Pakistan's polio vaccination campaign in merged districts of Khyber Pakhtunkhwa missed over 935,000 children under five due to security challenges and population displacement. Reduced staffing and funding cuts for WHO and UNICEF programs also impacted coverage. In Sindh, over 12,000 children were missed in Hyderabad and surrounding areas, with refusals and absent households cited. Despite these gaps, the nationwide campaign vaccinated over 44.6 million children across Pakistan.