent. Engagement with religious scholars, tribal elders and local communities helped improve cooperation. Yet access remains difficult. Insecurity, boycotts and harsh weather left 233,000 children unvaccinated during an early 2025 campaign. Nor is the challenge confined to remote districts. Karachi accounted for 58 percent of national refusals in the first campaign of 2026, showing how migration, urban poverty and neglected settlements also undermine eradication.
Those fighting to close these gaps face extraordinary risks. This week, four polio workers were abducted in Tank, two were kidnapped and later released in Lower South Waziristan, and two policemen escorting a vaccination team were shot dead in Mohmand. Government data records 96 deaths in attacks on polio campaigns since 2012. Many vaccinators, often women working for modest pay, enter hostile communities where state authority is weak. Protecting these workers must be central to the eradication effort, not an administrative afterthought.
Pakistan’s progress is also threatened by developments across the Afghan border. In September 2024, Taliban authorities reversed the expansion of house-to-house vaccination, returning to fixed-post arrangements and making it harder to reach children in remote and vulnerable communities. Pakistan cannot secure eradication while cross-border transmission persists. The simultaneous campaign launched in both countries from November 2 to 8, targeting 24 million children across 97 Pakistani districts, is therefore vital. It shows that cooperation against a shared public-health threat remains possible despite strained political relations.
Polio eradication is not beyond Pakistan’s capacity. India, despite its enormous population, crowded cities and mobile communities, was certified polio-free in 2014. Nigeria, once the epicentre of wild poliovirus transmission in Africa and challenged by insurgency in its northeast, helped achieve the continent’s historic interruption of transmission, certified by the WHO African Region in 2020. Neither faced an easy task. Both demonstrated that eradication demands sustained political commitment, reliable surveillance, community trust and vaccination that reaches every child, regardless of geography or social circumstances.
Polio is incurable, but preventing it is neither difficult nor beyond the state’s capacity. Pakistan has proved that it can bring infections down dramatically. What it has failed to prove is that it can sustain the commitment, consistency and public trust needed to finish the job. No child should have to suffer lifelong paralysis because the state could not reach his doorstep. The vaccine is available, the science is settled and the means are within reach. The virus has not defeated Pakistan. Pakistan has yet to defeat its own failures.