Pakistan stands at a critical juncture in its public health journey, showcasing both remarkable progress and persistent challenges. While nearing polio eradication, the nation grapples with emerging threats like extensively drug-resistant (XDR) typhoid and a high burden of tuberculosis. Supported by robust surveillance and global partnerships, Pakistan’s efforts underscore its vital role in international health security, even as it navigates resource constraints and aims for universal health coverage.
Polio Eradication: A Global Imperative
Continued Endemicity and Progress
- Pakistan remains one of only two countries where wild poliovirus is not eradicated, alongside Afghanistan. Cases have declined from 147 in 2019 to just six in 2023, though a resurgence to 41 cases occurred by October 2024.
- In 2025, Pakistan launched its second nationwide vaccination campaign aiming to immunize 45 million children. Despite violence and misinformation hindering efforts, early trends are encouraging with only six cases reported in 2025 so far.
Source: AP
National Leadership and Global Partnerships
- Under Dr. Shahzad Baig, Pakistan’s national polio eradication coordinator, the campaigns deployed nearly 400,000 vaccinators and 80,000 security personnel. Eradication is targeted by 2026.
- International partners—WHO, UNICEF, CDC, Rotary, GPEI, and the Bill & Melinda Gates Foundation—continue to support mass surveillance, door-to-door campaigns, and public awareness efforts.
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Surveillance & Synergistic Capacity Building
- Pakistan operates the world’s largest environmental surveillance network, with 65 sites detecting poliovirus through acute flaccid paralysis (AFP) monitoring. Its polio infrastructure was instrumental during COVID‑19, supporting testing, contact tracing, data integration, and coordination at National Emergency Operations Centres.
Source: NIH
Typhoid Threat: Extensively Drug‑Resistant (XDR) Strain
- Pakistan, especially Sindh province, has emerged as the global epicenter of XDR typhoid. Resistant to nearly all recommended antibiotics, the outbreak poses grave threats to children and public health.
- Overuse of antibiotics, poor sanitation, and limited surveillance contribute to escalating resistance and wider global health risks.
Tuberculosis: Focusing on High-Burden Regions
- Pakistan ranks among the top five TB burden nations, with around 510,000 new cases annually.
- The province of Khyber Pakhtunkhwa has implemented a WHO DOTS strategy since 2000, including the deployment of an Electronic Recording and Reporting System (ERS) to track cases and outcomes in real-time.
- National TB control programs, supported by domestic and foreign funding, remain central to disease control and reflect an expanding public health focus.
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Public Health Systems & Broader Initiatives
Institutional Strengthening by WHO & CDC
- The WHO Country Office in Pakistan supports development of national strategies for noncommunicable diseases (NCDs), maternal and child health, and epidemic preparedness under its 2024–2025 work plan.
- The U.S. CDC collaborates with Pakistan’s Ministry of Health, NIH, and National Public Health Institute on disease surveillance, laboratory capacity, workforce training, epidemic preparedness, influenza, typhoid, hepatitis, and vaccine-preventable disease control.
Universal Health Coverage & Pandemic Learning
- The COVID-19 pandemic exposed weaknesses in Pakistan’s primary health infrastructure. Experts call for transformative efforts toward universal health coverage—expanding service delivery, strengthening budgeting, reducing donor dependence, and enhancing accountability across all levels.
Innovation & Community Outreach
- Behavioral interventions using digital audio “nudges” in Quetta increased childhood immunization by 30%, highlighting the effectiveness of low-cost, context-sensitive public health tools.
- Text-mining-based epidemic detection systems like BIOPAK Flasher leverage Urdu and English media sources to detect outbreak signals early.
TB Screening in Vulnerable Populations
- Programs targeting marginalized groups, such as transgender communities in Rawalpindi, are deploying portable X-ray units and AI-supported TB screening camps in collaboration with Stop TB Partnership and NGOs like Dopasi Foundation
Implications for Global Health & Pakistan’s Role
Strategic Importance & Global Health Security
- Pakistan’s unique disease burden—particularly polio and XDR typhoid—makes it critical to global eradication campaigns. Any outbreak here has wider implications for international health security.
- The country benefits from being a testing ground for donor-funded GHI programs focused on vaccination coverage, surveillance, and health systems strengthening.
Source: NCBI
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Challenges Remain
- Progress is uneven, especially in remote and conflict-affected areas where health access is limited due to logistics, security risks, and mistrust.
- Noncommunicable and maternal health remain under-resourced compared to communicable disease control.
- Sustainability of funding and program ownership remains uncertain without increased national investments and systemic reform.
Pakistan’s public health journey underscores a complex narrative:
- Successes: remarkable polio reduction, functioning disease surveillance infrastructure, innovation in behavioral messaging, and targeted outreach in vulnerable communities.
- Challenges: XDR typhoid emergence, persistent TB, under-resourced primary health systems, and reliance on external funding.
As Pakistan progresses toward the SDG 2030 health goals, reinforcing national health infrastructure, broadening financial investment, enhancing accountability, and strengthening disease surveillance remain imperative.
