M. Waqar Bhatti
Islamabad: Pakistan needs a complete overhaul of its poliovirus eradication strategy, including integrating its polio and routine immunization programs under a unified command structure, to achieve success against the crippling disease, renowned public health expert and globally acclaimed scientist Prof. Dr. Zulfiqar A. Bhutta has recommended.
Despite ostensibly spending nearly $10 billion on eradication efforts since 2011, Pakistan witnessed a resurgence of wild poliovirus type 1 (WPV1) cases in 2024, reporting 72 cases, a dramatic spike from just six cases in 2023.
“The current approach of relying heavily on costly nationwide or subnational polio vaccination campaigns makes little sense without addressing the enormous gaps in routine immunization coverage,” said Prof. Bhutta, who holds key positions at Aga Khan University and the SickKids Centre for Global Child Health in Toronto, in an opinion and analysis piece published in The Lancet.
Pakistan spent $185 million on polio eradication in 2024, significantly more than the $97.5 million allocated for routine immunization by the federal government, supplemented by $80.6 million from international donors.
Despite this heavy investment, low vaccination rates and inequities persist, particularly in high-risk districts.
According to Prof. Bhutta, integrating the programs and management reforms would improve operational efficiency, technical oversight, and accountability while bridging critical immunity gaps.
Highlighting the challenges, he noted that 53% of the children who contracted paralytic poliomyelitis in 2024 had never received any routine vaccinations. Meanwhile, half of the affected children had already received seven or more doses of the oral polio vaccine (OPV) during mass vaccination campaigns, underscoring the need for a more effective and integrated strategy to bridge the immunity gap.
“Simply repeating the same strategies used over the past few decades and expecting different results is risky for global polio eradication,” he warned.
Prof. Bhutta attributed the setbacks to multiple factors, including political instability, conflict, vaccine misinformation, and security risks faced by health workers. He emphasized that community engagement through grassroots organizations and partnerships with the private healthcare sector, particularly family physicians and pediatricians, are essential to increase vaccination coverage and rebuild public trust.
He also pointed out the devastating toll on frontline health workers, noting that more than 200 polio vaccinators and security personnel have been killed in attacks over the past 15 years. “Addressing the safety and security concerns for vaccination teams and ensuring political stability are fundamental prerequisites for functional health and immunization systems,” he said.
The porous border with Afghanistan, where the Taliban takeover has disrupted community-based polio activities, further complicates eradication efforts. Prof. Bhutta stressed the need for targeted vaccination strategies for mobile populations and migrants, noting genetic evidence linking Pakistan’s recent polio cases to strains circulating in Afghanistan.
He urged the government to learn from Nigeria’s success in eradicating the virus through strengthened national programs, accurate surveillance, and strong community partnerships. “Pakistan must review its entire immunization strategy and significantly improve program performance. This includes appointing technically skilled managers on merit and fostering community engagement,” Prof. Bhutta advised.
Prof. Bhutta e emphasized that peacebuilding and stability in restive regions such as Khyber Pakhtunkhwa and Balochistan are essential components for the success of eradication efforts. With coordinated efforts and smarter strategies, Pakistan could overcome its challenges and achieve a polio-free future.
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