Eradication Strategy — How Pakistan Plans to Stop Poliovirus

Pakistan's polio strategy is set out in successive National Emergency Action Plans (NEAPs), agreed between the federal and provincial governments and the eradication partners. Each plan restates the same objective — interrupting wild poliovirus type 1 transmission — and adjusts tactics based on where the virus was actually found in the preceding year.

The strategy rests on six pillars.

1. A campaign calendar built around risk

The programme runs national immunisation days (NIDs), which target every child under five in the country — around 45 million — and sub-national immunisation days (SNIDs), which cover smaller populations selected by risk assessment. Case-response campaigns are triggered separately whenever a case or a positive environmental sample is confirmed.

The logic is that blanket coverage builds population immunity while targeted rounds put extra pressure on the districts where the virus is actually circulating. Which districts those are is decided by tier — see high-risk areas.

2. Microplanning down to the household

Every campaign is built on microplans: maps of each union council showing every settlement, the number of children in it, which team covers it, and how long that will take. Poor microplans are one of the most reliable predictors of missed children, so plan validation has become a core supervisory task rather than a paperwork exercise.

3. The right vaccine for the right job

Campaigns use bivalent oral polio vaccine (bOPV), which protects against the remaining wild type 1 and against type 3. Inactivated polio vaccine (IPV) is delivered through routine immunisation to maintain type 2 immunity after trivalent OPV was withdrawn globally in 2016, and fractional-dose IPV has been used in selected high-risk districts to stretch supply while boosting immunity. Novel oral polio vaccine type 2 (nOPV2) is reserved for variant type 2 outbreak response.

4. Surveillance that sees the virus first

Strategy depends on knowing where the virus is. Acute flaccid paralysis surveillance investigates every case of sudden-onset floppy paralysis in a child under 15, and environmental surveillance samples sewage at more than a hundred fixed sites, giving the programme warning weeks before a child is paralysed. Details are on the surveillance page.

5. Community engagement and demand

Refusals cluster in specific communities and are driven by specific beliefs — that the vaccine is unsafe, impure, or a foreign scheme. The programme's response is not argument at the door but sustained engagement through people the community already trusts: religious scholars, local elders, teachers and female social mobilisers from the same neighbourhood. The work of the ulema in particular is covered in Muslim ulema dispel misconceptions.

Alongside this, integrated health camps deliver services families actually want — routine immunisation, maternal health, nutrition — which changes the relationship from a repeated request into an exchange.

6. Cross-border coordination with Afghanistan

Pakistan and Afghanistan are treated as a single epidemiological block. The two programmes synchronise campaign timing, share genetic sequencing data, and vaccinate travelling children at around 500 permanent transit points on borders, highways, bus terminals and railway stations. A strategy that stops at the border would simply wait for reinfection.

Where the strategy is under most pressure

The recurring constraint is access. Where campaigns cannot run for consecutive rounds — most persistently in parts of southern Khyber Pakhtunkhwa — immunity gaps open regardless of how good the plan is elsewhere. That is why recent cases have concentrated so heavily in a small number of districts, as the district tracker shows.