o what if one of my eleven children has been paralysed by polio? I have 10 healthy children who will play with this crippled child and take care of him for his entire life,” was the defiant response of a father in Killah Abdullah, Balochistan, whose young boy was paralysed by Wild Poliovirus 1 this year. This chilling statement came during an investigation by health officials and communication experts from Quetta and Islamabad, revealing the deep-rooted challenges in Pakistan’s fight against polio.

Despite years of dedicated efforts, Pakistan remains one of the last countries battling polio, with 16 new cases reported in 2024. This includes 12 cases in Balochistan, three in Sindh (one from) and one in the Punjab. The refusal by parents to vaccinate their children, coupled with false finger-marking, unrecorded refusals and missed children continues to hamper eradication efforts.

A critical issue in Balochistan, particularly in the Quetta block (including Quetta, Chaman, Pishin and Killah Abdullah), is the alarming number of parental refusals and the connivance of vaccination teams. In many cases, instead of reporting refusals, vaccinators marked children’s fingers with black markers, falsely indicating that they had been vaccinated. This fraudulent practice undermines the integrity of vaccination campaigns and leaves many children unprotected.

Inam-ul Haq, provincial coordinator for the Emergency Operations Centre, Balochistan, disclosed that over 500 vaccinators were involved in the false finger marking and fake vaccinations. These individuals have been served show-cause notices. 74 of them have been terminated from service and blacklisted. The situation is dire. Three of the 12 children paralysed by polio in Balochistan this year have died due to complications from the virus.

Beyond Balochistan, Sindh has reported two polio cases this year, one in Karachi—a densely populated urban centre with a highly mobile population. The Punjab, despite its progress in polio eradication, has not been spared, reporting a case this year.

One of the most significant challenges nationwide is the high number of parental refusals to vaccinate the children. Misinformation and misconceptions about the polio vaccine, often fueled by rumours and conspiracy theories, leading many parents to deny vaccination for their children. These refusals are not always formally recorded. This creates a false sense of higher vaccination coverage than what actual.

Pakistan’s battle against polio is at a critical juncture. The challenges of vaccine refusal, false finger marking, unrecorded refusals and missed children are significant but not insurmountable.

In addition to false finger marking, missed children—those absent during vaccination drives or deliberately hidden by their families—pose a severe threat to the eradication efforts. In areas with security concerns or difficult-to-reach locations, polio workers face immense challenges in accessing all households.

In response to these challenges, health authorities in Karachi have launched an aggressive vaccination campaign targeting over a million children with a combination of fractional Inactivated Polio Vaccine (fIPV) and Oral Polio Vaccine (OPV). The fIPV is administered using the latest jet injector technology, which is needle-free and minimises discomfort for the child. The combined vaccination strategy is designed to boost immunity, particularly in high-risk areas like Karachi.

Irshad Sodhar, provincial coordinator for the Emergency Operations Centre,) Sindh, underscores the importance of overcoming refusals and ensuring that every child is vaccinated. “The fight against polio requires collective action. We need the support of all segments of society, including political leaders, religious scholars and community influencers to reach every child and ensure that they are vaccinated,” Sodhar says.

Dr Anwar-ul Haq, the national EOC coordinator, has been leading the national polio eradication efforts. He remains optimistic despite the setbacks. “We have come a long way, but the fight is not over. The emergence of new cases strengthens our resolve to continue our efforts until we achieve a polio-free Pakistan. The use of fIPV and OPV in high-risk areas is a critical component of our strategy,” he says.

Ayesha Raza Farooq, the former prime minister’s focal person for polio eradication, emphasises addressing refusals and misinformation. “Polio eradication is not just a public health issue; it’s also a matter of national pride and global responsibility. The government, health workers and international partners must continue to work together to overcome the remaining challenges,” she says.

Pakistan’s battle against polio is at a critical juncture. The challenges of refusals, false finger marking, unrecorded refusals and missed children are significant but not insurmountable. A multifaceted approach, including robust vaccination efforts, public awareness campaigns and community engagement, is essential to overcoming these barriers. The commitment of key stakeholders, including health officials, political leaders and international partners, remains strong. The goal of a polio-free Pakistan is within reach, but it will require collective action from all segments of society to achieve it.

The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International