Polio's last strongholds: Why Pakistan and Afghanistan can’t defeat the virus

As countries mark World Polio Day, the disease remains entrenched in Pakistan and Afghanistan, even as it has been eliminated from almost every other part of the world. The Global Polio Eradication Initiative (GPEI) is marking the day with a plain message: political commitment matters more than ever.Afghanistan has emerged as the bigger concern this year, reporting 42 cases of wild poliovirus type 1 in 2026, twice the 21 recorded in the whole of 2025.

Pakistan, meanwhile, has reported six cases, down sharply from 31 last year. The two countries have together reported 48 cases so far this year, against 52 in all of 2025.The resurgence follows a dramatic reversal in progress.In 2023, the two countries reported just 12 cases between them, with six each. The total surged to 99 in 2024, highlighting how fragile the gains against the virus remain.The threat extends beyond reported cases of paralysis.

Wild poliovirus continues to be detected in environmental samples, indicating that the virus is circulating even in places where no paralytic cases have been identified.Why is polio surviving today?Polio is a highly infectious viral disease that mainly affects children under five.It spreads primarily through the faecal-oral route, often in settings where sanitation and hygiene are inadequate.Most infections produce no obvious symptoms.

In a small proportion of cases, however, the virus attacks the nervous system and causes irreversible paralysis. There is no cure for polio-induced paralysis, making vaccination the principal means of prevention.Eradication requires every child to be reached, including those who miss routine immunisation or vaccination campaigns. In Pakistan and Afghanistan, insecurity, restricted access, mistrust and population movement have left gaps that allow the virus to keep circulating.Dr Sunil Sareen, a paediatrician at Apollo Spectra Hospital in Delhi, told TOI that political instability and uneven vaccination coverage had made it harder to reach children in high-risk areas.

“Even a few unvaccinated children can help spread the disease,” he said.The consequences of failure would extend far beyond the region.WHO has warned that if eradication efforts collapse, polio could cause as many as 200,000 new cases annually worldwide within a decade.The virus has already demonstrated its ability to travel: in October 2025, wild poliovirus was detected in a routine sewage sample in Hamburg, Germany.A chase that is almost 40 years oldThe global eradication effort began in 1988, when the World Health Assembly adopted a resolution to eliminate polio worldwide.

The resulting Global Polio Eradication Initiative brought together governments, the World Health Organisation (WHO), UNICEF, Rotary International and other partners to coordinate vaccination, surveillance and outbreak response.The progress has been extraordinary. According to the WHO, the number of wild poliovirus cases has fallen by more than 99% since 1988, when an estimated 350,000 cases occurred annually across more than 125 endemic countries.

Wild poliovirus types 2 and 3 have been declared eradicated. Type 1 is the only wild strain that continues to circulate.(function{function e{window.addEventListener(message,function(e){if(e.data[datawrapper-height]!==void 0){var t=document.querySelectorAll(iframe);for(var n in e.data[datawrapper-height])for(var r=0,i;i=t[r];r++)if(i.contentWindow===e.source){var a=e.data[datawrapper-height][n]+px;i.style.height=a}}})}e});But eradication is different from simply reducing cases.

A country can go years without reporting a paralytic infection and still have undetected transmission. To eradicate the virus globally, transmission must be interrupted everywhere, including in communities that are difficult to reach or where vaccination coverage remains uneven.Hence, the finish line keeps moving. The original goal was the year 2000. The GPEI now aims to certify wild poliovirus eradication by the end of 2027.In the past decade alone, more than $3 billion has been spent on the effort in Afghanistan and Pakistan.India beat it in the hardest placeIndia’s own story shows that this can be done.

When the Pulse Polio programme began in 1995, the country was recording an estimated 50,000 to 150,000 cases a year. As late as 2009, it still accounted for about 60% of the world’s cases.The risks were greatest in Uttar Pradesh and Bihar. Together they held about 300 million people, with roughly 5,00,000 births a month and heavy migration in and out. The CDC says that if polio could be ended there, it could be ended in the toughest settings anywhere.The method was relentless.

India added house-to-house vaccination to find children who were not brought to fixed sites. During national immunisation days since 2000, more than 2.3 million vaccinators visited about 209 million households to reach over 170 million children under five. Transit teams at bus stops, railway stations and on trains vaccinated nearly 10 million children in each campaign.Trust mattered as much as logistics.

Teams included at least one woman and one member of the local community, to ease entry into homes. Religious and community leaders were brought in where families were reluctant. Vaccinated children’s fingers were marked, and visited houses were marked too. Every home was numbered in detailed microplans, and independent checks measured coverage after each round.Sareen said Pakistan and Afghanistan could learn from India's combination of door-to-door vaccination and community engagement.

Local healthcare professionals, religious figures and community leaders can help counter misinformation, while follow-ups and outreach to migrant populations can help reach children who miss doses.Science also helped. India switched to more effective vaccines, monovalent in 2005 and bivalent in 2010. The last case of wild polio was reported in Howrah, West Bengal, on January 13, 2011.

On March 27, 2014, WHO declared the whole 11-country South-East Asia Region…