DUKKI, Pakistan — Outside her small, mud-walled house in western Pakistan, Gul Saima is cajoling her 3-year-old son to take a few steps. He cries as he struggles to lift his right leg and arm, both stiff and unyielding.
Overhead is a banner featuring a photo of a smiling boy on crutches. Ms. Saima, 38, is illiterate and cannot read the words printed in Urdu: “Don’t let your child’s dreams go to waste.” But the connection between the smiling boy and her son, Sayyad Karam, is painfully clear: Both have the paralysis that often follows a polio infection.
The health authorities hung the banners throughout the area for a polio awareness campaign — and apparently put one on Ms. Saima’s house in a clumsy attempt to show officials, many of whom have visited since Sayyad’s polio was diagnosed last month — that they are committed to it.
Sayyad’s diagnosis was a significant event, and not only for his family. So far, his is the only new polio case of the year in Pakistan — a historical low, according to official figures in a country where eradication efforts have been repeatedly foiled by ignorance, mistrust and militant attacks on vaccination teams.
Pakistan has come agonizingly close to declaring victory over polio. Each of the last three years, nongovernmental organizations involved in fighting it have optimistically declared it the virus’s final year, seeking support from international donors and local officials as they embark on the daunting task of vaccinating every child 5 and under in the country.
But polio has persisted here and in neighboring Afghanistan, where increasing instability has left both countries at risk, the finish line just beyond reach.
Sayyad’s diagnosis prompted an emergency vaccination campaign in Dukki, the small coal-mining town in Pakistan’s western province of Baluchistan where the family lives.
About 35 miles from Ms. Saima’s home, Saif ur-Rehman, the commissioner of Loralai, the district that includes Dukki, is checking in with some of the vaccination teams after the emergency campaign’s first day. The teams report their results to Mr. Rehman, and he responds with strident calls for greater efforts.
“This is a scar on our community,” he tells them, adding that if polio were to appear “anywhere else in the world, I don’t care. But this is our town, our community. It’s here and it’s here now.”
He makes a pointed comparison with India, Pakistan’s neighbor and main rival, which eradicated polio in 2014. The meeting goes well into the evening, even though almost everyone has been up since dawn, preparing and deploying the vaccination teams that go door to door under police escort.
After the meeting, Mr. Rehman explains his urgency. “We don’t hide anything,” he said. “The worst thing you can do in this scenario is try to paint a rosy picture.”
He is all too aware of the vulnerability of Baluchistan, Pakistan’s biggest province: It consistently ranks last in the country on progress markers like literacy, infant mortality and terrorism. Of the eight new polio cases in Pakistan last year, three were in Baluchistan.
“We know the issues we’re facing,” Mr. Rehman said. “It just presents an opportunity for us to get stronger.”
His positivity reflects a new optimism about the polio eradication campaign after years of painful setbacks. In 2014, 306 new cases were reported, the most in 15 years and more than three times as many as the year before.
And since 2012, militants have killed more than 70 anti-polio workers and police officers protecting them, attacks that began after the Pakistani Taliban accused vaccinators of being foreign spies. The situation worsened after the United States was found to have recruited a Pakistani doctor to help find Osama bin Laden under the guise of carrying out a vaccination campaign.
“Back then, everyone felt like their efforts were in vain,” said Dr. Rana Safdar, the national coordinator of the Emergency Operation Center for Polio Eradication. “If things kept going the same way, we knew we were going to get the same results.”
Since 2015, Dr. Safdar has overseen virtually every aspect of Pakistan’s battle against polio. In his office in Islamabad, the capital, he sits among a war room’s assortment of maps and weekly reports from across the country. Local bureaucracies, the World Health Organization, the Bill & Melinda Gates Foundation, Unicef — all report to and coordinate with Dr. Safdar’s office under a federal program similar to India’s.
“People needed to have some trust in the federal government to reach a solution,” he said.
But given the rampant corruption and sometimes deadly political rivalries within that government, trust is hard to come by. And many of the impoverished families that vaccinators seek out have never met a representative of the state.
Their suspicion is compounded by rumors that the polio vaccine causes impotence, death and, ironically, paralysis. Refusals are common, and some families will hide their children from vaccinators, or even attack them.
“They’ve chased us with sticks before, even,” said Saida Baloch, a cheerful 27-year-old leading an emergency vaccination team on its rounds in Dukki.
Ms. Baloch, who has worked as a vaccinator in Dukki since 2014, is well aware of the risks she and her team face. Attacks have been rare the past two years, but in January a mother-daughter vaccination team was shot and killed in Quetta, about 100 miles west of Dukki.
Despite the deaths, much of Pakistan’s recent success in battling polio can be attributed to the country’s improving security. Michel Zaffran, the director of polio eradication for the World Health Organization, says a bigger threat lies across the border in hard-to-reach places in Afghanistan.
“As long as we have the virus on either side of the border, we have a risk,” he said. “It’s a sneaky virus. It continues to hide in pockets where the vaccine isn’t reaching it.”
Of Afghanistan’s 13 cases last year, six were in Kandahar Province, just across the border with Baluchistan. (Nigeria, the only other country where the virus remains endemic, has not seen a new case in two years.)
Pakistan now has 55 monitoring sites where teams test water and sewage streams for polio, more than in any other country battling the virus. Until the samples are completely negative, it means the virus continues to circulate even if it has not paralyzed anyone. Currently, only two cities are testing positive for environmental polio: Peshawar in the north and Karachi in the south, which both serve as transit hubs.
The health authorities say the virus is now “ping-ponging” in Baluchistan. The strain found in Dukki came from another city just north of it, and that strain in turn was traced back to Karachi, where the virus has been present for over a decade. As long as carriers keep circulating the virus, children who go unvaccinated or miss a dose are at risk of contracting polio.
That is part of the reason that the final years of eradication efforts can prove the hardest, says Mr. Zaffran of the World Health Organization.
“We’re not out of the woods yet,” he said. “It’s not that we’re close, it’s that we’re closer than we’ve ever been.”