ISLAMABAD  - The real challenges in defeating polio in Pakistan are the fragile security situation of three virus reservoirs including Quetta, Karachi and Federally Administered Tribal Areas (Fata) and inaccessibility to immunisation.
Constant migration of population from these transmission zones to other parts of the country can place other areas and thousands of children at risk.
Minister of State for National Health Services, Regulation and Coordination Saira Afzal Tarar highlighted at a briefing the challenges Pakistan faces to become polio free as it remains one of the three endemic countries for polio along with Afghanistan and Nigeria. International polio eradication partners also accompanied the minister.
The self-imposed ban on polio vaccination in Fata has the potential to put millions of children across the country in jeopardy as the explosive outbreak in North Waziristan continues to spread.
Speaking at the World Polio Day event on Thursday, the minster stated that over 90 percent of the current polio cases in the country are linked to the ongoing 'raging' outbreak in North Waziristan and parts of Fata.
"Vaccination is not a privilege but the right of each and every child to a health and dignified life. Pakistan can meet the global target to stop poliovirus transmission by the end of 2014 only after ensuring access in the remaining polio reservoirs." She informed that so far 49 children have been paralysed for life with polio, out of which, 36 are from Fata, 3 from Punjab, whereas Sindh and Khyber Pakhtunkhawa have reported 4 and 6 polio cases respectively.
After the ban was imposed on vaccination in North and South Waziristan Agencies of Fata in July last year, almost 261000 children have not been reached. Of the 34 million children under five in Pakistan, less than half of one percent - 0.5 percent - are not vaccinated due to refusals by their parents or caregivers.
"If we cannot access children in areas such as Waziristan with the polio vaccine during this ongoing low transmission season, we will not be able to stop poliovirus transmission, and Waziristan will be seen globally as the only hurdle towards a world free of polio, And this can result in imposition of international restrictions on Pakistanis travelling abroad."
The minister said the eradication efforts in Pakistan are continually dragged into political agendas and the activities of Dr. Shakil Afridi who ran a fake vaccination campaign for the CIA to help find Osama bin Laden was a real setback for the campaign. 'We have highlighted on international forums during the Prime Minister's visit that politics and health issues should be kept apart. And the ministry has nothing to do with the release of Shakil Afridi who is under trial on espionage charges'.   
The polio eradication partners paid tributes to the polio workers and the security officials who lost their lives during the vaccination campaigns. So far since July 2012, 24 people have been killed and 14 injured in 24 targeted attacks during vaccination campaigns, predominantly in KPK and Fata.
"Today is also an opportunity to pay tribute to the relentless efforts of each and every member of our team who have successfully restricted the poliovirus to three identified reservoirs areas namely Fata, Quetta with its two neighboring districts of Killa Abdullah and Pashin and Karachi. Due to these efforts, Pakistan has seen a remarkable decrease of around 71 percent polio cases from 2011 till now." Endorse the statement of the minister, Per Engebak, Polio Team Lead at United Nations Children's Fund Pakistan, said 'the number of refusal is marginal and there is acceptance of vaccination in communities but the real challenge to vaccination efforts is access.
If Pakistan controls the virus circulation, Afghanistan would also be free from polio. They are interrelated. There is high mobility between areas of both countries that poses threats to Afghanistan as well.
There have been 65000 refusal cases during the recent September vaccination campaign while more than four lakh children remain unvaccinated every year.