For decades, Pakistan has been engaged in an uphill battle against polio, a disease that was once on the brink of eradication. Yet, just when the country seemed close to victory, the virus has resurged with alarming intensity. In 2024, 74 cases of wild poliovirus type 1 (WPV1) were reported across 34 districts—a stark reminder that this crippling disease is far from being consigned to history.
The most severely affected region has been Balochistan, where 27 cases surfaced from 13 districts, with Killa Abdullah emerging as a new hotspot. Sindh recorded 23 cases, while Khyber Pakhtunkhwa (KP) documented 22, including 11 in Dera Ismail Khan (DI Khan) alone. Even Punjab and Islamabad were not spared, each reporting one case. The resurgence has been particularly troubling in DI Khan, which had remained polio-free since 2019.
A Setback for Pakistan’s Eradication Efforts
This surge in cases represents a significant setback for Pakistan’s polio eradication efforts. In contrast, in 2023, WPV1 was confined to just three districts—Bannu, Orakzai (KP), and Karachi (Sindh)—with only six cases reported. Similarly, in 2022, the 20 detected cases were limited to North Waziristan (n=17), Lakki Marwat (n=2), and South Waziristan (n=1). The situation in 2021 was even more promising, with only a single case reported in Killa Abdullah, Balochistan. This pattern indicates that in recent years, Pakistan had managed to restrict the virus to a few areas, raising hopes for complete eradication. However, the sharp increase in cases in 2024, particularly in regions that were polio-free for years, highlights the severity of the resurgence. Compounding this crisis, environmental samples testing positive for WPV1 tripled in 2024, with 628 samples from 76 districts, compared to 188 in 2023—an alarming indicator of widespread viral circulation.If these numbers weren’t concerning enough, 2025 has already witnessed two fresh cases—one from DI Khan and another from Badin, Sindh. This early onset of cases underscores that the virus is not only persisting but also spreading to new areas. If urgent action is not taken, Pakistan risks a further explosion of polio cases, undoing years of progress and threatening global eradication efforts.
Why Is Polio Making a Comeback?
Despite having one of the world’s most extensive surveillance networks and a history of rigorous vaccination campaigns, Pakistan’s polio resurgence raises pressing concerns. Experts point to several key factors behind this resurgence:
- Low Routine Immunization Coverage: Shockingly, more than half of polio cases in 2024 occurred in children who had never received a single routine vaccine. Another 14% of cases were in children over five years old, indicating a significant immunity gap. While mass immunization campaigns have been effective in reaching millions, they cannot fully replace robust routine immunization programs.
- Vaccine Hesitancy and Misinformation: Misinformation surrounding polio vaccines continues to fuel resistance, particularly in Balochistan and KP. Conspiracy theories spread through social media, distrust in health authorities, and religious misconceptions have led many parents to refuse vaccination for their children, leaving entire communities vulnerable.
- Conflict and Accessibility Challenges: Certain areas, particularly in Balochistan and KP, remain hard to reach due to insecurity, militancy, and geographical barriers. Vaccination teams often face hostility, and in some cases, life-threatening violence. Without improved access to these high-risk areas, polio will continue to thrive in these pockets of vulnerability.
- Cross-Border Transmission: Genomic sequencing of WPV1 cases in Pakistan has revealed strong links to poliovirus strains circulating in Afghanistan. The frequent movement of people between the two countries, combined with uncoordinated immunization efforts, has allowed the virus to persist and spread.
A Call to Action
Polio eradication in Pakistan requires an urgent, multi-faceted approach. Routine immunization must be prioritized alongside supplementary vaccination campaigns. Health authorities must counter vaccine hesitancy through community engagement, involving religious leaders and local influencers to combat misinformation. Insecurity issues need immediate government intervention to protect frontline workers. Furthermore, Pakistan and Afghanistan must synchronize vaccination efforts to cut off cross-border transmission routes.Pakistan has proven before that progress against polio is possible, but the current resurgence demands immediate, decisive action. Without it, the country risks not only prolonging its own polio crisis but also jeopardizing global eradication goals. The world is watching—will Pakistan rise to the challenge?
By ISID Emerging Leader, Dr. Massab Umair
Dr. Massab Umair is a Virologist and Public Health Expert specializing in disease surveillance and health systems strengthening. He is also an Emerging Leader in Infectious Diseases (ISID).
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