The polio vaccination story of Pakistan

•Annual number of cases reduced by nearly 95% compered to pre vaccination era.•Trivalent oral polio vaccine (OPV) used between 1994 and 2004.•Bivalent OPV used from 2010 to present (currently in use).•Inactivated polio vaccine (IPV) introduced into the national Expanded Program of Immunization (EPI) in 2015.•House to house vaccination strategy implemented in 1998 – 1999 and expanded further in 2000 becoming a core aspect of Pakistan’s polio eradication strategy. To describe in chronological detail Pakistan’s decades long battle against poliovirus and evaluate the multiple factors impacting it. Pakistan’s fight is documented through various published research articles and reports on Pakistan’s progress in eradication of polio published by international agencies involved in elimination of poliovirus worldwide. The socioeconomic, religious, and political factors, violent religious militancy, conspiracy theories resulting in vaccine refusals are documented in detail emphasizing the ups and downs in the fight at different times since 1994 to present. Pakistan and Afghanistan are the only two countries in the world reporting cases caused by wild polio virus type 1 (WPV1) since 2017 and the only two countries that have never stopped the transmission of WPV1 Pakistan needs to work on a war footing to eliminate the disease. The need to act urgently is now being increasingly recognized by the Pakistani Government. Many difficulties still remain. Pakistan has reached a critical stage in the fight against polio. The world will not accept any further delay or complacency as there is apprehension around the world that Pakistan may “export” polio to other countries and undermine the worldwide success in eradicating polio.