FROM six cases in the first half of the year, Pakistan has now gone to 18 polio cases. Of the total, 13 have been reported from Balochistan, making the province the current epicentre of the crisis. The virus was most recently detected in a two-year-old boy from Quetta. Last month, a girl the same age succumbed to the disease in Balochistan’s Kharan district. As we approach the end of 2024, it is evident that unless the state acts with commitment, the dream of a polio-free Pakistan by next year will be dead. According to media reports, we administer more than 300m doses of the polio vaccine annually. And yet we have not been able to rid ourselves of it. It is not as insurmountable a challenge as one would believe. The years 2021 and 2023 showed us it is possible to restrict the number of cases to single digits. So, what has led to the rise in polio cases this year? We continue to see the familiar barriers: poor law enforcement that makes certain areas difficult for polio workers to cover without being targeted and cultural misconceptions leading to vaccine refusal. Of late, however, more intricate challenges have emerged. Families are refusing vaccines while demanding proper roads, water, and electricity. Then there is the long-standing security issue that plagues the region. At least 17 polio workers have reportedly been killed this year. Furthermore, disinformation continues to spread. Parents are led to believe that the vaccines are contaminated or cause infertility. Then there are bizarre justifications for vaccine refusal; one father from Hyderabad declared that he wouldn’t allow his son to be inoculated because it would result in him only siring daughters in the future. Further complicating efforts are reports of inflated coverage numbers by officials, ostensibly to reassure foreign agencies and donors. This is symptomatic of a festering wound, which will only worsen until it is treated. First and foremost, the government must address the vaccine hesitancy by actively countering disinformation. It must also better protect polio workers and resolve civic issues, so that immunisations do not become bargaining chips. Just as crucial is the need to ensure greater transparency so there are no loopholes for number fudging in the vaccination data. Let’s not slide into a full-blown polio crisis.