AKISTAN`S polio case count, with 105 days of the year lapsed so far, is in the single digits. But the question is: for how long? Environmental surveillance has detected poliovirus in sewage samples from 20 districts signalling that transmission persists across both urban and rural settings.

The virus continues to circulate silently in communities where immunisation coverage remains uneven. That even Karachi with its size, connectivity and relatively better health infrastructure is witnessing a surge in vaccine refusals speaks volumes about the scale of the challenge. According to Federal Health Minister Mustafa Kamal, as much as 85pc of all reported polio vaccine refusals in the country are concentrated in the city. Conspiracy theories about infertility, non-halal ingredients, and foreign agendas continue to circulate, particularly among Pakhtun and Urdu-speaking communities. Many households remain sceptical of state-run health campaigns and perceive them as selective interventions rather than genuine care. Gender dynamics also play a role, with women often requiring permission from male family members to vaccinate their children.

Operational missteps add to the challenge. The introduction of new methods such as needle-free jet injectors has, in some cases, sparked confusion and fear among parents unfamiliar with these technologies. Without prior sensitisation or explanation, such changes have fuelled further scepticism and inadvertently contributed to higher refusal rates. While officials have rightly reiterated that the oral polio vaccine is safe and essential, the message fails to resonate in communities where trust in the state is low and communication poorly tailored. Threats of legal penalties will only deepen resistance. The upcoming April 21 campaign offers a critical opportunity. The state must move beyond topdown directives and foster community-led engagement. Religious leaders, elders, and teachers must be enlisted to build trust and dispel myths. The state must win the confidence of its people one conversation, one household, and one drop at a time.