The incidence of polio – a crippling, but preventable disease – has significantly decreased worldwide owing to efforts under the Global Polio Eradication Initiative. However, it is still endemic in three countries: Pakistan, Afghanistan and Nigeria. Combating polio and other infectious diseases has now become a global obligation, since the virus can spread to other parts of the world due to frequent overseas travel. It is very likely that the incidence of infectious diseases will determine the foreign policy of many states and that foreign policy will direct the ways to deal with contagious diseases. Having said that, the persistence of polio in Pakistan – new cases have been reported this year – poses a challenge for the country at both domestic and international level. Internally, the challenges can be social, cultural, economic and political. As polio continues to paralyse more children, increase the burden of disease and create an additional need to devise further policy and practical measures to meet the needs of the affected people. At the external level, the apparent challenges are linked to foreign policy. For example, polio cases recently identified in Syria have been found to have been of Pakistani origin. The World Health Organization has now declared a polio emergency in Syria. The Syrian case was not a single incident either. The origin of polio cases identified in China in January 2012, at Al Azhar University of Egypt in December 2012 and in Palestine in March 2013, was also traced back to Pakistan. This is frightening other countries. There are inhernt risks involved in polio prevalence, as millions of children worldwide can get infected in countries where Pakistani and Syrian people are migrating. German scientists have warned that a polio epidemic can hit Europe because Syrians refugees are seeking asylum there and children in many European countries are given only a single dose of polio vaccine at the time of birth. Millions of children worldwide can get infected in countries to which Pakistani and Syrian people migrate. German scientists have warned that a polio epidemic can hit Europe because Syrians refugees are seeking asylum there and children in many European countries are given only a single dose of polio vaccine at the time of birth This means that some countries might demand a travel ban on Pakistanis. Travel to and from Pakistan also carries the risk of infections like measles, malaria and dengue fever. During the 2012-13 measles outbreaks Saudi Arabia debated about banning visas for Pakistanis. The question is why do these viruses exist in the country. To comprehend the causes behind the prevalence of polio in Pakistan, Svea Closser, an anthropologist, conducted an ethnographic research in 2006-07. She then published a book, Chasing Polio in Pakistan. The book describes the underlying reasons for the failure of polio programme. Her respondents varied from villagers in Pakistan to polio eradication planners in Switzerland and the USA. She explored the relationships among various stakeholders: the global e.g. the UN and the WHO; the national government; and local (district), e.g. managers, doctors and vaccinators. The chief factors responsible for the failure, she concluded are social, cultural, political and management related. For instance, she elaborates on how polio is tied to “office politics” at district level, where “District employees resisted the directives of their superiors in a number of ways, including refusal to work, falsification, corruption, false compliance, and direct confrontation.” One of the reasons was insufficient pay and imposition of “international mandates”. Closser found that local vaccinators were receiving $2.00 per day, while the WHO consultants were paid around $10,000 per month. Lack of negotiation of back up plans with the national government also created resentment against the nations setting the agenda. A poor monitoring system and patron-client relationships too hindered the achievement of goals. An important aspect she does not talk about in detail is the refusal of vaccine by parents and guardians of the children. In many areas, particularly in Khyber-Pakhtunkhwa, vaccination is being described as a Western plot to sterilize Muslims. In 2013, 28,000 families refused the vaccine putting about 119,000 children at risk. This year, too, thousands of families haev refused the vaccine. In 2015, arrest warrants were issued for more than 1,000 parents, who refused the polio vaccine. This year as many as 700,000 families refused polio vaccine across KP in April. The drive was then halted following attacks on the vaccination teams in which a security official was killed. In the past more than 100 vaccinators and their escorts have lost their lives in similar attacks. Polio eradication has thus become a real conundrum for Pakistan. There is need to revisit the whole paradigm of eliminating infectious disease at all levels. The ecopolitical, sociocultural and managerial factors need to be taken into account simultaneously. The goal setting needs to be realistic. Back up plans need to be negotiated on time, monitoring systems need to be improved and mechanisms introduced for local partnership. Salaries of vaccinators should be justified. Further ethnographic and multidisciplinary research is necessary. The writer is a PhD scholar at the University of Vienna, Austria