PAKISTAN’S latest polio case, a seven-month-old boy in Khyber district reported on Nov 6, is the ninth of 2026 and the seventh in Khyber Pakh­tun­khwa. It is another reminder of how elusive eradication has proved. After three decades of campa­i­gns, billions of dollars of international support, a field force of more than 400,000 workers, and the creation of one of the largest polio programmes in the world, the country has still not eliminated a pre­­ventable disease. Pakistan has not turned its abi­­lity to run campaigns into a system of public health protection that families trust, and that failure, which lies behind much of the refusal, is why the virus survives.

The obstacles usually cited are real: insecurity, population movement, and difficult terrain keep teams from some children, while refusals, misinformation, and religious misconceptions keep others from being vaccinated. They do not account for the survival of the virus in communities that vaccination teams reach campaign after campaign and where families still turn the teams away. The reason lies beyond the vaccine, in the relationship between the state, its health institutions, and the communities they serve, and in whether those communities trust them.

Political scientist Bo Rothstein has argued that trust in government depends on the quality and im­­partiality of public institutions: people trust ins­­titutions they experience as fair and reliable. Com­munication alone does not build trust, and a nati­onal health priority cannot command it. It grows out of people’s everyday experience of the state.

The polio programme mobilises on a scale few public institutions in Pakistan can match. It deploys hundreds of thousands of vaccinators, maps households, monitors........

© Dawn