Pakistan has once again declared a final push against polio, and once again the claim sits uneasily beside the evidence. More than 45 million children are to be vaccinated in the last nationwide drive of 2025, backed by over 400,000 frontline workers and the full weight of official symbolism. Yet the virus continues to surface in sewage samples from more than 20 districts. Case numbers may have fallen from 74 last year to roughly 30 today, but transmission persists. Pakistan and Afghanistan remain the only countries where wild poliovirus has not been eliminated, a distinction no nation should still bear. Authorities admit that nearly two per cent of children are still missed in each round in Khyber Pakhtunkhwa alone. In a province with 6.5 million under-five children, that translates into more than a hundred thousand left unprotected, enough for the virus to regenerate and mock every declaration of progress.
The persistence of refusals is often reduced to ignorance or superstition. That explanation is convenient and incomplete. Misinformation has thrived because trust was never rebuilt after it was broken. Rumours about religious prohibitions and foreign plots have been allowed to harden into social fact, reinforced by poverty, illiteracy and weak routine immunisation systems that long predate the current campaign. The shadow of the discredited CIA fake vaccination episode still lingers because the state never invested in sustained, credible engagement to counter its damage.
Even more damning is the violence that has come to define the polio effort. Nearly 100 people have died since 2012 (including 61 policemen and 27 health workers). Another 170 have been injured or kidnapped.
This grim tally of women vaccinators gunned down and of patrols attacked is unique to our crisis. Polio workers deserve national gratitude for their courage. However, the state also has a duty to protect them (and us) by rooting out the men behind this terror. Faced with fatigue and failure, frustration is hardening into coercion. Sindh’s previous threat to suspend identity documents, SIM cards or passports of parents who refuse vaccination reflects how narrow the space for persuasion has become. Whether such measures are defensible or excessive, they reveal a deeper truth: voluntary compliance collapses when the state waits too long to normalise public health obligations. Making routine immunisation records mandatory for school enrolment or travel, as many countries do, should not be controversial at this stage. Still, the law alone cannot substitute for legitimacy. An aggressive, sustained public information campaign is essential, one that treats communication as seriously as logistics. Chief Minister Murad Ali Shah’s call for mandatory polio public-service messages before news bulletins is a start, but messaging must be locally rooted and led by figures communities already trust. This fight was nationalised in 1994 under Mohtarma Benazir Bhutto. Three decades on, Pakistan has the resources and the knowledge to finish it. What it lacks is the political will to close the gaps it has long learned to tolerate.
