Pakistan has reported its fifth polio case of the year, this time, a 17-month-old girl in Bannu. The national tally is encouragingly small compared with 31 cases last year and 74 in 2024. That four of this year’s five cases have come from Bannu Division, three from Bannu district itself, is becoming hard to ignore.
Polio is being pushed back across much of Pakistan while holding its ground in precisely those places where vaccination teams have the least room to operate.
Those standing at the wheel need to realise how paralysis is only the visible end of poliovirus transmission. Most poliovirus infections produce no obvious symptoms, while roughly one in 200 leads to irreversible paralysis.
A handful of paralysed children can therefore sit on top of much wider transmission. Sewage surveillance often sees circulation before hospitals do. Bannu had positive environmental samples from October last year through March, evidence that the virus was already moving through the community well before the present cluster became visible.
The latest case was confirmed just after a week-long campaign vaccinated more than 28.2 million children in 112 districts with the help of over 273,000 workers. That scale deserves recognition. So does the sharp fall in cases over two years. Yet national coverage can conceal the places where eradication is actually being lost or won.
WHO warned last month that southern Khyber Pakhtunkhwa remains one of the country’s main reservoirs of wild poliovirus and estimated that around 250,000 children there were still unreached, largely because insecurity prevents consistent access. It also found that campaign quality remains uneven below the provincial level despite strong headline coverage.
Bannu illustrates the problem, where on several occasions, campaigns have been interrupted, vaccinators have faced kidnapping and security threats, and access to some communities cannot be taken for granted. Every missed round leaves another pocket of susceptible children in which the virus can continue circulating.
The coming colder months offer valuable space to close the gaps. That will require security for vaccination teams, precise tracking of repeatedly missed children and closer attention to sewage surveillance rather than celebration of headline coverage alone.
Pakistan has already shown that it can vaccinate tens of millions of children in a matter of days. Bannu, meanwhile, shows where the campaign is still being decided: among the much smaller number whom the system has not yet managed to reach.
