Vaccination is a bulwark against deadly infectious diseases. Done right, it protects whole populations from diseases that can cause disability and premature death. History bears witness to catastrophic epidemics that decimated large populations. In 1918, the Spanish flu infected more than a quarter of the world’s population and killed between 30 million and 100 million people. The death toll is more than all the deaths during the two World Wars. The epidemic was thus the worst catastrophe of the 20th century. In the 100 years since then, no other pandemic has caused deaths on such a large scale. Reasons for this include advancements in knowledge systems, improvements in and awareness related to hygiene; and improved income levels. Some of the fatal diseases of the last century, for instance smallpox, have been completely eradicated. However, new challenges are looming. The past century has seen the resurgence of some of the old pathogens including tuberculosis and measles; as well as the emergence of new ones, such as the HIV, the dengue fever, and the AMR. Left unattended, the pathogens can cause enormous destruction. The risks have multiplied as a result of factors like rapid growth of population, urbanization, globalisation and climate change. Pathogens can now spread far more easily than a hundred years ago and result in an uncontrollable catastrophe. Prevention is better than cure, more so given the new risk factors. Vaccination has been a great scientific break-through. However, an alarming situation has now developed with a growing number of parents choosing not to immunise their children. The refusal is the result of people’s anxieties linked to rumours of a conspiracy to use vaccination to poison select populations. A plethora of non-sense and mischief is going around on the social media to undermine universal vaccination in Pakistan. Many people have taken it upon themselves to propagate it. Over time, the phenomenon has become highly complex. The progress of vaccination uptake is unsatisfactory. The media has been reporting vaccination refusals and resentment hindering the uptake. The vaccination teams have been attacked and infectious outbreaks, real and fictional, blamed on vaccines. The reports reflect a critical state with regard to vaccination in the country. The controversies are a profound indication that something somewhere is wrong. It needs immediate attention. Such reports show that there is mistrust in vaccination, mistrust in administration and mistrust in global donors To mention just one example, there was a ‘rumour’ recently that polio vaccine was causing children to faint and die. It spread like fire, caused around 700,000 refusals and led to the killing of security personnel and a health worker in the Khyber Pakhtunkhwa. There appeared to be no other option for the authorities but to halt the drive across the country. Such rumours about vaccination are steering the country towards a perilous crossroads. The controversies are a profound indication that something somewhere is wrong. It needs immediate attention. Such reports show that there is mistrust in vaccination, mistrust in administration and mistrust in global donors. Such mistrust is particularly dangerous in a country like Pakistan given its dense population, the alarming level of malnutrition, poverty, illiteracy and an inadequate healthcare system. It can cause unbearable morbidity and mortality as infectious agents spread. The society cannot afford further delays and expect economic, social or political miracles. The situation demands extraordinary and concurrent efforts, not in a single realm but in all. The vaccination issue needs to be tackled proactively and in a realistic manner. The situation is already dire. The best thing to do is to draw on strategies and experiences of other countries. In Finland, for example, vaccination is voluntary, but coverage is more than 95 percent. Italy recently enacted the Lorenzin Law (No Vaccination No School) making vaccination compulsory for school-going children. The vaccination effort must be protected against misinformation, rumour mongering and politics. It is in the interest of everyone – citizens, government and global stakeholders -to resolves issues through negotiations. The protagonists must engage the antagonists. The negotiations must not aim at a victory in an ideological struggle but at winning back the lost trust of the long-suffering people. If such negotiations and precautions are delayed any further or taken lightly, more lives will be at stake and possibly lost. It is urgent to initiate best possible efforts for a vaccination programme to succeed. There are undoubtedly numerous economic, social and security problems in developing countries. It is wise and necessary to deal with all of them using an approach that does not ignore any of them. Nothing is unimportant and unrelated. These matters are weaved in such a way that ignoring or paying less attention to one of them affects the complex whole. This complexly knitted state necessitates devising and application of a holistic approach. Despite massive challenges knocking at our door, there is still a way forward. It is imperative that those whose actions and power count for more, do everything feasible to prevent an unintended outcome. They have to propose long-lasting solutions. A healthy nation state cannot be guaranteed without a healthy population. Mitigation and elimination of infectious diseases is no longer just a national responsibility, it has also become a global obligation. The writer is a PhD scholar at University of Vienna, Austria