The multiple attacks on polio workers this month brought into sharp focus Pakistan’s failing fight against the virus, which has been eradicated from all but three countries. The total number of polio cases in the country was 57 this year, a sharp drop from 118 in 2011, but a significant number nonetheless. So what happens if Pakistan doesn’t manage to eradicate polio?

For one, it could lead to a resurgence of the virus. According to the World Health Organisation (WHO), failure to eradicate polio from Pakistan, Afghanistan, and Nigeria – the last remaining strongholds of the virus – could result in as many as 200,000 new cases every year, within 10 years, all over the world.

This is a sobering fact, for two reasons: firstly, it threatens to undo prolonged eradication efforts by the international community — in 1988, when the world first pledged to get rid of the disease, there were 350,000 cases of paralytic polio; this year, there were 215. Secondly, endemic countries such as Pakistan run the risk of exporting the virus to regions which have been free of polio for years. Indeed, in 2011, 10 cases of polio surfaced in China, a country that had been declared polio-free since 1994 — these were traced back to neighbouring Pakistan.

Now, linked to this is the looming threat of a travel ban. The idea was first floated by the WHO in July; in early December, the Global Polio Eradication Initiative’s (GPEI) independent monitoring board made a similar recommendation, calling for all Pakistanis wishing to travel abroad to produce a certificate proving that they had been immunised against the virus. If imposed – and the GPEI recommends that it should from March 2013 onwards – the ban could have far-reaching implications: for students, for businessmen, for tourists and casual travelers. It would also require the state – which is already struggling to provide universal coverage – to embark on an extensive system of documentation and paperwork, which may prove to be beyond its scope.

Failure to eradicate also undoes, to some extent, the vast amount of economic resources funneled into the polio eradication campaign — and could lead to further costs in the future. According to the WHO, eradicating polio in the next five years would save the world at least 40-50 billion US dollars in health costs, mainly in poor countries.

Indeed, given the multiple hurdles involved – including those relating to conflict, poverty, administration and socio-cultural resistance – eradication is no small task; indeed in its final stages, eradication is, as one commentator put it “like squeezing jell-o to death”. When failure to immunise stems from ‘socio-cultural’ concerns, as is partly the case in Pakistan, it may also affect the incidence of other diseases. According to the general secretary of the Pakistan Pediatrics Association, for instance, anti-polio propaganda might have played a role in preventing people getting their children vaccinated against measles, leading to the deadly outbreak in interior Sindh this month.