Pakistan remains one of only two countries in the world — alongside Afghanistan — where wild poliovirus continues to circulate, even as neighbouring India marked 15 years since its last recorded case of the disease. Public health experts say repeated vaccination campaigns alone will not be sufficient to eliminate polio in Pakistan, calling instead for a sharper focus on reaching missed children, rebuilding community trust, and strengthening accountability mechanisms.

India's Eradication: A Model Under the Microscope

India reported its last wild poliovirus case in January 2011 and was officially declared polio-free by the World Health Organisation (WHO) in 2014. Bangladesh has also maintained its polio-free status. Experts stress that India's success was not the result of any single intervention. It emerged from a combination of sustained immunisation drives, rigorous surveillance of vulnerable geographies, effective community mobilisation, and an environmental monitoring system capable of detecting the virus before paralytic cases could appear.

Notably, specialists caution against attributing India's achievement solely to domestic health governance. While national ownership was critical, international organisations — including the WHO — provided indispensable technical expertise and surveillance support, according to reports. The lesson for Pakistan, experts argue, is that the two elements are complementary, not competing.

Why Pakistan Continues to Struggle

The challenge in Pakistan extends well beyond vaccine hesitancy, health officials say. A significant number of children continue to be missed due to population movement, uneven routine immunisation coverage, cross-border migration, and insecurity in certain regions. Misinformation and deep-rooted distrust in some communities have added another layer of difficulty, contributing to outright vaccine refusals and complicating nationwide eradication efforts.

This comes amid persistent concerns from global health bodies that the two remaining poliovirus-endemic countries — Pakistan and Afghanistan — represent the last significant reservoir of the disease worldwide. The longer transmission continues, the greater the risk of re-exportation to polio-free nations.

Environmental Surveillance: The Critical Detection Tool

Experts emphasise that the absence of paralytic polio cases does not confirm that transmission has ended. Since the vast majority of poliovirus infections do not cause paralysis, environmental surveillance — particularly the systematic testing of sewage samples — has become an essential tool for detecting viral circulation even in asymptomatic populations. Laboratory testing and genetic sequencing further allow authorities to map transmission chains and identify outbreak linkages across regions.

Cross-Border Coordination: An Unfinished Agenda

The continued detection of genetically related poliovirus strains in both Pakistan and Afghanistan underscores the urgent need for deeper bilateral coordination, health experts say. Frequent cross-border population movement means that vaccination campaigns, surveillance activities, and information-sharing mechanisms between the two countries must be aligned and synchronised to prevent the virus from spreading between populations. Without coordinated action, progress in one country risks being undermined by transmission in the other.

As the global health community pushes toward final polio eradication, Pakistan's path forward will require more than campaign repetition — it will demand structural reforms in immunisation delivery, transparent accountability, and sustained political will of the kind that helped India and much of South Asia consign the disease to history.