Refusals drop sharply in Karachi as polio teams expand outreach, influence

In a significant breakthrough for Pakistan’s polio eradication efforts, the number of refusal cases in Karachi has dropped significantly in the latest campaign — one of the lowest figures in recent years.

This marked decline reflects intensified efforts by the Sindh Health Department and the Provincial Emergency Operations Centre (PEOC), who have employed a multi-pronged strategy to reach hesitant families, including the forming of refusal conversion committees, engagement with religious and political leaders, and medical outreach for sick children.

“This time, only 37,000 refusal cases were reported in Karachi, which is significantly lower than in previous campaigns. It is a result of joint efforts from everyone,” said Nofil Naqvi, a spokesperson for PEOC, praising the district administrations, healthcare professionals and community mobilisers who contributed to the achievement.

According to official data, seven districts in Karachi accounted for 2,066,673 vaccinated children, achieving 94.3 per cent coverage, while Sindh as a whole reached a 97.7 per cent vaccination rate across 30 districts, targeting over 8.8 million children.

Yet, it is the sharp decline in refusals in Karachi — a city often marked by persistent vaccine hesitancy — that is being hailed as a major success.

The PEOC attributed much of this progress to the proactive initiative led by the Karachi commissioner, who proposed the establishment of refusal conversion committees (RCCs) in the highest-risk union councils (UCs). These committees, set up under the supervision of deputy commissioners, focused on 35 UCs with the most resistance.

A total of 205 RCCs were formed, each including local influencers, CBO representatives and area supervisors. These groups worked door-to-door, offering information, addressing concerns and convincing families to vaccinate their children.

District East stood out as a success story, where the inclusion of parliamentarians helped restore trust within communities. “The involvement of elected representatives made a significant difference. Their presence gave weight to the message that polio vaccination is a collective responsibility,” said Naqvi.

To address refusals based on medical concerns, the health department mobilised 157 medical doctors in coordination with the respective district health officers. These doctors visited homes where parents had previously cited illness as a reason for non-compliance.

More than 5,900 cases of sick refusals were documented after the February campaign and were systematically addressed in the April campaign through direct medical consultation and reassurance from professionals.

Authorities also took a firm stance on chronic refusals, where over 1,100 children remained unvaccinated despite multiple previous attempts. These cases were reported from families that had consistently refused vaccination in at least six campaigns.

With support from law enforcement agencies, and under the directive of the city commissioner, police officials were engaged to accompany teams to such households, and help facilitate safe dialogue and follow-up.

Recognising the challenge of refusals in affluent and middle-income urban areas, a temporary call centre was established at the PEOC in Karachi. Staffed by trained personnel, the call centre reached out to hesitant families from more educated and resource-rich UCs, using interpersonal communication techniques to persuade them. Successful conversions were reported back to local teams for follow-up and vaccination.

During a recent visit to the PEOC, Federal Health Minister Mustafa Kamal had proposed engaging local parliamentarians, particularly MPAs and MNAs from the MQM in areas like District East and Gujro, to help address over 2,600 outstanding refusal cases. His direction is already yielding positive results, with elected representatives actively participating in community engagement.

Naqvi stressed that this month’s polio campaign would again focus on areas with high refusal rates in previous drives. “We are revisiting these communities to apply the lessons we’ve learned, and reinforce our commitment to reaching every last child.”

This collaborative, community-driven approach — backed by the government, religious scholars, health professionals and the civil society — marks a critical step forward in the country’s fight to end polio once and for all.