Reaching the Unreached — Polio Drops in North Waziristan

Few operations in Pakistan's polio programme have mattered more than reaching the children of North Waziristan.

The two-year gap

From mid-2012, polio vaccination was banned across North Waziristan. For roughly two years, hundreds of thousands of children received no polio vaccine at all — not a missed round, but complete absence of protection through the period when they were most vulnerable.

The consequence was Pakistan's 306-case outbreak in 2014, the country's worst since 2000 and the great majority of all polio cases reported worldwide that year. It also prompted the WHO declaration in May 2014 that the international spread of poliovirus constituted a Public Health Emergency of International Concern — the declaration behind the polio vaccination certificate travellers still need today.

Reaching them

When military operations began in 2014 and families were displaced in very large numbers, the programme faced an unusual opportunity inside a humanitarian crisis: a population that had been unreachable for two years was suddenly in motion, passing through identifiable routes and gathering in camps and host communities.

The response was built around that fact:

• Vaccination teams at every route out of the affected area, catching families as they moved.
• Vaccination in displacement camps and in the host districts where families settled.
• Repeated rounds in host communities, because a single dose was never going to be enough for children with no prior protection.
• Careful tracking of where displaced families went, so follow-up rounds could reach them.

What it achieved, and what it did not

The operation reached very large numbers of previously unvaccinated children and was central to the collapse in cases from 306 in 2014 to 54 in 2015 and 20 in 2016. See polio cases in 2015.

What it did not do was permanently solve the district. Access in North Waziristan and the wider Bannu division has remained intermittent, routine immunisation coverage has never fully recovered, and southern Khyber Pakhtunkhwa continues to account for a disproportionate share of Pakistan's cases — three of the four confirmed in 2026 up to September.

The principle it established

Every child missed for two consecutive years becomes a national problem, and then an international one. That is why access negotiation in a handful of union councils is treated as a matter for the highest levels of government rather than a local operational detail.

Related: North Waziristan case record · polio cases in 2014