Fear and misinformation risk reversing Pakistan’s hard-won gains against polio | The Express Tribune

KHYBER PAKHTUNKHWA/
PESHAWAR:

Pakistan continues to stand at a critical juncture in its decades-long battle against one of the world’s most preventable diseases. New data from the National Immunisation Days (NIDs) held in October 2025 in Khyber-Pakhtunkhwa (K-P) offers both hope and warning: while the province achieved an impressive 99% vaccination coverage, the few remaining unvaccinated children still pose a serious threat to Pakistan’s polio-free goal.

According to official figures, vaccination teams reached 7.07 million children out of a target of 7.15 million, leaving only 1% unvaccinated and refusals down to just 0.3% across the province.

Districts such as Batagram, Mansehra, Torghar, Kohistan and Buner reported 100% coverage — a testament to the dedication of frontline health workers who continue to serve in challenging and often dangerous conditions. Yet behind these encouraging statistics lies one of Pakistan’s toughest public health battles — a struggle not only against a virus but also against mistrust, misinformation, inaccessibility and violence.

Khyber-Pakhtunkhwa, once the epicentre of poliovirus transmission, remains the most difficult province due to its unique combination of security threats, population movement and deep-rooted misconceptions about vaccination.

This year, polio workers and security personnel have faced a renewed wave of attacks, making 2025 one of the most dangerous years for those on the frontline. In several districts, particularly in southern K-P and the tribal areas, vaccination teams and police escorts were targeted, disrupting campaigns and forcing temporary suspensions. Despite the threats, health workers continued door-to-door efforts, often risking their lives to reach every household.

Read: Sindh warns of 20,000 polio cases if campaign falters

Officials from the Emergency Operations Centre (EOC) K-P said that while near-universal coverage was achieved, some children — particularly in Bannu, Dera Ismail Khan and Karak — remain “still not available” (NA) due to migration, insecurity or refusal. The latest data shows 84,572 children in this category, mainly from hard-to-reach and high-risk zones where displacement, poor roads and ongoing counterterrorism operations hinder access.

Over the past decade, Pakistan has made significant progress in reducing polio cases. In 2014, the country recorded more than 300 cases, the highest globally. By 2024, that number had fallen to single digits. Yet total eradication has remained elusive, hindered by insecurity, vaccine hesitancy and the continuous cross-border movement between Pakistan and Afghanistan, the world’s only two polio-endemic countries.

Misinformation remains one of the biggest barriers. Despite years of awareness campaigns, some families still believe false rumours that the vaccine causes infertility or that repeated doses are unnecessary. In conservative communities, such misconceptions are often amplified by social media and religious misinterpretations, creating pockets of resistance that health teams must tackle patiently, door to door.

The October 2025 NIDs data, however, shows a sharp decline in refusals — just 0.3% of parents declined vaccination, compared with more than 2% in previous years. Districts such as Torghar, Chitral Upper and Kohistan reported zero refusals, reflecting growing public confidence. Health officials attribute this improvement to sustained communication efforts, engagement with local clerics, and the perseverance of female community health workers, whose personal outreach has helped shift perceptions in conservative areas.

But the challenge is far from over. Polio remains a moving target — both literally and figuratively. Migrant families, seasonal labourers, nomadic tribes and refugees frequently move between districts or across the Afghan border, creating gaps in coverage that the virus can exploit. Even a single missed child, experts warn, can reignite transmission.

Read more: How to eradicate polio?

Despite these obstacles, K-P’s near-99% coverage is a remarkable achievement. Districts such as Peshawar, Swat, Mardan and Bajaur recorded strong results, vaccinating nearly all targeted children. In Peshawar alone, more than 869,000 children were immunised — a dramatic turnaround for a city once labelled a “polio reservoir”. Officials credit the province’s “missed children mapping system” and real-time monitoring for improving accountability and campaign quality.

Health experts say the final stage of eradication is always the hardest.

“Pakistan has reached a point where the virus survives only in the smallest of cracks — the last few missed children, the last few insecure neighbourhoods,” said a senior EOC official in Peshawar. “But if we lose focus now, the virus will exploit those cracks and return.”

The data from K-P sends a powerful message: Pakistan has the tools, commitment and public will to end polio, but it must sustain its momentum. Security for health workers must remain a top priority, misinformation must continue to be countered through community trust, and border coordination with Afghanistan must be strengthened to prevent the virus from circulating.

As the country stands closer than ever to eradicating poliovirus, the sacrifices of frontline workers — many of whom have lost their lives — serve as a reminder that eradication is not just a health objective but a national mission.

The road to a polio-free Pakistan is in sight, but it will demand unwavering political commitment, community cooperation and continued protection for those who carry the vaccine from door to door.