It was an innocuous thing any five-year-old would do.
When Sadia Sulaiman was a child, construction work on her neighbour's house produced the perfect place to play — a mud pit.
So she did.
She played in it, came home and had a bath.
Then, the fever hit.
For 21 days, she had high temperatures.
One night, a doctor gave her an injection.
By the next morning, she could not walk.
"My legs were not good," she recalls.
"I could not even touch the floor."
Another, well-known doctor eventually gave her a diagnosis.
"He told my mother that I have polio, and it's incurable," she told the ABC.
"He counselled my mother to stop going around for treatment [to make me walk again]."
Sadia did learn to walk again.
As an adult, she now walks with one foot constantly hovering above the ground, leaning on a crutch underneath her opposite arm.
But that second doctor was right about one thing.
There is no cure for poliomyelitis, commonly known as polio.
The highly infectious viral disease invades the nervous system and largely affects children under the age of five.
Serious cases result in permanent paralysis, usually of the legs.
Of those, five to 10 per cent die when that paralysis moves to the muscles required to breathe.
For more than 96 per cent of the world's population, polio poses virtually no threat.
It is only endemic in two countries, according to the World Health Organization (WHO).
Sadia's home — Pakistan — is one of them.
And the trajectory to eradicate the disease there is not exactly going in the right direction.
Goals for 2025 already impossible
At the end of 2023, Pakistan looked like it was on the verge of getting rid of polio for good.
It had recorded only six cases that year, down from 20 in 2022 and 84 in 2020.
"We were hoping that by 2024, we will be able to say that polio is almost gone," Tariq Bhutta, a professor of paediatrics and former chairman of Pakistan's federal immunisation program, told the ABC.
But in 2024, cases soared.
There were 74 recorded across the country throughout the year.
Already, six cases have been recorded in 2025.
Employees at the office of the Expanded Programme on Immunization (EPI) in the state of Punjab told the ABC they were working towards eradication by 2027.
That would require zero transmission of wild poliovirus in 2025 and again in 2026, then again in 2027 when Pakistan could apply for eradication certification from the WHO
At the time the ABC spoke to EPI employees, the country had already recorded three cases.
It's now had six.
Professor Bhutta said it was impossible for the 2027 timeline to be achieved.
"We have had this going on since 2000, and we are moving the targets every time," he laughed.
Vaccine suspicion still rife
Professor Bhutta said the country has not been able to reach eradication point for several reasons.
Attacks on vaccine workers, especially in provinces with already heightened security risks, and conspiracy theories about vaccines are common.
The only other country still with endemic polio, Afghanistan, is right next door with an extremely porous border.
Professor Bhutta said there were still "misunderstandings and myths" about what polio immunisation drops do, including that it's "a Western conspiracy".
"[In] some areas, even in a small mosque, a mosque person can say: 'No, don't give polio drops to our children, because it might cause infertility in our population,'" he said.
There is also still a hangover from 2011, when the CIA tracked down Al Qaeda leader Osama bin Laden in Abbottabad after a local doctor running a hepatitis vaccination program allegedly passed the agency information.
Shakil Afridi visited the compound where bin Laden was staying weeks before he was assassinated by US military forces, to reportedly take DNA from children.
It's believed he passed material gathered during that vaccination drive on to US intelligence agents, though it's not clear whether he played a direct role in revealing the terrorist leader's location.
The news enraged Islamist groups and led to increased attacks on vaccination workers across Pakistan.
"That did cause a serious setback to the whole program," Professor Bhutta said.
"People who previously were a little suspicious of the whole campaign, they became confirmed in their suspicion that this is a conspiracy by the West, particular USA, to spy on us and get information about things, and they are not really keen to protect the children against polio."
Attacks on immunisation teams continue to this day, although the motivations are not always entirely clear.
Many occur in the provinces of Balochistan and Khyber Pakhtunkhwa, where militant groups wage a campaign against security forces.
While Sadia Sulaiman said she had never been attacked while on a vaccination drive, she aid she was often met with fierce resistance from parents.
"People think that it is a conspiracy of America to sterilise [their children]. They have doubts over the contents of the vaccine, they doubt [it because] no-one has seen the manufacture of it, where it came from," she said.
"Who will do our duty if we stop due to fear? Who will save children?"
She said being able to physically show parents a real-life example of what polio could do their kids often helped.
"I tell them I am scared of falling, slipping, at every step," she said.
"I ask them: 'Do you want your children to be like me?' Do not commit atrocity on your children.
"They get angry, speak angrily, but when they hear [what I have to say] then they calm down and get their children vaccinated."
Has Trump thrown a spanner in the works?
Senior WHO officials have warned US funding cuts to the WHO under Donald Trump may delay the eradication of polio in Pakistan and Afghanistan.
The WHO works with groups including the Gates Foundation and UNICEF to end polio.
UNICEF's polio grant has already been terminated after the US cut 90 per cent of USAID's grants.
Hamid Jafari, the director of the polio eradication program for the WHO's Eastern Mediterranean Region, which includes Pakistan and Afghanistan, said the partnership was missing $US113 million ($210 million) from the US that was expected this year, Reuters reported.
He said it would largely impact personnel and surveillance, but that the vaccination campaigns in both countries would be protected.
Professor Bhutta said he wasn't concerned about the effect it would have on Pakistan's eradication campaign.
"The WHO gives us technical advice, technical expertise, we do not get money from [it]," he said.
"That money comes from Gavi [a public-private global vaccine alliance], from Japan, from Qatar, from Saudi Arabia."
Samra Khurram, the director of the EPI in the state of Punjab, agreed.
She said monitoring may be affected, but did not believe the operational side of the program would be.
"I think there will be no more effects on the polio program," Dr Khurram said.
"The [Pakistani] government is very committed and willing to eradicate."
A spokesperson for the Gates Foundation told Reuters no foundation could fill the gap left by the US.
What will it take?
Professor Bhutta doesn't think the conspiracy theories, attacks on vaccine workers and porous border with Afghanistan explain the entire failure to eradicate polio in Pakistan.
He believes the country's anti-polio campaign needs a complete overhaul.
Workers like Sadia Sulaimun say the current immunisation program fatigues parents, deterring them from keeping their children's immunity up to date.
The recommendation is for children in Pakistan to be given four doses of oral polio vaccination drops between birth and 14 weeks, as well as an immunisation at 14 weeks.
But due to poor sanitation and the risk of kids contracting diarrhoea — rendering the vaccine ineffective — kids are often given more doses.
"They often ask me, 'Why do you keep asking every time?'" she said.
"I tell them I will ask [to vaccinate their child] even if I see them 1,000 times.
"It is my duty."
Injecting the vaccine is safer and more effective, because it contains a dead virus, rather than a weakened live one like in drops, and therefore does not cause vaccine-associated paralysis.
But that requires more rigorous training and equipment for vaccinators.
Pakistan's current polio vaccination campaigns rely on intensive weeks-long drives of vaccinators going door-to-door, unannounced, to give children drops.
Professor Bhutta estimates Pakistan has already had about 200 campaigns in the past 30 years.
He believes, until that is not the way Pakistan vaccinates its children, the country's chances of eradicating polio are slim.
"Campaigns are not the solution," he said.
"We have already had … the largest number in the world. We have to look for other strategies to do it. I think the main strategy has to be to improve the routine immunisation that every child born should be registered [and] should get all the vaccines before he [or she] is two years old.
"Unless we reach every child, it's not possible."
As for suggestions that only when Afghanistan reaches eradication, so too can Pakistan, he scoffs.
"I'm not ready to blame Afghanistan for our own problems," he said.
"If we can protect every child in this country, even if there are cases in Afghanistan, they are not going to affect us.
"Iran is also our border country … and there's a lot of movement there.
"Iran hasn't had a polio case for the last 20 years because they have done their job so well.
"Our whole region has done it — except us."
