Pakistan built a world-class Polio system. Then 40,000 Karachi families said no

Forty thousand Karachi families refused polio vaccines this year. In a city where the virus circulates through every district, those refusals represent the gap between Pakistan's impressive polio infrastructure and its inability to close the final mile of eradication. Pakistan has cut polio cases by more than 99.6% since 1994—from 20,000 annual cases to just 30 this year. It has built one of the world's most extensive surveillance systems: 127 environmental sampling sites, 12,500 reporting locations, and campaigns that reach 45 million children. Two of three global poliovirus strains have been eliminated. But Pakistan and Afghanistan remain the only countries where polio still circulates. And in 2024, the WPV1 strain resurged across 90 districts, forcing authorities to overhaul their approach with a "2-4-6 roadmap" under the National Emergency Action Plan. "The last mile is actually very difficult to achieve," said Dr Azra Pechuho, Sindh's Minister of Health and Population Welfare, speaking at Aga Khan University on Friday. "It's the small pockets we're missing as the number of infected children is reducing." A two-hour event brought together the top names in Polio from the WHO, Sindh government, federal government and AKU. Environmental samples confirm what health officials already know: the virus persists in underserved communities that vaccination campaigns struggle to reach. Every district in Sindh shows ongoing transmission. The 42,000 vaccine refusals across Sindh—40,000 of them in Karachi—reflect what Dr Azra calls "vaccination fatigue." But Dr Sebastian Taylor from the Technical Advisory Group for Polio Eradication cautioned against assuming families refuse because of too many vaccines. Many refusals stem from lack of knowledge rather than vaccine overload, he said. The WHO reports that authorities have narrowed the gap, reducing missed children from 1.48 million to 1.13 million. But low routine immunization coverage, vaccine hesitancy, and population movement continue leaving spaces where the virus survives. South Khyber Pakhtunkhwa presents the most urgent challenge. "That's where we need to do something really fast and really hard," said Prof. Shahnaz Ibrahim, chair of the National Certification Committee, which annually determines whether Pakistan qualifies as polio-free. The certification process requires three consecutive years with no cases and no environmental detection of the virus—and Pakistan cannot achieve it alone. "It has to be both Pakistan and Afghanistan as a unit," Prof. Ibrahim explained. The Prime Minister's Focal Person for Polio Eradication, Ayesha Farooq, noted that WPV1's genetic diversity is "increasingly squeezed," meaning fewer chances of new strains emerging. Dr Azra said eradication remains achievable if Pakistan maintains focus during the upcoming low-transmission season. "To the students today, you don't have to study smallpox. It's history," said Aziz Memon, National Chair of Pakistan's PolioPlus Committee. "Let us put polio in the books of history."

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