Islamabad: Pakistan’s southern Khyber Pakhtunkhwa has been declared the most alarming hotspot in the global battle against polio, as the Technical Advisory Group (TAG) for Polio Eradication sounded the alarm over persistent virus circulation, repeated operational failures, and vast numbers of missed children in the region.
Despite multiple rounds of vaccination, including four successive ComVI (community vaccination) campaigns conducted without independent monitoring, southern KP remains a critical reservoir of wild poliovirus, with ongoing transmission in districts like Bannu, D.I. Khan, Lakki Marwat and Tank.
Environmental surveillance and case detection data confirm that this zone, which has contributed 41% of all WPV1 cases in Pakistan and 82% in KP since 2018, continues to fuel spread across the country.
“In southern KP, we see a massive accumulation of missed children, fake finger marking, inaccessible union councils, and weak monitoring,” the TAG observed in its provisional feedback report presented after its three-day meeting held from June 24–26 in Islamabad.
“This area poses the biggest challenge to both national and global eradication efforts and must be treated as an emergency within an emergency.”
The review, based on progress under the National Emergency Action Plan (NEAP) 2024-25, revealed that none of the six key milestones set in January 2025—including virus interruption in the Peshawar bloc, Punjab, and central Pakistan—were met.
The TAG concluded that widespread transmission persists in Karachi, Lahore, Quetta, Sukkur, and southern KP, even though the virus resurgence appears to have peaked.
As of June 27, 2025, Pakistan had reported 13 WPV1 cases, after ending 2024 with 74. A major concern highlighted in the report is the continued transmission in areas showing high campaign quality indicators, raising suspicion about data reliability and true campaign performance.
In contrast to southern KP, Peshawar-Khyber bloc showed promising results, with no polio case reported and only one remaining WPV1 lineage detected in environmental samples, reflecting significant improvement.
Sindh, which was initially seen as a bright spot due to strong government commitment, has now emerged as the second biggest concern after southern KP.
Despite improved Lot Quality Assurance Sampling (LQAS) scores and high coverage figures, intense virus circulation continues in Karachi and northern Sindh districts, including Kambar, Larkana, and Sukkur.
TAG recommended that an internationally-led evaluation of the September National Immunization Days (NIDs) be carried out in Sindh to investigate the apparent disconnect between reported indicators and ongoing transmission.
To contain the virus, the TAG urged the government to conduct expanded age group fIPV campaigns for children aged 0–15 years in Karachi, Lahore, and Peshawar by the end of September 2025, and to offer at least four more ComVI rounds in southern KP with proper external monitoring, team supervision, and quality assurance.
The appointment of Dr Soofia Yunus as Director General of the Federal Directorate of Immunisation (FDI) was welcomed by the TAG, but it called on the government to ensure that she is assigned full-time responsibility for the national EPI programme.
The group also urged the implementation of an emergency EPI improvement plan in southern KP and Quetta, supported by the deployment of 2,000 vaccinators and an expanded focus on nutrition, community outreach, and recruitment of female vaccinators to reach zero-dose children.
Elsewhere, Lahore was classified as a zone of endemic WPV1 transmission with year-long circulation and low campaign quality. Islamabad’s campaign quality remains poor due to reliance on one-person vaccination teams and volunteers.
On the other hand, some positive indicators were noted in Gilgit-Baltistan and Azad Jammu & Kashmir, where routine immunization and surveillance are relatively stable.
The TAG also called for right-sizing of the polio workforce, redeployment of resources from low-risk zones, digital payments for vaccinators within 10 days, improved operational monitoring, and enhanced synergy between the Polio Eradication Initiative (PEI) and the Expanded Programme on Immunization (EPI).
The TAG concluded that while a natural immunity boost from the 2024 resurgence and high-quality SIAs offer a window of opportunity, failure to act decisively now could mean another lost chance to end polio.
The current feedback is provisional, and a final report is expected within a few weeks after incorporating additional reviews and stakeholder input.
The next comprehensive TAG review will take place in February 2026, where the global body will assess whether Pakistan is on track to interrupt WPV1 transmission before the high season begins.
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