Eradication Within Reach — A View from the Field

In 2021 Pakistan recorded a single wild poliovirus case for the entire year. No endemic country has come closer to zero without crossing the line. Understanding both halves of that sentence is what "within reach" actually means.

How far the country has come

Roughly 20,000 cases a year in the early 1990s. Eight in 2017. One in 2021. Thirty-one in 2025. Four by September 2026. A reduction of close to 99.8 per cent since the national programme began in 1994.

That was delivered by hundreds of thousands of frontline workers, several campaign rounds a year, a surveillance network that investigates every case of childhood paralysis and samples sewage at more than a hundred sites, and three decades of sustained effort.

Why the last part is the hardest

Every child who was easy to reach was reached years ago. What remains are children who are missed because campaigns cannot safely enter their union council, because their family was travelling again, because they live in a settlement no microplan describes accurately, or because a parent refused.

Poliovirus needs very little: a sufficient number of susceptible children in close enough contact. Because roughly one infection in two hundred causes paralysis, the virus can circulate invisibly for a long time before anything becomes visible.

What would have to hold

• Access in southern Khyber Pakhtunkhwa. Three of Pakistan's four cases in 2026 up to September came from the Bannu division. The programme has been explicit that security-related access constraints there are why children miss critical vaccination.
• Campaign quality, round after round. Not coverage reported, but children actually vaccinated in the union councils that matter.
• Community trust. The 2019 collapse — from 12 cases to 147 after a single false rumour — is the clearest evidence available that trust is infrastructure, not messaging.
• Routine immunisation. Campaigns supplement it; they cannot replace it. Where routine coverage is weak, the susceptible pool refills continuously.
• Cross-border coordination. Pakistan and Afghanistan are one epidemiological block. Neither finishes alone.

What finishing would look like

Not a single announcement. Certification requires three consecutive years with no wild poliovirus detected in people or in the environment, with surveillance sensitive enough to be believed. The practical signals to watch are environmental positivity falling, its geography narrowing, and southern KP moving from persistent detection to sustained absence.

The honest position

Pakistan has been close before and lost ground. The difference between close and finished is whether every round reaches the same hard-to-reach children, in the same districts, without a gap.

Related: eradication within reach · eradication strategy · cases by province