This year, 40,000 families in Karachi refused to receive the polio vaccine. In a city where the virus is circulating in every district, those denials represent the gap between Pakistan’s impressive anti-polio infrastructure and its inability to travel the last mile of eradication.
Pakistan has reduced polio cases by more than 99.6% since 1994: from 20,000 cases annually to just 30 this year. It has built one of the most extensive surveillance systems in the world: 127 environmental sampling sites, 12,500 reporting locations and campaigns reaching 45 million children. Two of the three global strains of poliovirus have been eliminated.
But Pakistan and Afghanistan remain the only countries where polio still circulates. And in 2024, the WPV1 strain re-emerged in 90 districts, forcing authorities to review their approach with a “2-4-6 roadmap” under the National Emergency Action Plan.
“The last kilometer is actually very difficult to reach,” Dr. Azra Pechuho, Sindh’s Minister of Health and People’s Welfare, said at the Aga Khan University on Friday. “What we are losing are the small pockets as the number of infected children reduces.” A two-hour event brought together the biggest names in polio from the WHO, the Sindh government, the federal government and AKU.
Environmental samples confirm what health officials already know: The virus persists in underserved communities that vaccination campaigns are struggling to reach. All districts of Sindh show continuous transmission.
The 42,000 vaccine refusals in Sindh (40,000 of them in Karachi) reflect what Dr. Azra calls “vaccine fatigue.” But Dr. Sebastian Taylor of the Polio Eradication Technical Advisory Group cautioned against assuming that families are refusing to get vaccinated because there are too many vaccines. Many refusals are due to lack of knowledge rather than vaccine overload, he said.
The WHO reports that authorities have narrowed the gap, reducing excluded children from 1.48 million to 1.13 million. But low systematic vaccination coverage, doubts about vaccines and population movements continue to leave spaces where the virus survives.
Southern Khyber Pakhtunkhwa presents the most pressing challenge. “That’s where we have to do something really fast and really hard,” said Professor Shahnaz Ibrahim, chairman of the National Certification Committee, which annually determines whether Pakistan qualifies as polio-free.
The certification process requires three consecutive years without cases or environmental detection of the virus, and Pakistan cannot achieve it alone. “It has to be both Pakistan and Afghanistan as a unit,” Professor Ibrahim explained.
The Prime Minister’s focal point for Polio Eradication, Ayesha Farooq, noted that the genetic diversity of WPV1 is “increasingly reduced,” meaning less chance of new strains emerging. Dr Azra said eradication is still possible if Pakistan maintains its focus during the upcoming low transmission season.
“For today’s students, there is no need to study smallpox. It is history,” said Aziz Memon, national president of the Pakistan PolioPlus Committee. “Let’s put polio in the history books.”
