A decade ago, the fight against polio looked very different. The tools were simpler, yet the resolve was unwavering. Health workers went door to door, carrying life-saving vaccines in their coolers, determined to reach every child. Routine immunization drives were relentless, and small but meaningful incentives — often non-monetary — helped keep health workers and volunteers motivated. These grassroots strategies laid the foundation for the progress we see today, even as new technologies and innovations now strengthen the fight.

Yet, polio remains a formidable enemy. It's a highly infectious viral disease that primarily affects children under five years old, especially in areas of dense population, poor sanitation, and compromised healthcare systems. It can cause irreversible paralysis and, in some cases, death. Today, Pakistan and Afghanistan stand as the last two countries where polio is still endemic. These nations are not just battlegrounds but symbols of hope and resilience in the global fight to eradicate the disease. The challenges are immense, but the progress over the years proves that even the most stubborn adversary can be overcome with innovation and the commitment to leave no child behind. 

Navigating communities was no small feat; Polio workers and volunteers relied on paper maps and manual data collection methods, which frequently resulted in inaccuracies and delays. This made it challenging to identify polio hotspots and deploy rapid responses effectively. 

Although these conventional strategies succeeded in eradicating polio from many regions, challenges remained, particularly enormous costs associated with deploying immunization campaigns and difficulty of accessing children in hard-to-reach areas.  

The struggle against polio in Pakistan is multifaceted because of a complex interplay between social, cultural, and geographical factors. Additionally, years of conflict and political instability in certain areas have hindered consistent access to vulnerable populations and have further complicated eradication efforts.

Despite these obstacles Pakistan has made remarkable progress, thanks to the unwavering commitment of health workers, government initiatives, and international support. 

Today, the country has leveraged advances in technology to transform various aspects of its polio eradication campaigns, optimized resource allocation and improved public health strategies. Here are four innovations Pakistan uses to forge a path toward a polio-free country. 

1. Needle-free syringes for polio immunization campaigns
   The widely known polio vaccine is administered using an intramuscular delivery with a needle and syringe. Now needle-free syringes have been introduced. This syringe — introduced in 2019 by the WHO during its polio eradication campaign in Pakistan — drives the vaccine through a nozzle orifice that delivers the dose into the skin without the penetration of a needle.
   
   The results from using these needle-free syringes were outstanding. This method of vaccine administration helped increase campaign coverage by 18.4% compared to the traditional needle and syringe method. In a survey of caregiver and vaccinator acceptability in Karachi, Pakistan, 97.6% of vaccinators and 99.6% of caretakers preferred  jet injectors to needle and syringe. This is because of its speed of use and less discomfort associated. These needle-free injectors also reduce the risk of accidental needlestick injuries both during injection and while managing waste. Additionally, they produce minimal waste. 
   

2. Social listening to combat vaccine hesitancy and misinformation
   Social media is a powerful force in shaping public narratives, particularly in the healthcare sector, where its influence on vaccination discourse is profound.

   Social listening is a sophisticated surveillance system that  monitors and analyzes misinformation through advanced digital tools. The misinformation challenge has grown significantly, especially during the COVID-19 pandemic, highlighting the necessity of social listening in combating vaccine hesitancy and misinformation. By identifying false narratives early and responding promptly, vaccination campaigns for polio can effectively rebuild public trust and enhance immunization rates.

   A notable example of effective social listening is found in Pakistan's approach to tackling polio misinformation. The Pakistani government implemented targeted campaigns that engaged medical professionals and community leaders to directly counteract vaccine-related rumors. Additionally, they collaborated with Meta to eliminate harmful content regarding polio vaccines from Facebook, demonstrating a proactive stance in safeguarding public health.

3. Real-time data using RapidPro
   At the start of this article, we highlighted the challenges faced by polio workers and volunteers who relied on paper maps and manual data collection methods, often leading to inaccuracies and delays. Fortunately, innovations like RapidPro have effectively bridged this gap.

   RapidPro is an innovative open-source tool for real-time data collection through various communication channels, including SMS, voice calls, and social media platforms like Facebook, Telegram, and WhatsApp. This tool allows health authorities to gather accurate information on critical areas such as health, nutrition, education, water and sanitation, and polio vaccination coverage — even in remote and hard-to-reach locations. With RapidPro, field data can be analyzed quickly to identify gaps and develop strategies to enhance vaccination campaign coverage.

   Since its launch, RapidPro has made a significant impact by reaching millions in diverse communities. For instance, in 2018, the tool was successfully used to engage families of 37 million children across 163 districts in Pakistan. This demonstrates how technology can be used in ensuring that no child is left unprotected against polio.

4. Geographic Information Systems (GIS)
   Today, we use smart phones to locate our favorite coffee shop and hangout spots. This is all possible using the global positioning system (GPS), a satellite-based navigation system that is available across the globe. Geographic information systems (GIS) software, such as ArcGIS and GoogleEarth, which are powerful visualization and analytic tools, have been found useful in public health services. 

   In recent years, GIS technology has become integral to modern polio eradication efforts. It empowers health workers to use mobile phones to pinpoint areas with low vaccination coverage, thereby facilitating the precise delivery of polio vaccines. The data collected by health workers in the field is integral to applying the software to create detailed maps that show areas where polio is still endemic. This piece of technology also enables health officials to employ advanced analytical techniques to identify outbreak patterns, advancing beyond the traditional annual cumulative incidence data alone. We can see an example where the National Emergency Operations Center (NEOC) in Pakistan employed GIS in building strategic campaigns to combat polio from July 1, 2018, to June 30, 2019. GIS was used to identify high-risk areas, mapping out districts with where the poliovirus was suspected and conduct surveillance in tracking the spread of poliovirus. This approach helped the vaccination teams and their partners enhance operational efficiency, ultimately supporting the goal of polio eradication in Pakistan.

It is quite clear that technology plays a crucial role in enhancing polio eradication efforts in Pakistan. The integration of cutting-edge tools such as needle-free syringes, social listening platforms for misinformation management, real-time data collection systems like RapidPro, and GIS technologies not only streamlines vaccination campaigns but also signifies Pakistan’s progress towards achieving a polio-free future. 

However,  these technological interventions alone cannot win this battle. The true strength of Pakistan's polio eradication efforts lies in the synergy between these innovative tools and the commitment of health workers, government agencies, and international partners. It's all about combining cutting-edge technology with community-centered strategies to eradicate the disease. This holistic approach brings us closer to a world without polio and  paves the way for tackling other global health issues with innovation, compassion, and determination.