Pakistan remains one of only two countries in the world — alongside Afghanistan — where wild poliovirus transmission is still endemic, as persistent gaps in vaccination coverage and entrenched community resistance continue to put children at serious risk, according to a recent report. The findings expose a widening gulf between official immunisation claims and ground realities in one of the world's most challenging public health battlegrounds.

The Scale of the Coverage Gap

Despite repeated nationwide vaccination drives, nearly one million children were missed during a single campaign alone, according to the report. More than 53,000 families reportedly refused to allow their children to receive polio drops, reflecting deep-seated vaccine hesitancy in parts of the country.

Government officials and health functionaries have claimed that approximately 98 per cent of citizens are fully vaccinated. However, independent estimates of routine immunisation coverage have placed the actual figure as low as 60 per cent — a stark discrepancy that critics argue undermines the credibility of official reporting.

Virus Still Circulating in Sewage Samples

The continued detection of poliovirus in sewage samples across multiple regions of Pakistan has further compounded concerns. Environmental surveillance data indicates that wild poliovirus remains in active circulation and that transmission has not been interrupted — a critical threshold required for eradication to be declared.

This is not merely a logistical failure; it signals that population-level immunity — the essential barrier needed to halt transmission — has not been achieved in key geographies.

Security Threats and Ground Realities in Khyber-Pakhtunkhwa

Pakistan's polio crisis has been particularly acute in Khyber-Pakhtunkhwa, where vaccination teams have faced militant attacks, community resistance, and significant access challenges. Nearly 100 people have reportedly been killed in targeted attacks on polio vaccinators since 2012 — a grim toll that has hampered the ability of health workers to reach the most vulnerable children.

A combination of security threats, entrenched poverty, and vaccine hesitancy has severely complicated eradication efforts. Notably, other countries that faced comparable challenges — including conflict, poverty, and public resistance — have nonetheless managed to interrupt poliovirus transmission, raising pointed questions about programme design and government accountability in Pakistan's case.

Accountability Gaps and Programme Failures

The persistence of endemic polio has drawn growing criticism of the government's approach. Analysts and public health advocates argue that repeated directives, task forces, and externally supported programmes have not been matched by sufficient accountability for outcomes or genuine community engagement.

Low routine immunisation coverage leaves entire communities vulnerable to outbreaks and makes the population-level protection threshold — necessary to halt transmission — structurally out of reach. The lack of trust among significant sections of the population remains, according to the report, one of the most formidable obstacles to achieving comprehensive immunisation.

What Comes Next

Until Pakistan closes the gap between claimed and actual vaccination rates and addresses the structural barriers to reaching missed children, wild poliovirus will continue to circulate — posing a risk not only domestically but also to neighbouring countries and the broader global eradication effort. Sustained accountability, independent coverage verification, and meaningful community engagement are widely seen as the minimum prerequisites for progress.