Urooj Niazi 
The World Health Organisation (WHO) has extended the WHO Pakistan travel restrictions for another three months due to the continued threat of international spread of wild poliovirus type 1 (WPV1). The decision follows the latest assessment of the WHO Polio International Health Regulations Emergency Committee, which concluded that the risk of international spread continues to be a public health emergency of international concern.
The committee identified continued WPV1 transmission in major reservoirs, notably Karachi and southern Khyber Pakhtunkhwa, and also noted the close epidemiological linkage between Pakistan and Afghanistan. The extension is designed to cut down the opportunities for infected travelers to bring the virus across borders, and give Pakistan more time to boost its vaccination and surveillance efforts.
Pakistan Sustains WPV1 Transmission In Critical Areas
The WHO assessment highlights Karachi and South KP in particular, both of which remain key areas in the transmission of WPV1. The committee also noted that geographical spread and transmission in epidemiologically important areas have raised the need for enhanced surveillance and for consistently high immunisation coverage.
WHO’s assessments of Pakistan and Afghanistan have also highlighted the Quetta Block and the wider south cross-border corridor. Previous committee reviews have identified the area as an important transmission corridor, noting how movement across national borders can complicate eradication efforts and require coordinated action on both sides.
Rules On International Travel Remain Linked To Polio Vaccine
According to the WHO interim recommendations, Pakistan should ensure that residents and long-term visitors aged over four weeks receive a dose of bivalent oral polio vaccine or inactivated polio vaccine between four weeks and 12 months before international travel. Vaccination must be given at least by departure to travellers undertaking urgent journeys who have not received the necessary dose during this time.
Travellers are also required to carry valid documentation via an International Certificate of Vaccination or Prophylaxis. The recommendations are for international travel from any point of departure and are designed to reduce the likelihood of movement of poliovirus from one country to another through movement of people.
Polio Program Central To Pakistan’s Eradication
In addition to routine vaccination, supplementary immunisation activities have continued in Pakistan as part of the national eradication program . These campaigns are particularly important in areas where children may miss their regular doses due to mobility, difficult terrain, insecurity or limited access to health care services.
In particular, the most recent evaluation by WHO had called for routine and supplementary immunisation activities to ensure equal access to all population groups and geographical areas. The committee also emphasised the need for high-quality surveillance that will be able to detect new poliovirus isolates rapidly and to monitor changes in transmission patterns.
Coverage Of Vaccination: Challenges Of Security And Access
The WHO has said that ongoing transmission is partly due to variations in the quality of the campaign and the presence of unimmunised and under-immunised children in key areas. Access constraints linked to insecurity can also make it difficult for vaccination teams to access all households consistently, creating pockets where the virus can continue to circulate.
These challenges demonstrate the importance of local coordination and community engagement. Health authorities, community representatives and vaccination teams can work together to identify missed children, improve confidence in vaccination and ensure that campaigns reach communities which are difficult to access through conventional approaches.
Need For Continuous Surveillance In Karachi, South Kp
Karachi, with its large and mobile population, remains a major target for Pakistan’s polio eradication efforts. High population density, movement between neighbourhoods, and links with other parts of the country mean that regular environmental monitoring and vaccination are especially important in creating complex surveillance requirements.
South KP is also important in that it is located in a wider cross-border transmission corridor. The WHO has regularly reported that southern Afghanistan and parts of Pakistan, notably South KP and the Quetta Block, are connected epidemiologically and therefore require cross-border coordination.
Cross-Border Cooperation With Pakistan Is Still Important
Due to the close epidemiological relationship between Pakistan and Afghanistan, cross-border coordination is an important aspect of eradication planning. Poliovirus does not respect political boundaries, and progress in one country can be influenced by virus transmission in neighbouring communities.
WHO has called for better national, regional and local coordination to boost vaccination coverage among travellers and high-risk cross-border populations. Other recommendations include closer supervision of vaccination at border transit points and monitoring of travellers who may cross borders without appropriate vaccination.
Broader Eradication Efforts May Be Aided By Travel Restrictions
The temporary travel advice is no substitute for vaccination campaigns. Instead, they give an extra layer of protection while transmission is still occurring. The measures require vaccination and documentation for international travel to mitigate the risk of international exportation of poliovirus.
WHO’s assessment also makes clear that travel measures are just one part of a wider eradication strategy. Good surveillance, fair vaccine coverage and better cooperation across borders are still the key to creating the conditions under which these recommendations can be lifted.
Targeted Action Can Help Pakistan Build On Progress
The recent extension by WHO gives Pakistan another window to ramp up efforts in areas where some transmission is still focused. Continued focus on Karachi, South KP and other epidemiologically important locations can help close immunity gaps while strengthening the surveillance network needed to detect any remaining virus circulation.
Close integration between vaccination teams, local administrations, security authorities and community networks can also be an advantage for the national response. Reliable access to children, accurate field information and consistent campaign quality are important in ensuring that missed communities are not left out of the eradication program.
