29.3M Vaccinated, So Why Does Polio Persist in Pakistan?
News Desk
ISLAMABAD: Pakistan’s latest anti-polio campaign has reached more than 29.3 million children under the age of five, but persistent vaccination gaps, security-related disruptions and continued virus circulation raise questions about whether the country is reaching every child at risk.
Conducted from September 21 to 27 under the government-led Pakistan Polio Eradication Initiative (PEI), the campaign deployed more than 273,000 frontline workers across selected high-risk districts. Despite the scale of the operation, preliminary figures from the National Emergency Operations Centre (NEOC) show that 627,776 children remained unvaccinated, underscoring the challenges confronting Pakistan’s decades-long effort to eliminate the disease.
The campaign covered districts across Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan, Islamabad and Gilgit-Baltistan. It was the fourth nationwide or sub-national vaccination drive of the year and the second sub-national campaign in 2026.
Although officials described the campaign as successfully completed, the remaining unvaccinated children highlight a persistent weakness in the eradication strategy: reaching millions of children does not necessarily mean that every child has been protected.
Falling cases, but transmission remains a concern
Pakistan has made considerable progress in reducing polio cases, from approximately 20,000 annually in the early 1990s to 31 in 2025. However, six cases have already been reported in 2026, indicating that the threat has not been eliminated.
Four of this year’s cases originated in southern Khyber Pakhtunkhwa, where security challenges have restricted access to some children. The concentration of cases in the region highlights the vulnerability of communities where insecurity obstructs vaccination and complicates public health operations.
The decline in reported cases is an important achievement, but it should not be mistaken for the interruption of poliovirus transmission. Continued infections demonstrate that gaps in immunity remain and that the programme must sustain its efforts in high-risk areas.
Nearly 628,000 children remain unvaccinated
According to preliminary campaign data, more than 11.4 million children received polio drops across 30 districts of Sindh, while Punjab vaccinated more than 9.07 million children in 11 districts. Khyber-Pakhtunkhwa reported over 7.21 million vaccinations across 37 districts, and Balochistan reached more than 2.32 million children in 32 districts.
In addition, over 443,000 children were vaccinated in Islamabad and approximately 140,000 in two districts of Gilgit-Baltistan.
Authorities reported reaching 100 per cent of the targeted children across 113 selected districts. However, this figure requires context: reaching the target population during campaign activities is not the same as successfully vaccinating every eligible child.
Of the children missed during initial house-to-house visits because they were unavailable, their parents refused vaccination or other circumstances intervened, follow-up teams reached 86 per cent. Yet 627,776 children—2.1 per cent of the overall campaign target—remained unvaccinated.
The figures raise an important question about the effectiveness of follow-up mechanisms. While repeated visits can close coverage gaps, the continued presence of a substantial number of unvaccinated children shows that existing outreach efforts are not sufficient to reach everyone.
Children who repeatedly miss vaccination rounds are particularly concerning because their continued exclusion can leave pockets of low immunity in communities vulnerable to poliovirus transmission.
Security disruptions expose operational weaknesses
Security challenges remain among the most serious obstacles to Pakistan’s eradication programme. In southern Khyber Pakhtunkhwa, insecurity has hampered access to some children, while the latest campaign was postponed in Dera Ghazi Khan and Rajanpur in Punjab because security personnel were assigned to other essential duties.
The NEOC said the two districts would be covered at a later date in coordination with the relevant authorities.
However, delayed campaigns create additional logistical demands and require authorities to ensure that children are not overlooked during rescheduling. The postponements also demonstrate how vaccination activities remain dependent on security arrangements and the availability of personnel.
With four of the six reported polio cases in 2026 originating in southern Khyber Pakhtunkhwa, improving access to vulnerable communities must remain a priority. This requires sustained coordination between health authorities, law enforcement agencies and local administrations, alongside strategies tailored to communities where routine vaccination activities face repeated disruption.
Repeated campaigns cannot replace stronger routine immunisation
The latest drive focused on children who had missed previous campaigns, had never received a dose or belonged to mobile, migrant and other high-risk populations. These efforts are essential, but the repeated need to locate previously missed children also highlights the difficulties of achieving consistent vaccination coverage.
Pakistan’s reliance on recurring campaigns must be accompanied by stronger routine immunisation services, reliable monitoring and targeted outreach to underserved communities. Otherwise, children who miss one campaign may remain vulnerable until another round reaches them.
The NEOC has urged parents to ensure that every child under five receives two drops of the polio vaccine during every campaign, regardless of previous doses. It has also stressed the importance of completing routine immunisation schedules to protect children against other vaccine-preventable diseases.
Parental cooperation remains important, but responsibility cannot rest on families alone. Authorities must also address the practical barriers that prevent vaccination, including insecurity, population movement, access difficulties and persistent gaps in follow-up.
Cross-border risks demand sustained vigilance
The September campaign was conducted simultaneously in Afghanistan as part of coordinated efforts to strengthen population immunity and reduce the risk of cross-border poliovirus transmission.
Coordination between the two countries is critical because population movement can allow the virus to spread between communities. However, synchronised campaigns will only deliver lasting results if vaccination teams can consistently reach children in vulnerable areas on both sides of the border.
The NEOC has acknowledged the contributions of frontline workers, parents, communities, provincial and district administrations, health departments, law enforcement agencies, partner organisations and the media.
Their efforts have helped Pakistan make substantial progress, but the remaining challenges cannot be overlooked. The persistence of polio cases, the number of children left unvaccinated and security-related disruptions demonstrate that campaign success must be measured not only by the number of doses administered but also by the programme’s ability to close immunity gaps and interrupt transmission.
For Pakistan, the central challenge is no longer simply mobilising vaccination teams on a massive scale. It is ensuring that repeated campaigns translate into consistent protection for every eligible child, particularly those living in the most difficult-to-reach communities. Until that happens, the goal of a polio-free Pakistan will remain within reach but not yet secured.
