Of the two, Pakistan is the bigger worry, says Tangermann. The number of cases rose in Afghanistan in 2008, but nowhere near as high as they did in Pakistan, where type 1 exploded and the virus spread into previously polio-free areas. In Afghanistan, President Hamid Karzai has pledged his support for eradication; Pakistan, on the other hand, "must become more committed under its new government," says Heymann.
Fundamentalist leaders in Pakistan have issued fatwahs saying the vaccine is unsafe and threatening vaccinators. "Refusals" have risen considerably. In February 2007, a Pakistani doctor and his driver were killed by a remote bomb while they were returning from a village where they were trying to persuade parents to let their children be vaccinated.
Equally unsettling, the Geneva team suspects that the program in Pakistan is weaker than they imagined and that the viral foe may be tougher. Earlier reports that vaccination teams reached 95% of the target children seem to have been fabricated, says Tangermann. And recent studies by Grassly and colleagues at Imperial suggest that viral transmission is much more efficient in Pakistan than previously believed, closer to that of India than that of Nigeria. "Pakistan is the only place we really have questions about what we are dealing with," says Aylward.
It says something when Pakistan is considered to be doing worse than Afghanistan. Read the full story here (you will need magazine access).