Why is Pakistan a threat to ‘‘The Polio Eradication and Endgame Strategic Plan 2013–2018’’? A look into the past decade

The fight against endemic polio transmission is restricted to three countries: Pakistan, Afghanistan, and Nigeria. In 2012, when the world saw the lowest numbers of cases from polio-reporting countries, the World Health Organization (WHO) initiated a comprehensive strategy, ‘‘The Polio Eradication and Endgame Strategic Plan 2013–2018’’.1 The plan (as it will be called from this point onwards) aims at: (1) wild polio virus (WPV) interruption by the end of 2014, (2) a strengthened immunization system and

cessation of oral polio vaccine (OPV), (3) containment and certification, and (4) the quest for maintenance of a polio-free world by 2018. Pakistan, unable to cope with the first objective, had the highest case count of the past decade (306 in 2014).2 Looking at the active transmission of WPV and the number of cases so far in Pakistan, it can be deduced that the struggle to deliver a polio-free world by 2018 is failing. The continuous reporting of cases during the past decade, despite consistent immunization coverage, is worrisome. An answer to ‘‘Why such unpredictability in polio cases during the last decade?’’ may help reduce the polio case count in the country.