Pakistan is one of only two countries where poliomyelitis (polio) remains endemic, the other being Afghanistan. While polio eradication in Pakistan is not yet complete, the trajectory is unmistakably downward. Reported wild poliovirus cases fell from 147 in 2019 to 84 in 2020, 1 in 2021, 20 in 2022, 6 in 2023, 74 in 2024, and 29 as of October 2025. Launched in 1994, the Pakistan Polio Eradication Programme has grown into a nationwide enterprise powered by 339,521 trained workers, the world’s largest surveillance network, state-of-the-art laboratories, high-quality data systems, and expert epidemiological leadership. Over the past year, intensified operations further reduced transmission. Polio cases declined from 74 in 2024 to 29 as of October 2025. Surveillance remains robust and sensitive, detecting even atypical or mildly symptomatic infections. In 2025, 13 cases presented with mild symptoms and 11 with moderate paralysis, evidence that the system is capturing a broader clinical spectrum.
High-Level Commitment and Oversight
Pakistan’s political commitment to eradication is enduring. The Prime Minister chairs regular National Task Force and stock-take meetings; the Federal Minister for Health leads operational follow-through. During the 2024–25 campaign season, six large-scale rounds (four nationwide, two sub-national) helped millions of vulnerable children cross the immunity threshold. The programme has tightened efforts to find and vaccinate missed children during and between campaigns; zero-dose and missed-child data are now digitized and tracked for follow-up.
Strategy for Core Reservoirs
The programme maintains a laser focus on core reservoirs in KP, central Pakistan, and other epidemiologically important zones. In addition to large-scale rounds, targeted fIPV–OPV activities in reservoirs and blocks rapidly boosted immunity among high-risk children. A comprehensive Central Pakistan Strategy aligned with TAG recommendations guides district-specific planning, high-quality implementation, and continuous quality improvement.
Community-led vaccination (COMVI) engages elders, local influencers, and religious leaders to increase acceptance and access. Integration with routine immunization and essential health services has been strengthened, including Integrated Services Delivery to address broader community needs.
PEI–EPI Synergy
PEI and EPI are working in lockstep to raise routine coverage in priority areas. Round III of the “Big Catch-Up” has been completed; zero-dose data are digitized for targeted action. Polio vaccines will also be administered during the Measles–Rubella campaign in November, further closing immunity gaps. Because Pakistan and Afghanistan form a single epidemiological block, coordination is intensive. Vaccination for all age groups continues at official border crossings; synchronized, biannual campaigns are conducted in bordering UCs; and nationwide rounds are fully harmonized across both countries to disrupt transboundary transmission. A strong social and behaviour change communication network is active at the grassroots, engaging tribal elders, local leaders, religious figures, and other trusted influencers. Messaging is tailored to address refusals, tackle fatigue, and connect households to broader PHC services.
Roadmap to Zero Polio / NEAP (2025–26)
Drawing on lessons from 2024–25, Pakistan has developed a Roadmap to Zero Polio (NEAP 2025–26) with national approaches and province-specific strategies:
- Phase I: Optimization, Simplification, and Catch-Up (Jul–Sep 2025)
Adjust strategies based on recent experience; conduct catch-up rounds; prepare for high season. - Phase II: High-Performance Campaigns and Focused Interventions (Aug 2025–Apr 2026)
Implement optimized, high-quality, large-scale rounds with focused RI add-ons. - Phase III: Keeping Up and Mopping Up (Mar–Jun 2026)
Sustain sensitive surveillance; map residual risks; end final transmission chains.
Three campaigns are planned for Q4 2025: a sub-national round in September, nationwide rounds in October and December. Phase I of the September SIA vaccinated 19.8 million children. In line with TAG advice, an extended-age fractional IPV campaign is planned in core reservoirs for children up to 15 years.
Pakistan’s polio programme is holding the line. The circle is tightening; the end is in sight. Finishing the job will require discipline, precision, and solidarity, qualities the programme has demonstrated repeatedly. If we stay focused on the last pockets, learn from every detection, and keep faith with the communities we serve, polio eradication in Pakistan, which once seemed impossible, can and will be a future free of polio—forever.
Written by ISID Emerging Leader, Dr. Nadia Noreen