Frontline Workers — Pakistan's First Line of Defence Against Polio

Pakistan's polio programme runs on people. A national immunisation round reaches around 45 million children under five within a few days, and that is only possible because hundreds of thousands of frontline workers move through the country at the same time.

What the job actually is

A vaccination team is usually two people, recruited locally and trained before each round. They carry a cool box, a tally sheet and a finger marker, and they work to a microplan specifying which settlements they cover, how many children live there and how long it should take.

The work is physical and repetitive: streets, staircases, mountain paths, desert tracks, in summer heat that the cold chain has to survive as well. A team may knock on two hundred doors in a day and be turned away at twenty of them.

Why so many are women

A large share of the workforce is female, and this is structural rather than incidental. In many Pakistani households, only a woman can enter and speak to the mother — who is usually the person who decides whether a child receives the drops.

Female mobilisers also do the work that campaigns cannot do at speed: returning to a household that refused, sitting with a mother, answering the same question for the fourth time. The programme's consistent finding is that refusals are resolved by patient repetition from someone the family recognises, not by better arguments from a stranger.

The risk

Polio workers and the police assigned to protect them have been killed in Pakistan. The consequences extend well beyond the immediate loss: campaigns suspend, areas become inaccessible, recruitment gets harder, and teams start moving with armed escorts — which changes how they are perceived at the door and makes the patient household conversation far harder.

Security-related access constraints in southern Khyber Pakhtunkhwa are currently the largest single driver of Pakistan's remaining cases. See on attacks against workers.

What they have achieved

Pakistan recorded roughly 20,000 polio cases a year in the early 1990s. It recorded 31 in 2025. That reduction — close to 99.8 per cent — was delivered by people earning modest wages, walking, knocking and explaining, round after round, for three decades.

What families can do

Open the door. Have children under five present when the team calls. Ask questions if you have them — the team would far rather answer than record a refusal. And call 1166 if no team reaches your street.

Related: vaccine heroes · going the extra mile · programme structure