Targeted violence against community health workers: A critical barrier to Pakistan’s polio eradication goals

Workplace violence is a significant occupational risk faced by healthcare personnel in community-based settings, posing a global public health threat. Pakistan, one of the few countries, where polio remains endemic has faced targeted violence against polio workers, hindering its progress in eradicating the disease. This violence has profoundly impacted vaccination campaigns, leading to a resurgence of polio cases and the tragic loss of over 200 polio vaccination workers and security officials in recent years. Such violence not only endangers lives but also hampers vaccination initiatives creating fear among workers and reducing immunization coverage, particularly in high-risk areas. The history of these attacks intensified by a breach of trust has compounded resistance from militant groups and the spread of misinformation. Cultural norms, gender-based resistance, and socio-economic vulnerabilities further impede vaccination efforts. This letter proposes the use of community-based approaches such as employing voluntary community mobilizers (VCMs) to enhance public trust and vaccination coverage through strategies including the establishment of polio immunization centers in vulnerable areas, strengthening multi-sectoral partnerships, involving local influencers to address community concerns and implementing safety measures and incentives for health workers. These strategies aim to improve worker safety, promote vaccine acceptance, and ensure sustainable progress toward a polio-free Pakistan.