ARACHI economic powerhouse, cultural melting pot, and bustling metropolis of over 20m souls. There is much that distinguishes it among Pakistan`s urban centres. Sadly, it has also earned the distinction of being a crucial battleground in our fight against polio. Recent data shows that this year the city has already seen over 41,800 vaccine refusals 97pc of all refusal cases in Sindh. More worrying are reports that some polio workers overstate vaccinations to ensure higher compensation, leaving more children vulnerable to the virus.

Nevertheless, there has been some progress. Even the current refusal numbers mark a substantial improvement from the general situation five years ago. The government`s efforts have focused on community engagement initiatives, mobilisation of influencers, and involvement of health facilities, schools, seminaries and mosques in advocacy campaigns. One promising development in Karachi`s latest polio drive is the use of fractional Inactivated Poliovirus Vaccine which enhances immunity when combined with oral polio vaccine. The success of this approach should be closely monitored and, if effective, expanded to other high-risk areas.

Karachi`s dense population, continuous movement of people, and the persistent detection of polio in environmental samples means there are high transmission risks. A key challenge that keeps major progress at bay is mistrust in public health initiatives.

The government must strengthen community engagement through direct dialogue with parents who refuse vaccination, providing them with factual information to counter conspiracy theories. It must also overhaul the compensation structure for vaccination teams, shifting from quantity-based incentives to quality-focused metrics that reward accurate reporting and genuine community engagement. Digital tracking and community feedback systems should be implemented to ensure data integrity. Our success in eradicating polio depends on eliminating these last pockets of resistance. Karachi should not be a weak link in this fight.