As a child, Sadia Suleman found the perfect playground in the construction site next door – a mud pit. She would play there, take a bath when she got home, and then develop a fever. For 21 consecutive days, she had a high fever.
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03-31, 2025One night, a doctor gave her an injection. The next morning, she couldn't walk. "My legs wouldn't work," she recalled, "I couldn't even touch the ground." Another prominent doctor eventually diagnosed her condition. "He told my mother that I had polio and that it was incurable," she told the Australian Broadcasting Corporation (ABC). "He advised my mother to stop seeking treatment and give up on the idea of me walking again."
Sadia eventually learned to walk again. As an adult, she walked with one foot always suspended in the air, supported by a crutch under her other arm. But the second doctor was right about one thing: polio, commonly known as poliomyelitis, is incurable. This highly contagious viral disease invades the nervous system, primarily affecting children under the age of five. Severe cases can lead to permanent paralysis, usually in the legs. In these cases, 5% to 10% of patients die when paralysis spreads to the muscles required for breathing.
For over 96% of the world's population, polio poses little threat. According to the World Health Organization (WHO), it is only endemic in two countries. Sadia's home country, Pakistan, is one of them. Moreover, the trajectory for eradicating the disease in the country is not exactly heading in the right direction.
At the end of 2023, Pakistan seemed on the verge of completely eradicating polio. Only six cases were recorded that year, down from 20 in 2022 and 84 in 2020. Tariq Bhutta, former chairman of Pakistan's Federal Immunization Program and professor of pediatrics, told ABC: "We were hoping that by 2024, we would be able to announce that polio was almost gone." But in 2024, cases surged. A total of 74 cases were recorded nationwide throughout the year. Six cases have already been recorded in 2025.
Staff at the Punjab Expanded Program on Immunization (EPI) office told ABC that they are working to eradicate the disease by 2027. This would require achieving zero transmission of wild poliovirus again in 2025 and 2026, after which Pakistan can apply to the WHO for eradication certification in 2027. While ABC was talking to EPI staff, the country had already recorded three cases. Now there are six. Professor Bhutta said the 2027 timeline is impossible. "We've been doing this since 2000, but we keep moving the goalposts," he said with a laugh.
Professor Bhutta said there are several reasons why the country has failed to reach the point of eradication. Attacks on vaccine workers, especially in provinces where there is already a higher security risk, and conspiracy theories about vaccines are common. Afghanistan, the only other country where polio is still endemic, is next door, and the border between the two countries is extremely porous. Professor Bhutta said there are still "misconceptions and fallacies" about the effects of polio immunization drops, including that it is a "Western conspiracy." He said: "In some areas, even in a small mosque, the person in the mosque will say: 'No, don't give our children polio drops because it may make our population infertile.'"
The lingering impact of the Central Intelligence Agency (CIA) tracking down al-Qaeda leader Osama bin Laden in Abbottabad in 2011, after a hepatitis vaccination program allegedly run by a local doctor passed information to the agency, has also had a lasting impact. Shakil Afridi visited bin Laden's compound weeks before he was assassinated by U.S. forces, reportedly to extract DNA from children. It is believed that he passed materials collected during the vaccination campaign to U.S. intelligence officers, although it is unclear whether he played a direct role in revealing the terrorist leader's location. The news angered Islamic groups and led to an increase in attacks on vaccination workers across Pakistan. "This really caused a serious setback to the whole program," Professor Bhutta said. "People who were a little skeptical about the whole movement before, they were even more convinced that this was a conspiracy by the West, especially the United States, to spy on us and get information about things, and they were not really keen to protect children from polio."
Attacks on immunization teams continue to this day, although the motives are not always entirely clear. Many attacks occur in Balochistan and Khyber Pakhtunkhwa provinces, where armed groups are attacking security forces. Sadia Suleman said she has never been attacked while conducting vaccination campaigns, but she said she often encounters strong resistance from parents. "People think it's a conspiracy by the United States to sterilize their children. They are skeptical about the ingredients of the vaccine, they suspect [it is] because no one has seen it being manufactured, where it comes from," she said. "If we stop working because we are afraid, who will fulfill our duty? Who will save the children?"
She said that being able to show parents real cases of what polio can do to their children often helps. "I tell them that I'm afraid of falling and afraid of slipping with every step," she said. "I ask them: 'Do you want your children to be like me?' Don't commit atrocities against your children. "They get angry, they speak angrily, but when they hear [what I say], they calm down and get their children vaccinated."
Senior World Health Organization officials have warned that U.S. funding cuts to the WHO under Donald Trump could delay the eradication of polio in Pakistan and Afghanistan. The WHO is working with groups including the Gates Foundation and UNICEF to end polio. UNICEF's polio grants have been terminated after USAID had 90% of its grants cut by the U.S. Hamid Jafari, director of the WHO's polio eradication program for the Eastern Mediterranean region (including Pakistan and Afghanistan), told Reuters that the partnership is missing $113 million (A$210 million) that the U.S. was expected to provide this year. He said this would largely affect personnel and monitoring, but vaccination campaigns within both countries would be protected.
Professor Bhutta said he is not concerned that this will have an impact on Pakistan's eradication campaign. "The World Health Organization provides us with technical advice, technical expertise, we don't get funding from [it]," he said. "The funding comes from Gavi [a public-private global vaccine alliance], Japan, Qatar, Saudi Arabia." Samra Khuram, director of the Punjab EPI, agreed. She said monitoring may be affected, but does not believe the operational aspects of the program will be affected. "I don't think the polio program will be affected anymore," Dr. Khuram said. "[The Pakistani] government is very committed and willing to eradicate it." A Gates Foundation spokesperson told Reuters that no foundation can fill the gap left by the United States.
Professor Bhutta believes that conspiracy theories, attacks on vaccine workers, and the porous border with Afghanistan do not fully explain Pakistan's failure to eradicate polio. He believes that the country's anti-polio campaign needs a complete overhaul. Workers like Sadia Suleman say that the current immunization program exhausts parents, preventing them from keeping their children's immunizations up to date. Children in Pakistan are recommended to receive four doses of oral polio vaccine drops between birth and 14 weeks, and to be immunized at 14 weeks. But due to poor sanitation and the risk of children contracting diarrhea (which renders the vaccine ineffective), children often receive more doses. "They often ask me, 'Why do you ask every time?'" she said. "I tell them that even if I see them 1,000 times, I will ask [to vaccinate their children]. "It's my duty."
Injectable vaccines are safer and more effective because they contain an inactivated virus, rather than an attenuated live virus like the drops, so they do not cause vaccine-associated paralysis. But this requires more rigorous training and equipment for vaccinators. Pakistan's current polio vaccination campaign relies on vaccinators going door-to-door, unannounced, for weeks-long intensive campaigns to give children drops. Professor Bhutta estimates that Pakistan has conducted about 200 campaigns in the past 30 years. He believes that unless Pakistan does not vaccinate children in this way, the country's chances of eradicating polio are slim. "Campaigns are not the solution," he said. "We've done...the most campaigns in the world. We have to look for other strategies to do this. I think the main strategy has to be to improve routine immunization, that is, every child who is born should be registered [and] should get all the vaccines before the age of two. "Unless we reach every child, it's not possible." As for the claim that Pakistan can only achieve eradication when Afghanistan achieves eradication, he scoffed. "I'm not prepared to blame our own problems on Afghanistan," he said. "If we can protect every child in this country, even if Afghanistan has cases, they won't affect us. "Iran is also our border country...and there's a lot of movement there. "Iran hasn't had a case of polio in the last 20 years because they're doing a good job. "Our whole region has done it - except us."
