Pakistan is one of only two countries in the world, alongside Afghanistan, where poliomyelitis remains endemic. Wild poliovirus case counts have fluctuated significantly over the past decade: 147 cases were recorded in 2019, falling to 84 in 2020 and just 1 in 2021, before rising again to 20 in 2022, 6 in 2023, and 74 in 2024. By December 2025, reported cases for the year had decreased to approximately 30, attributed to intensified nationwide vaccination campaigns targeting more than 45 million children per round.
The country's polio immunization campaign began in 1974 under the WHO's Expanded Programme of Immunization, with formal eradication efforts starting in 1994 through the Pakistan Polio Eradication Programme, which now employs up to 339,521 trained polio workers. Despite early CDC and WHO predictions in the 1990s of eradication by 2000, vaccination coverage lagged due to logistical barriers, population being uninformed, and inadequate immunization strategies. International organizations including WHO, UNICEF, the CDC, Rotary International, and the Bill and Melinda Gates Foundation subsequently funded intensive door-to-door campaigns.
A major setback to public trust occurred in 2011, when the CIA employed Pakistani doctor Shakil Afridi and local health officials to run a fake vaccination campaign in Abbottabad, aiming to collect DNA samples to confirm Osama bin Laden's location ahead of the raid that killed him. This ruse had lasting consequences: since 2012, at least 70 polio workers have been killed in Pakistan, with many attacks claimed by the Pakistani Taliban, who allege vaccination campaigns are a cover for intelligence gathering. Polio cases rose from 198 in 2011 to 306 in 2014, the highest since 2000.
Militant attacks on vaccination teams have continued, including a January 2016 suicide bombing near a polio center in Balochistan that killed at least 15 people, a November 2022 bombing of a police truck escorting vaccinators in Quetta that killed 3, and a September 2024 shooting that killed a polio worker and a policeman.
Misinformation has also impeded eradication, including claims that vaccines contain pig fat or alcohol, or cause infertility. In April 2019, over 25,000 children were rushed to hospitals amid a panic driven by false rumors that the vaccine causes fainting and vomiting. Vaccine hesitancy persisted into 2025, with over 60,000 documented refusals recorded during the April 2025 campaign, concentrated in Sindh and Balochistan.
Other structural factors cited include poor health infrastructure, government negligence, political unrest in militant-controlled areas such as the Federally Administered Tribal Areas, climate conditions that reduce vaccine efficacy, natural disasters such as the 2010 floods, and low parental literacy affecting immunization completion. In response to a 2024 resurgence, the government launched a National Emergency Action Plan (July 2024–June 2025) and additional nationwide vaccination drives, including an October 2024 initiative targeting 45 million children.