Why Orthodoxy is crippling Pakistan’s polio fight, worsening health crisis

Pakistan is grappling with a rising polio crisis, as the highly contagious Wild Poliovirus type 1 (WPV1)—the last remaining wild poliovirus serotype—continues to spread.

In 2024, the country recorded 68 polio cases, a stark increase from just six cases in 2023. The majority of these cases were reported in Khyber Pakhtunkhwa (21 cases), Balochistan (27 cases), and Sindh (19 cases), while even the relatively prosperous capital, Islamabad, confirmed a case.

On January 8, 2025, Pakistan marked its first polio case of the year in a 13-month-old girl from Tank district in Khyber Pakhtunkhwa, bringing the total to 69 confirmed cases.

This marks a significant jump compared to the six WPV1 cases reported in Pakistan in 2023. It should also be noted that 69 reported WPV1 cases have risen from a single case in the first half of 2023.

The actual number of cases could be higher due to factors such as limited access to healthcare in remote areas, underreporting, and challenges in surveillance. Additionally, vaccine hesitancy and misinformation contribute to the persistence of the virus, making it difficult to obtain an accurate count of all cases.

According to the Centers for Disease Control and Prevention (CDC), there is evidence to indicate widespread virus transmission in core polio reservoirs such as Karachi, Peshawar, Quetta blocks, and central Pakistan, even though case counts have remained relatively low.

Though there is no cure, polio is preventable with safe and effective vaccines that provide lifelong protection. Despite this, low vaccination coverage among children under five has long been a challenge in Pakistan. In response to concerns about the resurgence of WPV1, Pakistan says it has administered over 300 million doses of the oral vaccine annually. However, the disease continues to remain rampant in the country. Many health experts and analysts are questioning the  failure to manage the spread of poliovirus.

Pakistan’s Independent Monitoring Board revealed in September 2024 that over four million planned vaccinations were missed in 2024 alone. It further revealed that the pressure to meet vaccination targets has fostered unethical practices such as fake finger-marking and concealing unvaccinated children. Such practices compromise the accuracy of immunization data and undermine efforts, particularly in high-risk areas like Khyber Pakhtunkhwa and Balochistan.

Additionally, logistical issues such as maintaining the cold chain for vaccine storage and distribution remain a hurdle in many parts of the country.

The ongoing spread of polio in Pakistan is attributed to challenges such as insecurity, misinformation about vaccinations, and community resistance. Pakistani authorities have been accused of not prioritizing vaccination campaigns, especially in high-risk areas, and curb the spread of the virus.

International health organizations have expressed concern and urged Pakistan to implement emergency measures to stop the spread of the virus. Representatives from these organizations are expected to visit Pakistan later this month to assess the situation and provide additional support to the ongoing vaccination campaigns.

Already, according to World Bank figures, more than half of Pakistan’s children are born stunted. A large majority are also malnourished in their early years, putting them at a great disadvantage both physically and mentally, right from the start of their lives. Now, there’s the constantly growing threat of polio as well—something almost all the world overcame a long time ago.

Vaccination campaigns in Pakistan have faced several challenges that have hindered their success in stopping the spread of polio despite significant financial investment, especially from international funding agencies. Firstly, there is a significant amount of misinformation and mistrust among certain communities regarding the safety and efficacy of the polio vaccine. A vast majority of Pakistanis believe that the vaccine contains harmful substances or is part of a conspiracy. The CIA's use of a fake hepatitis vaccination campaign to locate Osama bin Laden in 2011 has also fueled distrust and suspicion among some communities.

Secondly, insecurity and violence in certain regions, particularly in Khyber Pakhtunkhwa and Balochistan, have made it difficult for vaccination teams to access these areas and carry out their work safely. Militant groups, particularly in Khyber Pakhtunkhwa and Balochistan, have issued fatwas against vaccination and targeted vaccination workers.

In Balochistan’s Mastung district, a bomb attack in November 2024 targeted a police vehicle on its way to escort polio vaccinators, killing nine people, including five children. Similar incidents occurred in Khyber Pakhtunkhwa, where health workers and their security escorts were targeted by militant groups, leading to the deaths of 20 people. The perpetrators draw strength from conspiracy theories that permeate communities across the country, casting vaccination campaigns as Western plots.

Thirdly, some religious leaders and communities have opposed vaccination campaigns, believing that the vaccine goes against their religious principles. These religious leaders believe that the polio vaccination drops contain traces of pork and alcohol, which are prohibited in Islam. Madrassas have convinced people that the polio vaccination drive is a cover to make future generations infertile and reduce the world’s Muslim population.

One of the biggest rumors surrounding the vaccine is that it is not halal. A laboratory under the Drug Regulatory Authority of Pakistan tested the vaccine in 2015 and certified it as halal. This move was also aimed at putting to rest rumors that certain hormones were being added to the vaccine to make children sterile. Yet, these rumors have persisted.

One polio case should suffice to jolt any government into urgent action. Yet, even a constantly rising number of cases, year after year, has failed to grab the attention of Pakistan’s leaders and policymakers. It shows how deeply out of touch with ground reality Pakistan’s ruling classes have become, and how little they really care for the most compromised sections of society. This is a collective failure of all institutions—government, media, civil society, etc.

Pakistan needs to be condemned for its culture of complacency on vital issues like vaccination, especially because polio (poliomyelitis) is a highly communicable disease caused by the poliovirus. The virus primarily spreads through person-to-person contact, often via the fecal-oral route. This means it can be transmitted through contaminated food and water or direct contact with an infected person's fecal matter. It can also spread through oral secretions, though this is less common.

Most people infected with poliovirus do not have any visible symptoms. The virus can cause paralysis, which can be life-threatening. Vaccination is the most effective way to prevent polio. If the disease continues to infect more people, the international community may impose travel restrictions due to polio cases.

There is a consistent lack of political commitment in Pakistan to eradicating polio, and successive governments have failed to properly coordinate and implement vaccination campaigns. Another reason is the hybrid government’s abject failure to create an overarching narrative to counter years of brainwashing by the extreme right, which has led most people to shun the vaccine in Pakistan.

This is a severe indictment of the Shehbaz Sharif government, which has been too occupied with political and judicial intrigues and tinkering with the constitution for petty gains to give the country’s real problems the time, attention, and resources they demand and deserve