Originally published on 21 March 2026 by Nosheen Khan for the JHU/BSPH course “Social and Behavioral Foundations of Primary Health Care.”

Pakistan remains one of only two countries where wild poliovirus still circulates. In southern Khyber Pakhtunkhwa—districts like Bannu, North and South Waziristan, Tank, Lakki Marwat, and Dera Ismail Khan—vaccine refusals and low routine immunization coverage continue to fuel transmission. In some areas, routine coverage is critically low, leaving large numbers of “zero-dose” children.

For years, the response has relied on repeated mass campaigns. While these efforts have saved millions of children globally, in southern KP they are no longer enough. Communities face fatigue, misinformation, and deep-rooted distrust. Many families ask a simple question: “Why only polio drops, but no other health services?”

Evidence from the Global Polio Eradication Initiative and World Health Organization shows that access, trust, and behavior change are as critical as vaccines themselves. Similarly, UNICEF Pakistan highlights the importance of community engagement and social mobilization in addressing refusals.

A Needed Shift: From Campaigns to Communities

Southern KP needs a programmatic shift, not a new law. The provincial government—through the Khyber Pakhtunkhwa Department of Health and the Pakistan Polio Eradication Programme—should transition toward a community-centered, integrated service model:

  • Combine polio vaccination with routine immunization, nutrition, and maternal-child health services
  • Engage Jirga councils and religious networks to counter misinformation
  • Invest in female frontline workers to improve access in conservative areas
  • Strengthen routine immunization systems to rebuild trust

This approach addresses the root causes of refusal, not just the symptoms.

Why This Matters Now

With ongoing transmission and persistent immunity gaps, the cost of inaction is high—not just for Pakistan, but globally. A child missed today is a risk tomorrow.

Call to Action

The Khyber Pakhtunkhwa Department of Health and Pakistan Polio Eradication Programme must revise implementation guidelines within the next 6–12 months to integrate polio efforts with broader health services in southern KP. Development partners should align funding and technical support to accelerate this shift.

Ending polio in Pakistan will not come from more campaigns alone—it will come from building trust, delivering services, and putting communities at the center.