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Pakistan: the final frontier for global polio eradication
  1. Syed Osama Ahmad,
  2. Fouad Yousuf,
  3. Ahmed S Bux,
  4. Ahmed Abu-Zaid
  1. College of Medicine, Alfaisal University, Riyadh, Riyadh Province, Saudi Arabia
  1. Correspondence to Dr Syed Osama Ahmad, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia; sahmad{at}

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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.

The obstacles to setting up a successful national polio immunisation programme in Pakistan

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 …

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  • Contributors SOA was invited by the Journal and participated primarily in writing the manuscript and idea generation. FY participated primarily in writing the manuscript and also contributed to the language review. ASB contributed to the language review, writing the manuscript and examining its content. AA-Z, contributed to formatting in regard to manuscript structure and organisation.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.