PAKISTAN is losing momentum in its fight against polio. This year, 26 cases of wild poliovirus have been confirmed, most of them in KP, with smaller numbers in Sindh, Punjab and GB. While the count may not be as high as last year’s 74, environmental surveillance tells a troubling tale. In August, out of 126 sewage samples tested from 87 districts, 51 were positive — a 40pc positivity rate. In Sindh, 24 of 29 samples, or more than 80pc, carried the virus. The figures that make the headlines are only the surface; the silent spread should worry us far more.

After three decades of door-to-door campaigns, eradication fatigue is evident. Communities have grown weary, refusals are climbing, and misinformation thrives. But conspiracy theories are only part of the problem. A government that cannot provide clean water, reliable clinics or decent schools struggles to persuade parents to trust a vaccine. Polio has become a measure of state legitimacy. Climate disasters have added new complications. Floods and displacement have left millions unsettled. Migrant families in makeshift shelters are among the hardest to reach. Those excluded from vaccination are often the same children denied education and healthcare. The virus flourishes in these gaps of inequity. Meanwhile, vaccinators still face danger. In September three were kidnapped in Tank, underscoring the risks borne by front-line staff. Exhausting, high-pressure drives under the threat of violence are unsustainable. The costs are global as well as domestic. The virus now lingers in just Pakistan, besides Afghanistan. Each case chips away at billions already spent and risks renewed travel restrictions or donor fatigue. The world’s patience is not infinite. Polio can still be beaten, but not by drops alone. Pakistan needs to rebuild trust, fold vaccination into broader healthcare, and link eradication to climate recovery. Unless the state can protect its citizens and win back confidence, the ‘last mile’ may prove to be a never-ending road.

Published in Dawn, September 18th, 2025