The world was close to eradicating polio, but fake vaccination records, problems with the vaccine, and mistakes in the campaign have allowed the disease to make a comeback.

 For the past ten years, Sughra Ayaz has gone door to door in southeastern Pakistan, trying to convince parents to let their children get vaccinated against polio as part of a global effort to eliminate the disease. She often hears their concerns — some practical, like needing food and water more than vaccines, and others based on false beliefs, such as claims that the drops cause infertility.

Ayaz says the campaign faces heavy pressure to succeed, leading some supervisors to tell workers to falsely record that children have been vaccinated. She also says vaccines aren’t always stored properly, which reduces their effectiveness.

The World Health Organization (WHO) and its partners launched the polio eradication campaign in 1988, aiming to completely wipe out the virus — something only achieved once before with smallpox. The world came close in 2021, with just five cases in Pakistan and Afghanistan, but infections have since surged, with 99 cases reported last year. Afghanistan and Pakistan are still the only countries where polio has never been stopped.

Insiders say the campaign has been held back by poor management, reliance on outdated methods, and problems with the oral vaccine. Issues include fake vaccination records, unqualified vaccinators, skipped areas during campaigns, and failure to address concerns that the oral vaccine can, in rare cases, cause outbreaks when it mutates.

Local workers have long raised these problems, but they say senior managers rarely act. WHO acknowledges challenges, citing cultural resistance, remote locations, and dangers to health workers — more than 200 have been killed in Pakistan since the 1990s. Still, officials insist progress has been made, with billions of children vaccinated and millions spared from paralysis.

The oral polio vaccine is cheap, easy to give, and has been key to eliminating polio in many countries. But in rare cases, it can cause paralysis or spark new outbreaks, especially in areas with low vaccination coverage. Many experts say the campaign should switch to injectable vaccines, which don’t carry these risks, but there aren’t enough doses and they’re more expensive to administer.

Critics argue that the program is stuck in old habits, spending over $1 billion a year with little recent progress in Pakistan and Afghanistan. Villagers have staged boycotts, demanding food, medicine, and clean water instead of polio drops. The campaign also faces growing mistrust fueled by conspiracy theories and past incidents, like a fake vaccination drive run by the CIA in 2011.

For many families, rejecting the vaccine is about fear and pressure from community leaders. In rural Afghanistan, one mother said she wants her children vaccinated but risks being beaten or thrown out if she disobeys her male relatives, who believe the false rumors.

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