Polio Isn’t Gone, It’s Growing in Silence

Pakistan’s announcement of its 19th wild poliovirus case in 2025, a five-month-old boy in Lakki Marwat, Khyber Pakhtunkhwa, is not merely another medical statistic. It is an alarm bell. After decades of striving and international support, polio still lives in Pakistan. Twelve of the year’s cases have originated in Khyber Pakhtunkhwa province alone, again placing it in the spotlight as a high-risk area where insecurity, misinformation, and suspicion stand in the way of one of the most uncomplicated medical interventions in history: vaccination.

The figures themselves are staggering. Cases of polio in Pakistan had fallen from approximately 20,000 per year in the early 1990s to low single digits in 2018. Since then, the comeback has been catastrophic. In 2024, Pakistan had 74 cases of wild poliovirus, adding to the total of 99 globally, while the remaining 25 cases were from neighboring Afghanistan. This year, Pakistan has 18 of the 20 cases reported globally until date. The virus is not only infecting kids, it’s spreading quietly through wastewater as well, evidenced by hundreds of environmental test positives. Each of these indicators bypassed vaccinations and quiet viral spread.

Polio is not just about halting the disease in a single country. If the virus continues to spread within Pakistan, the globe still has an active risk. The instant the virus crosses one border to enter a country that was once polio-free, years of worldwide effort and billions spent in eradication would be unraveled. More importantly, polio results in irreversible paralysis and, at times, death in children. There is no cure. Vaccination is the sole protection. It’s inexpensive, safe, and widely available throughout Pakistan, but sadly underutilized.

In spite of the free oral polio vaccine (OPV) being administered by the Pakistani state in door-to-door and fixed-site campaigns, thousands of children still go unvaccinated. It is not for lack of the vaccine but because of deep-seated prejudices and conspiracy theories among some sections of society. In areas such as Khyber Pakhtunkhwa and areas of Balochistan, parents are resistant to vaccinating children, as they believe in myths that the vaccine leads to infertility or is included as part of a conspiracy by foreign nations. Such misinformation has prevailed even after health workers and government campaigns’ relentless efforts to dispel it. They were further strengthened by the CIA’s false vaccination campaign in 2011, which broke confidence in healthcare programs throughout the tribal belt. The aftermath was deadly, over 200 polio workers and security personnel have been killed in targeted attacks in the past decade.

Low literacy levels, particularly among mothers, also contribute to this distrust. Poverty, lack of adequate access to information, and the role of neighborhood clerics or local leaders who peddle anti-vaccine talk provide a climate where rumor trumps reality. Here, it is not a matter of insufficient resources but insufficient trust that perpetuates the virus.

If polio is to be eliminated, Pakistan will have to spend money on changing minds and hearts. Engagement with communities needs to be stepped up. Local religious leaders, teachers, and most of all, female health workers need to be equipped to initiate discussions in homes where doubt prevails. Low-tech interventions, such as audio messages or picture messages sent through mobile phones, have already achieved dramatic reductions in immunization levels in areas such as Quetta. It’s about behavior change, not the administration of drops.

The administration also needs to combine OPV and IPV (injectable polio vaccine) methods more efficiently. While OPV is inexpensive and simple to deliver, it has a rare risk of vaccine-derived strains. IPV, though more expensive and more difficult to distribute, is safer and more accepted across the world. Increasing IPV on top of OPV in high-risk areas would provide another level of security, but all this will work only if health workers are protected and the system is confident of cold-chain integrity, open record keeping, and zero tolerance for corruption or fraudulent data.

Polio is not a political problem. It is a human problem. An ethical one. With the vaccine available at no cost, every case now represents not a gap in supply but a breakdown in trust. Every denial leaves a child vulnerable. Each myth accepted provides the virus with another day to spread. Pakistan possesses the resources, the vaccines, and the technical expertise. The time to stop polio isn’t next year or the next campaign. It’s today. For each child unable to walk. For each parent who mourns. For each health worker who puts his or her life on the line. Pakistan needs to become polio-free now, no excuses, no more waiting.