Polio continues to persist in Pakistan after decades of effort. Why? I firmly believe we can eliminate polio-if only we stop selling our national pride short for a paltry $150 million. Frankly, the existence of Polio in Pakistan says far more about our priorities than about our capacity. After decades of vaccination campaigns, billions spent globally, and near-universal eradication elsewhere, Pakistan remains one of only two countries in the world-alongside Afghanistan-where polio has never been eliminated. For a country that sees itself as a regional power, this is not just a public-health failure; it is a national embarrassment.
Over the past year, Pakistan has regained some international standing. It has demonstrated military competence and restored a degree of credibility in the world. FM Asim Munir and the armed forces deserve credit for this shift. But such respect is inherently temporary. In the modern world, lasting prestige does not come from military strength alone. It comes from economic performance and social outcomes-education, literacy, women’s empowerment, healthcare, nutrition, and basic public health indicators. By those measures, polio stands out as the most glaring and unnecessary stain on Pakistan’s image. This article focuses only on polio, not because it is our biggest challenge, but because it should be the easiest to solve. Unlike education reform or poverty reduction, polio eradication is technically simple. The vaccine works. The disease is preventable. What remains is political will.
Pakistan today occupies a unique and unenviable position. Of nearly 200 countries, only two have failed to eliminate polio. Afghanistan, after decades of war, sanctions, and state collapse, is one of them. Pakistan, a nuclear-armed country with functioning institutions, is the other. With all due respect to Afghanistan, Pakistan is the only major country still burdened by this disease. That distinction is indefensible.
Why does polio persist?
The first obstacle is not science, but access. Polio cases are concentrated in defined pockets-parts of KPK bordering Afghanistan, and areas of Balochistan and Sindh. These regions suffer from insecurity and militant violence. Since 2012, more than 100 polio workers and security personnel have been killed, creating fear and disrupting campaigns. This raises an uncomfortable question. A state capable of combating insurgencies, securing borders, and projecting military power worldwide surely has the ability to protect health workers. The issue is not capacity; it is prioritisation. If polio eradication were treated as a core national-security objective, the threat to vaccinators could be neutralised.
Frankly, the existence of Polio in Pakistan says far more about our priorities than about our capacity.
The second obstacle is misinformation amplified by religious figures. Myths that polio vaccines cause sterility or represent Western conspiracies continue to circulate. Meanwhile, some clerics have declared vaccination un-Islamic. What makes this particularly troubling is that the identities and locations of the most vocal opponents are well known. A state that can shape political outcomes appears inexplicably restrained when faced with a small number of agitators.
In many cases, opposition to vaccination seems less about belief and more about leverage-creating nuisance value to extract attention or concessions. Afghanistan, ironically, has adopted a more pragmatic approach. By engaging local imams and administering polio drops at mosques-almost certainly with financial incentives-it has worked around resistance. It is not ideologically elegant, but it is effective. Pakistan should not be too proud to adopt what works.
The third issue is money-and the perverse incentives it creates. Pakistan’s polio program receives roughly $100-150 million annually from international partners. There are stakeholders who would rather see this funding continue indefinitely. But this raises a fundamental question: is Pakistan’s dignity really worth only $150 million? And, to add insult to injury, in Saudi Arabia, depending on their mood, Pakistanis are administered polio vaccines upon arrival, regardless of age or prior immunisation. Few things are more demeaning for a nation than being treated as a permanent public-health risk.
The fourth concern is employment. Around 260,000 polio workers-most of them women-are involved in vaccination campaigns. Many fear that once polio is eliminated, donor funding will end and jobs will disappear. This fear is understandable, but misplaced. The solution is not to preserve polio, but to plan the transition. Pakistan’s routine immunisation coverage remains weak, with roughly one-quarter of children missing basic vaccines. The infrastructure created for polio-trained workers, cold-chain systems, surveillance networks-can and should be absorbed into broader public-health programs.
Moreover, Pakistan faces a massive shortage – by some estimates around 4 million – of healthcare workers, while global demand for health and elder-care staff is also in millions. These workers are not surplus; they are an asset.
What, then, must be done?
First, religious obstruction must be addressed decisively-through a mix of engagement and enforcement. Persistent offenders should face consequences, including restrictions on overseas religious travel. Mosques should be incorporated as vaccination sites, with incentives aligned accordingly. Second, polio workers must be given explicit guarantees that their livelihoods will continue through integration into mainstream health services or international placements.
Third, and most importantly, Pakistan’s leadership must place national image and self-respect above donor dependency. Pride should not be auctioned for $150 million. Polio is not merely a health issue. It is a test of governance, seriousness, and national confidence. If Pakistan cannot eliminate a disease the rest of the world has consigned to history, no amount of military prestige will command lasting respect.
The choice is ours, Mr FM! And sorry, I am addressing this to you since the political leaders have consistently failed, and their sense of national pride when it comes to polio is nonexistent.
The writer is a former Senior Advisor to the Government and a sector development specialist. He is a member of the APP Think Tank and Pakistan’s Buddhist Heritage Promotion Ambassador
for Green Tourism, a company under SIFC.