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Mahmood et al highlighted many of the factors that have made it difficult to eradicate polio from Pakistan.1 Their editorial was very informative.
However, we believe that another factor plays a major role in the failure to eradicate polio in Pakistan. Pakistan shares an extensive border with Afghanistan, a country still struggling to eradicate polio as mentioned in the Mahmood et al editorial. The border is not properly secured, and large numbers of war-affected Afghan refugees have passed into Pakistan in search of better life opportunities. According to a survey by the Migration Policy Institute, more than 1,400,000 Afghan refugees are unregistered in Pakistan, and approximately 1,543,556 are registered.2 When such huge numbers of people illegally migrate, they are not subject to mandatory immunizations, thereby greatly increasing the chances that the polio virus will spread in the border areas of Pakistan.3 This issue was addressed in a delegate meeting of the Independent Monitoring Board of Polio held in the United Kingdom.4 Further, substandard facilities, poor sanitation, lack of proper infrastructure, and overcrowding in the refugee camps in Pakistan have increased the spread of infectious diseases such as polio.5
Consequently, the government has taken measures to monitor border activities, repatriate illegal refugees, and implement proper immunization techniques in the refugee camps in an effort to eradicate polio completely from Pakistan.
The Zarb-e-Azb military operation successfully cleared out militant-occupied areas in different parts of Pakistan, specifically Khyber Pakhtunkhwa, North Waziristan, and the Federally Administered Tribal Areas (FATA). Now that the militants are gone, the polio vaccinators will be able to successfully vaccinate children in these areas that were difficult to access, and polio will be eradicated in Pakistan by 2018.