PAKISTAN has now registered 50 polio cases this year. We all saw it coming and yet there was nothing we could do to stop it. While officials go around touting ‘increased’ vaccination coverage, the virus continues to gain ground, with Balochistan reporting 24 cases, Sindh 13, KP 11, and even the relatively better-administered Punjab and Islamabad recording a case each. The Expanded Programme on Immunisation, launched in 1978 with great promise, appears to have lost its way. While it achieved remarkable success in its early decades, its effectiveness against polio has been undermined by a slew of obstacles. However, while hindrances such as persistent vaccine refusals and security challenges do exist, it is time to ask the hard questions: does the state truly possess the commitment to eradicate polio? Or is there a reliance on international funding with nothing to show for it? An audit of polio funds at both federal and provincial levels is sorely needed. The public deserves to know how billions in aid have been utilised, and why, despite these resources, we continue to fail our children. Simultaneously, the obstacles hindering eradication efforts do need targeting. Over 43,000 vaccine refusals in Sindh during October reveal a troubling trend. While Sindh’s chief minister has responded with characteristic bureaucratic fury — threatening to remove DCs and health officers — such reactions fail to address the root causes of vaccine hesitancy. With only 69pc of Sindh’s under-five children fully immunised, the solution requires more than administrative fixes. But perhaps most concerning is the coverage claimed and the continued detection of positive environmental samples. In Sindh alone, 66pc of samples from 20 districts tested positive for the virus this year. This calls into question the quality of our vaccination efforts. The EPI programme must be revitalised with a focus on strengthening routine immunisation rather than relying solely on supplementary campaigns. Polio workers must be protected, fairly compensated and supported. Public health campaigns must expand, engaging clerics and influencers to address vaccine fears. At the same time, parents must be made aware that refusing the vaccine is not just a private decision but a public health hazard. With Afghanistan showing fewer cases this year, the question is no longer whether polio can be eradicated, but whether Pakistan will rise to the challenge or continue to let its children bear the burden of inaction.