At UNGA80, Shehbaz and Bill Gates Turn From Pakistan’s Polio Progress to the Children Still Beyond Immunization’s Reach
By Sadaf Sundas Riaz | SCN NEWS
ISLAMABAD, Sept. 25, 2025 — Prime Minister Shehbaz Sharif's meeting with Gates Foundation Chair Bill Gates on the sidelines of the United Nations General Assembly on Thursday carried none of the geopolitical drama surrounding many of Pakistan's other engagements in New York, but it touched a challenge with consequences measured directly in children's lives. The two discussed Pakistan's continuing campaign to eradicate polio, alongside immunization, nutrition, flood assistance, financial inclusion and digital transformation, with Shehbaz describing polio eradication as a government priority and both sides reaffirming cooperation on health and wider socioeconomic development. The familiar commitment, however, now confronts a more demanding measure of success: after decades of campaigns, international financing and repeated vaccination drives, Pakistan's polio challenge is no longer simply whether vaccines exist, but whether its health system can consistently reach every child required to eliminate transmission.
That distinction matters because polio is one of the clearest examples of what global health cooperation can achieve — and how difficult the final stage of disease eradication can become. Vaccination has pushed the disease out of most of the world, transforming a virus once capable of paralyzing children across continents into a threat concentrated in a remarkably small number of places. Pakistan's continued battle therefore sits at the intersection of international health financing and highly local conditions: whether vaccination teams can reach communities repeatedly, whether parents trust the programme, whether mobile and underserved populations remain inside surveillance systems and whether routine immunization becomes strong enough that protection does not depend indefinitely on emergency-style campaigns.
The Gates Foundation has been deeply involved in Pakistan's polio-eradication effort, and Thursday's meeting reflected a partnership extending beyond a single disease. According to the government's readout, Shehbaz thanked the foundation for support to polio eradication, immunization and nutrition, while also acknowledging its assistance following Pakistan's recent floods and the catastrophic floods of 2022. Both sides agreed to continue cooperation across health, nutrition, digital transformation and broader socioeconomic development.
Those areas are more connected than they initially appear. A child missed by vaccination services may also be a child whose family struggles to reach primary healthcare, adequate nutrition or other essential services. Flooding can displace families and interrupt routine healthcare precisely when contaminated water, poor sanitation and crowded living conditions increase health risks. Poverty can make transport to clinics difficult, while population movement can make vaccination records and follow-up harder to maintain. Polio can therefore function as more than an infectious-disease indicator: persistent transmission can expose gaps in the systems intended to reach vulnerable children.
This makes the phrase “finishing the job” more complicated than delivering another round of vaccine doses. Eradication requires repeatedly reaching children who are easiest for health systems to miss. National vaccination totals can look impressive while relatively small pockets of under-immunized children allow transmission to continue. The closer a country moves toward elimination, the more those remaining gaps matter because success depends not on the average child being protected but on the virus running out of susceptible children through whom it can circulate.
Pakistan's challenge also has global consequences. Polio eradication is not complete anywhere until transmission is stopped everywhere because infectious diseases do not recognize political borders. Continued circulation preserves the possibility of international spread, meaning vaccination work undertaken in Pakistani communities contributes to a global public-health objective. Conversely, failure to interrupt transmission places decades of worldwide eradication investment under continuing pressure.
For Pakistan, however, international partnership cannot substitute for domestic health capacity. External financing can purchase vaccines, strengthen surveillance, support technical expertise and help train workers, but the decisive encounter still occurs locally — often at a family's doorway, clinic or vaccination point. Trust between communities and health workers, accurate information, security for vaccination teams and reliable primary healthcare ultimately determine whether international resources become immunity for an individual child.
That is where Thursday's meeting deserves examination beyond its official language. High-level commitments are valuable partly because they sustain political attention and financing, but Pakistan has made the commitment to eliminate polio many times before. The meaningful benchmark is therefore increasingly operational: whether the country can convert national political commitment into uninterrupted protection at district, community and household level.
Nutrition belongs inside that discussion as well. Vaccination cannot be separated completely from the wider conditions determining child health. Malnutrition weakens children and increases vulnerability to illness, while poor sanitation and inadequate healthcare compound risks faced by low-income communities. A health system capable of identifying an unvaccinated child should ideally be capable of identifying nutritional vulnerability and other preventable health risks around that child too.
This creates an opportunity to rethink polio infrastructure as part of a stronger health system rather than a vertical campaign existing alongside it. Networks built for surveillance, vaccination, community engagement and data collection can potentially strengthen routine immunization and primary healthcare if institutional knowledge and local relationships are retained. The long-term dividend of eradication would then extend beyond eliminating one virus: Pakistan could emerge with a more capable system for finding and protecting children who have historically remained hardest to reach.
Recent flooding reinforces the importance of that approach. Shehbaz thanked the Gates Foundation during Thursday's meeting for its contribution following Pakistan's 2025 floods as well as its earlier support after the 2022 disaster. Climate shocks can quickly transform a health problem into a systems problem by damaging clinics, disrupting transport, displacing families and increasing pressure on clean water and nutrition. Pakistan's health resilience will increasingly depend on whether essential services can continue when communities are moving or infrastructure is under stress.
Digital systems, another area discussed during the meeting, could also become relevant if they improve identification of underserved populations, financial inclusion or delivery of public services. But technology is not automatically inclusion. A digital system is only as effective as its ability to incorporate families with limited connectivity, documentation or access. The same principle governing polio eradication applies to digital development: the people most difficult to reach may be precisely those whose inclusion determines whether a programme succeeds.
That gives the Shehbaz-Gates meeting a broader development significance during UNGA80. Much of High-Level Week is devoted to global goals expressed at enormous scale — billions of dollars, millions of displaced people and national development indicators. Polio eradication reduces those ambitions to an unusually precise unit of accountability: one child missed can matter.
It is difficult to imagine a clearer interpretation of the Sustainable Development Goals' promise to leave no one behind. In many development programmes, substantial national progress can coexist with communities that remain excluded. Eradication does not permit the same comfort. A vaccination campaign cannot declare victory because 95 or 99 percent of children are protected if the remaining pockets are sufficient to sustain transmission.
That makes polio simultaneously one of Pakistan's most frustrating health challenges and one of its most revealing development tests. The science is established. The vaccine exists. International partners remain engaged. Political leaders repeatedly state their commitment. What remains is the difficult work of ensuring that geography, poverty, displacement, mistrust or weakness in basic services does not determine which child remains outside protection.
The meeting between Shehbaz and Gates therefore should not be judged by whether it produced another declaration of commitment. Its significance lies in whether sustained international partnership can help Pakistan move from repeated campaigns toward the institutional capacity required to reach every remaining vulnerable community.
Pakistan does not need to discover how polio is prevented. Humanity solved that scientific problem decades ago. Its unfinished task is a problem of delivery — ensuring that a proven solution reaches every child regardless of where that child is born, how poor the family is, whether floods force the household from home or how difficult the community is for the health system to reach. If Pakistan eventually becomes polio-free, the achievement will mean more than defeating a virus. It will demonstrate that the country's health system learned how to find the children it once missed.