Polio Workers Going the Extra Mile for Vaccination

The children who remain unvaccinated in Pakistan are, almost by definition, the hardest to reach. Everyone easy was reached years ago. What is left requires teams to go considerably further than a standard campaign round accounts for.

Distance

In mountainous districts of Khyber Pakhtunkhwa and Gilgit-Baltistan, teams walk routes that no vehicle reaches, sometimes for hours, to vaccinate a handful of children in a scattered settlement. In sparsely populated Balochistan districts, a day's work may produce a few dozen vaccinations. The arithmetic is poor and the work is done anyway, because a child in a remote settlement is as susceptible as a child in a city — and often more so, because routine immunisation coverage there is lower.

Movement

A large share of Pakistan's missed children are missed because they were not there. Nomadic and pastoral families move seasonally; labourers move for work; families cross the Afghan border for trade and kinship. A microplan built on fixed households does not describe this population.

The response is to vaccinate where people travel rather than where they live: around 500 permanent transit points on borders, highways, bus terminals and railway stations, plus teams that follow seasonal migration routes.

Refusal

The most demanding work is not physical. A household that refuses is not closed permanently — it is a conversation that has not finished. Teams and social mobilisers return, sometimes many times, bringing a religious scholar, a community elder or a female mobiliser from the same neighbourhood when the objection calls for it.

This is slow and it is the only thing that works. The programme's consistent finding is that the messenger determines whether the message is accepted. See parental refusals.

Access

In parts of southern Khyber Pakhtunkhwa, campaigns cannot run at all for security reasons. Where that happens, teams work through negotiated short access windows, vaccinate in displacement camps and host communities when families move, and rely on community-based vaccinators recruited from within the area who can operate where outside teams cannot.

This is currently the largest single driver of Pakistan's remaining cases — three of the four confirmed in 2026 up to September came from the Bannu division.

Why it matters

Eradication is decided entirely at the margin. The children who are easy to reach are already protected; the outcome depends on the last few per cent. Every extra mile is aimed at exactly that group.

Related: frontline workers · high-risk areas