The global polio eradication initiative (GPEI), which started as a resolve from World Health Organization (WHO) leaders in 1988 to eradicate polio globally, has been labelled as the largest international health initiative to date. Billions of dollars and thousands of employees have been deployed worldwide since its conception, with the singular aim of eradicating this disease [1]. The first 14 years of this program saw huge success as indigenous polio was eradicated in all but six countries in the world [2].

The current situation in 2024 is that polio has been eliminated in all but two countries of the world, the exceptions being Pakistan and Afghanistan. Nigeria was the latest country to achieve elimination status in 2020 [3].

This paper discusses the introduction of innovative technology to address the current gaps in Pakistan’s polio program. Public Health Innovation Framework has been proposed in the paper as a guiding tool for the introduction of this innovation to the polio program of Pakistan.

Pakistan has failed to achieve polio-free status despite monumental international donor support, advocacy for the program, and long-standing commitment from the country to the program. By failing to achieve polio-free status in the last decade, the country has missed an important window. This has made the achievement of future targets more difficult due to new challenges such as population explosion, climate change, economic recession and vaccine hesitancy in the post-COVID era, misinformation, social media, and increased inequality [4].

These newer challenges mean that new solutions must be introduced to tackle old problems. However, the Pakistan polio program has not been updated in many years. The supplementary immunization activities (SIAs) and polio campaigns are paper-based and outdated, and no attempt has been made to digitalize the program [4].

The PEI program in Pakistan was on track, with significant progress being made from 2015. However, the surge of cases in 2019 followed by the COVID-19 pandemic proved to be enough to derail progress. The halting of activities and transfer of polio resources to COVID-19 vaccinations resulted in an increased number of cases in 2020. The number of cases decreased in 2021, either due to relaxed surveillance or restriction of inter- and cross-border movements due to lockdowns. The current situation in Pakistan is that 40 confirmed WPV cases have been notified since 24 Oct 2024, and environmental samples are continuously positive in many urban and peri-urban areas of Pakistan [5]. This signifies continuous transmission of the virus in the communities, due to the presence of unvaccinated “missed children.” In order to achieve elimination status, the country’s focus should be on reaching and vaccinating these missed children, who are the hidden foci of transmission. This can be achieved by improving the quality rather than the quantity of our SIAs, which is contrary to the current norm [6].

As mentioned earlier, we are in unprecedented times and are facing problems with no current known solutions; therefore, this is the best time to experiment with digital technology.

The tool used to introduce our proposed innovation is the Framework for Public Health Innovation [7]. The innovation being proposed is the introduction of GIS mapping in the micro-planning phase and using GPS technology to track paths of vaccinators in SIAs and National Immunization Days. Nigeria, the last country to eliminate polio in 2020, has introduced this GPS/GIS technology in their NIDs [8].

As Pakistan has failed to achieve their elimination target, and with the impending threat of funding withdrawal, it is evident that the current elimination efforts in Pakistan are not enough and need to be supplemented by innovative methods. Thus, this climate provides an ideal playground to introduce evidence-based innovation.

The innovation should be piloted in high-risk districts of Sindh and Baluchistan, where most polio cases have been reported.

A nationwide SIA should be planned, targeting the high-risk mobile population (HRMP). This would include the nomadic population who do not come under formal health systems. A targeted campaign would be launched all over the country using the results and gains achieved in the first stage.

Digitalization would be formally incorporated into the polio program.

WHO and UNICEF, being the main partners, would work in collaboration with the districts. However, the main ownership of the initiative would belong to governmental bodies. Ownership of the innovation is essential to achieve sustainable gains, as seen in polio elimination in India and Nigeria.

The introduction of technology would involve the use of resources; thus, strict accountability for governmental agencies should be introduced to the program. Independent third parties with no conflict of interest should be involved in the accountability process [8].