As we mark World Immunization Week 2025, we’re reminded that vaccines remain one of the most powerful tools in public health. This year’s theme, “Immunization for All,” highlights the need to reach every child, everywhere. In Pakistan, a country still fighting to eliminate polio and other vaccine-preventable diseases (VPDs), the urgency of this mission is especially clear.

Pakistan continues to carry a heavy burden of VPDs, with global attention focused on its ongoing efforts to eradicate polio. While the country has made notable progress in both polio control and routine immunization, many challenges remain.

Logistical constraints, low vaccine demand, inefficient service delivery, and limited community engagement all hinder progress. Awareness and acceptance of vaccines often depend on household income, education levels, and whether families live in urban or rural areas. These barriers are made worse by low health spending and a reliance on international donors, which constrain long-term sustainability. The creation of the Federal Expanded Program on Immunization (EPI) in 1978 was a critical step forward. The program significantly reduced childhood illness and death through wide-scale immunization against diseases like tuberculosis, polio, and measles.

However, momentum slowed after Pakistan’s 2010 government decentralization, which shifted responsibility to provincial governments. While decentralization can help tailor services to local needs, it has also created confusion and service gaps where roles are unclear and infrastructure is weak.Still, Pakistan is home to one of the world’s largest Lady Health Workers (LHWs) programs. These trained women live and work in their own communities, providing health services and making regular home visits.

LHW-led door-to-door campaigns – like those used in the polio effort – have proven especially effective in reaching rural and underserved communities. Their success shows that community-based approaches, built on trust and presence, can outperform top-down interventions that lack strong local ties. In recent years, the immunization system has faced new challenges. The COVID-19 pandemic and the 2022 floods tested its resilience. The floods displaced over 600,000 people and damaged more than 2,000 health facilities. During the pandemic, LHWs had to halt their outreach, leaving families without expected services.

At the same time, misinformation and fear about COVID-19 vaccines disrupted routine immunizations. After the floods, VPD outbreaks – including cholera, polio, and malaria – spiked as access to basic health services were heavily disrupted. To close these gaps, Pakistan has recommitted to improving vaccine coverage, equity, and access. A key part of that strategy is expanding the reach of the LHW program, which remains a cost-effective and trusted delivery model.

In early 2025, the Federal EPI program, in partnership with global organizations, launched the second phase of the Big Catch-up Immunization Drive. Building on momentum from the first phase, the campaign mobilized over 18,000 vaccination teams to conduct outreach through health facilities, mobile units, and home visits across urban, rural, and remote areas.

To support the campaign, UNICEF has led efforts to raise public awareness and build support among parents, caregivers, and community and religious leaders.

At the same time, the Federal EPI is rolling out a Synergy Framework and Integrated Plan Development to improve coordination across provinces and partners. A key priority is strengthening coordination at the district and sub-district levels to prevent fragmented efforts.

These plans also include stronger disease surveillance and the development of a responsive national vaccination strategy. While Pakistan has made real progress in routine immunization and the fight against polio, sustained effort is needed. Expanding outreach, improving coordination, and preparing for future crises will be essential.

A resilient, integrated immunization system – grounded in proactive planning and community engagement – will be key to overcoming Pakistan’s burden of VPDs and advancing the global goal of immunization for all.

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