Pakistan: the final frontier for global polio eradication

With outbreaks in the Middle East and Africa already under control, the world has moved much closer to achieving global polio eradication.1 Among the three endemic countries (Nigeria, Pakistan and Afghanistan), Nigeria has made a significant progress with only six reported cases of polio in 2014, and no new cases reported since July 2014.1 Unfortunately, Afghanistan has regressed, with 28 cases reported in 2014 compared to 14 cases in 2013. However, most of these cases can be attributed to the cross-border transmission from Pakistan.1 On the other hand, Pakistan experienced an unprecedented rise in polio cases in 2014, which has been largely attributed to the influx of unvaccinated residents from Federally Administered Tribal Areas (FATA) to other parts of the country.2 For the first time in the 21st century, the annual reported cases of polio in Pakistan exceeded 300.1 This editorial aims to briefly highlight: (1) the obstacles to setting up a successful national polio immunisation programme in Pakistan; and (2) the current positive developments and pending issues yet to be resolved towards achieving national polio eradication. Analysing the statistics from the endemic countries, it is quite evident that Pakistan poses a major hurdle towards achieving global polio eradication. Pockets of unvaccinated residents and positive environmental samples continue to persist due to several obstacles preventing successful immunisation campaigns in certain localities. The three major obstacles identified were: (1) extremist-related security issues; (2) parental refusal of vaccination; and (3) concerns about the efficacy and safety of the polio vaccine.3 ### Extremist-related security issues Attacks on healthcare workers and lack of incentives …