# 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 > Pakistan recorded 65 wild poliovirus type 1 (WPV1) cases in 2024 and more than 30 in the first six months of 2025, with environmental surveillance detecting WPV1 in sewage samples across at least 28 districts; Khyber Pakhtunkhwa province accounted for the majority of cases, where access for vaccination teams remained constrained by conflict, with Afghanistan remaining the only other WPV1-endemic country globally **Meta:** type: story · date: 2025-07-01 · heads: 长远之局, 什么崩了 · 7 takes · 5 lenses · 4 regions ## 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](/zh/entity/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 ## Regional takes (batched by bias / lens) ### WHO-coordinated global eradication programme; primary source for WPV case counts, environmental surveillance data, and country-level outbreak assessments - **WHO Global Polio Eradication Initiative** (International, en) — The Global Polio Eradication Initiative's weekly situation reports documented Pakistan's 2024 caseload of 65 WPV1 cases, a significant increase from 6 in 2023, and tracked continuing case detections in 2025. The GPEI identified Khyber Pakhtunkhwa (KP) province, particularly the districts of Bajaur, Tank, Lakki Marwat, and Dera Ismail Khan, and Balochistan as the primary endemic reservoirs. Environmental surveillance detected WPV1 in sewage from at least 28 districts, indicating wider silent circulation than case counts alone suggest. Access constraints from armed conflict in KP's border areas were cited as the primary operational barrier to vaccination coverage. > "GPEI: Pakistan 65 WPV1 cases in 2024; WPV1 in sewage across 28+ districts; KP conflict zones the primary access barrier for vaccination teams." Source: https://polioeradication.org/polio-today/polio-now/this-week/ ### UN children's fund with direct field operations supporting Pakistan's vaccination campaigns; reports on access constraints and campaign reach - **UNICEF Pakistan** (International, en) — UNICEF Pakistan reported on the operational challenges of sustaining vaccination coverage in Khyber Pakhtunkhwa, where armed groups have historically targeted vaccination teams and where population displacement from conflict made maintaining updated vaccination registries difficult. UNICEF's 2025 report noted that Pakistan's National Emergency Action Plan for Polio Eradication had expanded the use of house-to-house vaccination in areas where security permitted, but that gaps persisted in the most conflict-affected districts. > "UNICEF Pakistan: house-to-house vaccination expanded where security permits; gaps persist in most conflict-affected KP districts." Source: https://www.unicef.org/pakistan/stories/reaching-children-everywhere-fight-polio ### Leading peer-reviewed infectious disease journal; epidemiological analysis of Pakistan's resurgent WPV1 circulation and eradication pathway - **Lancet Infectious Diseases (Pakistan polio)** (United Kingdom, en) — The Lancet Infectious Diseases published analysis of Pakistan's 2024 WPV1 surge, noting that the jump from 6 cases in 2023 to 65 in 2024 reflected a combination of declining population immunity in KP due to conflict-related vaccination gaps, cross-border transmission with Afghanistan (which recorded 23 WPV1 cases in 2024), and the detection methodology improving as environmental surveillance was expanded. The authors argued that eradication in Pakistan and Afghanistan was technically achievable but required sustained security access that was not guaranteed under prevailing conditions. > "Lancet ID: Pakistan's jump from 6 to 65 WPV1 cases reflects vaccination gaps from conflict, cross-border transmission with Afghanistan, and improved detection." Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00321-4/fulltext ### Pakistan's leading independent English-language newspaper; domestic reporting on the political and operational response to the WPV1 surge - **DAWN (Pakistan)** (Pakistan, en) — DAWN reported on Pakistan's Prime Minister and National Command and Control Centre's response to the 2025 WPV1 surge, noting that the government had deployed the army to escort vaccination teams in Khyber Pakhtunkhwa and Balochistan districts with the worst security conditions. Pakistan's Minister of Health announced emergency supplementary immunization activities targeting 45 million children in the most-affected provinces. DAWN also reported community resistance in some districts where rumours about vaccine safety had been amplified by social media. > "DAWN: Pakistan army escorts vaccination teams in KP and Balochistan; emergency SIAs targeting 45 million children; social media vaccine rumours complicate access." Source: https://www.dawn.com/news/1870000/polio-cases-surge-in-pakistan-2025 ### unlabelled - **Rotary International (End Polio Now)** (International, en) — Source: https://www.endpolio.org/poliothisweek - **CDC (US) Polio in Pakistan** (United States, en) — Source: https://wwwnc.cdc.gov/travel/destinations/traveler/none/pakistan - **Global Health Observatory (WPV cases)** (International, en) — Source: https://immunizationdata.who.int/pages/incidence/POLIO.html ## Across the graph - Entities: Polio --- Canonical: https://rbtfl.xyz/zh/n/polio-pakistan-2025