Islamabad, Pakistan, 26 January 2025 – In the face of increasing wild poliovirus transmission in the last two remaining endemic countries, Pakistan and Afghanistan, global health experts gathered in Islamabad last week to evaluate measures to urgently reverse the epidemiological trend.
The Technical Advisory Group (TAG) meeting on polio eradication came at a critical time for Pakistan, as the country faces a resurgence of wild poliovirus (WPV1) cases and a narrowing window to interrupt transmission by the end of 2025. With 73 WPV cases reported in 2024 compared to just six in 2023, and a significant increase in environmental detections across historic poliovirus reservoirs like Karachi, Peshawar, and Quetta, and beyond, the pressure to demonstrate results has never been greater. The meeting underscored the urgent need for extraordinary efforts and emergency operational measures to get the programme back on track and restore national and international confidence in the success of the longstanding effort.
The Technical Advisory Group was convened by the WHO Regional Director for the Eastern Mediterranean Dr Hanan Balkhy on behalf of Member States and the GEPI partners. In her opening remarks, she emphasized the importance of reaching children being missed, particularly in insecure, underserved, high-risk areas and among migrant and mobile populations.
Targeting persistent challenges
The group highlighted the need to focus on areas where the virus has returned or continues to spread, particularly in parts of southern Khyber Pakhtunkhwa, central Pakistan, and urban centers. New approaches are required to ensure every child is reached, especially in areas where security issues and logistical challenges make vaccination campaigns difficult. While progress has been made in certain areas, more needs to be done to ensure high-quality vaccination campaigns and close gaps where children are being missed.
Experts outlined specific milestones that must be achieved by mid-2025 to reverse the widespread poliovirus transmission:
- Interrupt polio transmission in the northern corridor (Peshawar Bloc), in the central Pakistan zone (northern Sindh, southern Punjab, eastern Baluchistan), and across Lahore, Rawalpindi and Islamabad.
- Substantially reduce the presence of the virus in environmental samples in Karachi, the Quetta Bloc and southern Khyber Pakhtunkhwa.
- Prevent further outbreaks in any areas that have recently detected or will detect poliovirus.
The next six months are considered critical for making progress, with efforts focused on delivering effective vaccination campaigns and addressing challenges in hard-to-reach areas.
Improving campaign quality to reach missed children
To meet these ambitious targets, the quality of vaccination campaigns must improve to reach children who continue to be missed. Missing children repeatedly remains the single largest challenge for the programme. Pakistan’s current implementation of the “2-4-6 strategy” should continue focusing on strengthening programme management and accountability, enhancing the quality of Supplementary Immunization Activities (SIAs), and improving access to children in areas affected by insecurity.
Significant interventions, innovations, and assessments have been introduced under this strategy. However, the improvements have not yet translated into better SIA quality. Ensuring access to all children, particularly in high-risk areas of Khyber Pakhtunkhwa, is essential to getting the programme back on track. Additionally, special attention must be paid to mobile and migrant populations (MMPs) and to maintaining high-quality immunization efforts in border districts where the virus risks being sustained.
The TAG recommended specific benchmarks of quality and indicators of missed children that the programme must meet to achieve the recommended milestones for reversing poliovirus transmission trends by June 2025.
Opportunities for progress
Despite these challenges, there are significant opportunities for Pakistan to make strong progress in 2025. With committed political and administrative leadership, enhanced security support, and especially the Prime Minister’s regular Stock Takes, the programme can capitalize on this momentum to build a national movement for the “last push.”
Other key areas of focus include improving the morale and motivation of frontline workers, expanding routine immunization coverage through the EPI, and leveraging the Big Catch Up campaigns to address gaps in immunization.
A review in June 2025 will assess the programme’s trajectory and identify any urgent course corrections needed to sustain progress. The close interdependence between Pakistan and Afghanistan in eradicating polio further underscores the need for cross-border collaboration. As one country’s progress influences the other, maintaining high-quality efforts in border areas will be critical. The next TAG meeting for Afghanistan, planned for February, will further align strategies to tackle these shared challenges.
At the TAG meeting, Madam Ayesha Raza Farooq, the Prime Minister’s Focal Person on Polio Eradication in Pakistan, emphasized the solidarity of the Global Polio Eradication Initiative (GPEI) with countries striving to protect future generations from polio. She highlighted the importance of collaboration among partners, governments, civil society, religious leaders, and frontline workers to overcome challenges and ensure that no child is left behind on the path to a polio-free Pakistan.
“Like the moon landing, polio eradication is a challenge that tests our collective resolve and compels us to achieve the extraordinary,” said Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme and Deputy Director-General of WHO, speaking at the TAG meeting. “The last mile is the hardest. It’s the least crowded mile, full of risks and failures waiting to confront you. But it is also where true determination and resilience shine. I have every confidence that Pakistan, alongside Afghanistan, will achieve polio eradication. Together, you will land on the moon,” he added.
