Islamabad: Pakistan’s struggle with two of its deadliest infectious diseases, polio and tuberculosis, once again dominated the global health agenda as the World Health Organization’s Strategic Advisory Group of Experts (SAGE) on Immunization warned that sustained poliovirus transmission in Pakistan and Afghanistan, along with rising TB cases, continue to pose grave risks for regional and global health security.
Meeting in Geneva from September 22–25, 2025, SAGE underscored that eradicating polio will not be possible without sustained national political leadership and accountability. While technical measures such as novel oral polio vaccines, fractional doses of inactivated vaccines, and strengthened surveillance remain essential, experts stressed that Pakistan must ensure political resolve at every level to reach zero-dose children and close immunity gaps.
Despite repeated campaigns, Pakistan remains one of only two countries in the world where wild poliovirus continues to circulate. Outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) also remain a major concern, with experts supporting the wider use of the novel type 2 oral poliovirus vaccine (nOPV2) in high-risk districts.
The advisory body also urged bOPV-using countries, including Pakistan, to maintain their current immunization schedules until global consensus on cessation is achieved.
Tuberculosis was another priority on the SAGE agenda. With 16 vaccine candidates in clinical development, including five in advanced trials, experts noted that a breakthrough vaccine such as M72/ASO1E could be licensed as early as 2028.
Pakistan, one of the world’s high-burden TB countries, could be among the primary beneficiaries of these developments. However, experts cautioned that new vaccines must undergo rigorous evaluation to confirm effectiveness across different epidemiological settings, including in IGRA-negative individuals who are likely to be vaccinated in programmatic rollouts.
The meeting also reaffirmed the four-dose schedule for the malaria vaccine, highlighting its potential in high-burden countries, and called for closer alignment of the fourth dose with other interventions in the second year of life.
While malaria remains endemic in parts of Pakistan, particularly Sindh and Balochistan, experts believe that the availability of a proven vaccine could be a critical tool in reducing child mortality if introduced alongside existing interventions.
Another major discussion revolved around the broader crisis facing immunization systems worldwide. SAGE highlighted that geopolitical instability, shrinking national health budgets, and reduced donor funding are eroding vaccination gains. For Pakistan, where recent HPV and polio campaigns have been marred by refusals and mistrust, the information and trust crisis poses an additional threat. “Technical interventions alone cannot succeed without public confidence and consistent political ownership,” the experts stressed.
The group also reviewed progress on the Immunization Agenda 2030 (IA2030), warning that several global targets are at risk of being missed unless countries, including Pakistan, strengthen their monitoring systems and integrate immunization more effectively into primary healthcare.
COVID-19 vaccination was assessed in the context of waning demand and low uptake, with experts advising an updated review of its role in protecting pregnant women and infants. Meanwhile, the threat of avian influenza A(H5) led SAGE to recommend targeted vaccination of high-risk occupational groups such as health workers and laboratory staff in areas where animal-to-human transmission is possible.
Looking ahead, experts supported the development of novel combination vaccines to reduce the number of injections for children and improve acceptance rates. For a country like Pakistan, where overstretched health workers and parental hesitancy hinder coverage, such vaccines could reduce the burden on both providers and families.
SAGE will release its full report in the Weekly Epidemiological Record on December 5, 2025. For Pakistan, the message is clear: without strong political resolve, efficient governance, and sustained investment, the world’s last polio stronghold and one of the highest TB-burden nations risks undermining decades of global progress in immunization.
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