Pakistan reports 65 wild poliovirus cases in 2024 and surges to over 30 in the first half of 2025, concentrated in Khyber Pakhtunkhwa and Balochistan, as WHO retains Public Health Emergency of International Concern

Summary

Pakistan is one of only two countries in the world where wild poliovirus type 1 (WPV1) remains endemic, the other being Afghanistan. Pakistan recorded 65 WPV1 cases in 2024, a tenfold increase from 6 cases in 2023, followed by more than 30 cases in the first half of 2025. Environmental surveillance of sewage has detected WPV1 in at least 28 districts, indicating that reported cases underrepresent the true scope of active circulation. Khyber Pakhtunkhwa province, particularly the districts of Bajaur, Tank, Lakki Marwat, and Dera Ismail Khan, accounts for the majority of cases, with armed conflict constraining vaccination team access to the highest-risk areas. Pakistan and Afghanistan together form the last remaining reservoir of WPV1 globally, with significant cross-border transmission between the two countries.

The split

Pakistan's government framed the 2024-2025 surge as a security and access problem requiring military escort of vaccination teams, rather than a fundamental gap in the eradication programme design. Pakistan's National Emergency Action Plan for Polio Eradication, funded partly by international donors including USAID and the Bill and Melinda Gates Foundation, emphasised the rapid expansion of house-to-house vaccination in accessible areas. Public health researchers pointed to a more structural problem: that the districts with the highest poliovirus circulation are also the districts with the longest histories of vaccine refusal driven by religious and political actors, suggesting that supply-side campaign intensification alone would not reach the holdout populations. Afghanistan's Taliban government's restrictions on female vaccination workers also constrained the cross-border coordination essential for eradication on a geographic corridor that does not respect national boundaries.

By the numbers

• 65: Pakistan WPV1 cases in 2024 (up from 6 in 2023)
• 30+: Pakistan WPV1 cases in H1 2025
• 28+: districts with WPV1 detected in environmental (sewage) surveillance
• 23: Afghanistan WPV1 cases in 2024
• 2: countries remaining endemic for WPV1 globally (Pakistan and Afghanistan)
• 45 million: children targeted in Pakistan's emergency supplementary immunisation activities (2025)

Why it matters

Pakistan's Polio resurgence matters because WPV1 is an existential threat to the entire global eradication effort: as long as the virus circulates in Pakistan and Afghanistan, it can be exported to any country whose vaccination coverage has slipped, including countries in the Middle East, Central Asia, and Africa that have seen periodic importations. The 2011 assassination of Osama bin Laden in Abbottabad, after a CIA-linked fake vaccination campaign was used to collect DNA, created lasting vaccine distrust in KP that has proven impossible to fully overcome and continues to provide armed groups with a pretext for targeting vaccinators. WHO's PHEIC designation for poliovirus remains in effect and includes travel health recommendations that affect Pakistani citizens' international movement.

What to watch

• Pakistan's 2025 full-year WPV1 case count when finalised in early 2026
• Whether Afghanistan's Taliban government allows female vaccinators to return to field duty in border districts
• Whether US government funding for GPEI through USAID is sustained following the 2025 US foreign aid review
• Environmental surveillance expansion in Pakistan's urban centres, which provides earlier warning of silent WPV1 circulation