Sindh stood at the threshold of a historic milestone—poised to be declared polio-free after maintaining nearly three consecutive years without reporting a single case. It was an extraordinary achievement, reached under the disciplined leadership of the previous Emergency Operations Centre (EOC) Coordinator. The program had, against the odds, earned the cautious optimism of global health experts. Communities once fractured by misinformation and distrust were beginning to see vaccination teams not as intruders but as protectors. The fragile hope of eradication was within touching distance. Then, the winds shifted. As soon as the incumbent EOC Coordinator took over, the virus began to whisper its way back into the province. Whispers soon became echoes; echoes now resound as warnings.
Sindh, particularly Karachi, is once again awash with the specter of poliovirus, detectable in its sewage, creeping silently through neglected communities and uncoordinated institutions. Polio in Pakistan has become more than a public health challenge; it is a mirror held up to the state’s institutional decay. Despite another round of national anti-polio drive to be begun today—with the familiar images of politicians administering oral drops, media briefings, and lofty proclamations—the virus still persists, and with it, the world’s attention. Afghanistan, long scapegoated for exporting the virus through its displaced populations, has seen fewer cases than Pakistan current and the past year. It is an inconvenient fact that strips away the last of the justifications that policymakers in Islamabad or Karachi might offer.
The Prime Minister, Shehbaz Sharif, has assumed a visibly active role in this renewed campaign, and his efforts should not be dismissed outright. His public advocacy for vaccination, his symbolic gesture of administering polio drops, and his appeals to parents are all commendable. But these efforts, no matter how genuine, cannot replace the rigorous machinery required to beat the virus into extinction. Campaigns driven by political optics cannot substitute for campaigns rooted in operational excellence and ground-level credibility.
At the core of the issue lies a troubling inertia—especially within Sindh’s EOC. The center, which ought to function as the brain of the province’s polio response, has become mired in a bureaucratic torpor that neither inspires confidence nor demonstrates urgency. What was once a taskforce driven by data, discipline, and deep community engagement has slipped into predictable patterns of performative action. Announcements are made, meetings held, and press releases churned out. But none of it translates into the type of coordinated fieldwork and meticulous monitoring that eradication demands.
The institutional rot does not stop there. In too many cases, leadership roles and technical positions within the EOC have become tokens handed to well-connected insiders, rather than experts steeped in public health knowledge and field experience. The decision-making tree is cluttered with competing egos and blurred responsibilities, creating a paralysis that only the virus benefits from. What results is a deeply demoralized workforce, often unsure of their mission and unsupported in their delivery. The vaccinators on the frontlines, many of whom are women braving hostility and hardship, deserve far better from those who claim to lead them.
The national EOC, based in Islamabad, cannot absolve itself either. Its primary role is not to merely rubber-stamp provincial plans or to issue ceremonial directives. It is meant to supervise, support, and when necessary, intervene. Yet its response has too often been passive, limited to internal memos and polite reminders. What is required now is a robust audit of provincial performance, not a celebration of symbolic milestones. Transparency in reporting, especially concerning positive environmental samples and missed children in campaigns, is the foundation upon which trust can be rebuilt. Anything less only deepens suspicion, both among the public and international observers.
And the world is watching, warily. Many countries now require proof of polio vaccination for Pakistani travelers—a quiet but unmistakable indictment of country’s handling of the crisis. Each new restriction imposed by a foreign government is not just a bureaucratic inconvenience; it is a silent judgment, a sign that Pakistan is seen not as a partner in global health but as a persistent risk. This is not to say that the problem lacks solutions. The blueprint for success already exists—in Pakistan’s own past. When the EOC in Sindh operated under competent leadership, when data flowed freely and decisions were evidence-driven, the virus was pushed back.
Communities were engaged, not ignored. Campaigns were adaptive, not redundant. Accountability was real, not rhetorical. Now, with the virus resurging, the federal government must act decisively. The Prime Minister must demand a performance review of Sindh’s EOC leadership and not shy away from making difficult changes if needed. There is no room for political patronage in a war against a disease that cripples children for life. The safety of millions of children must outweigh the comfort of a few bureaucrats. This moment demands something more than the routine. It demands an end to the cycle of excuses. It demands urgency. Most of all, it demands humility—the humility to admit failure, to listen to experts, and to re-center the effort on the communities that matter most.
Without these changes, the anti-polio campaign risks becoming just another theatre of gestures, where headlines are made but milestones never reached. Pakistan does not need another campaign; it needs a course correction. The virus will not wait for better intentions. It will exploit every gap, every delay, every lie told in boardrooms and press releases. And it will keep coming back, as it has now, until the state decides to truly fight. Until that happens, Sindh will remain not the beacon of eradication it once nearly became, but a cautionary tale of how quickly success can be undone when vigilance gives way to vanity.
