Has COVID-19 influenced parental perceptions and knowledge about polio vaccination in Pakistan?

BACKGROUND: Despite global vaccination efforts, Pakistan remains one of the last 2 countries where wild poliovirus is still endemic. AIM: To assess the change in parental knowledge and perceptions about polio vaccination after COVID-19 pandemic. METHODS: From January to April 2025 we interviewed 308 parents, who were permanent residents for ≥2 months, with at least one child aged 0-5 years and willing to provide informed consent, in 4 administrative subdivisions of North Waziristan District, Pakistan. We analysed the data using SPSS version 22 and used McNemar's test to assess changes in perceptions. RESULTS: Average short answer knowledge score increased from 6.2 ± 2.3 pre-COVID-19 to 8.3 ± 2.1 post-COVID-19, resulting in overall significantly better knowledge of polio vaccination (P < 0.0001). Good knowledge (mean score ≥ 9) increased from 36.3% to 58.7%, knowledge of the viral etiology increased from 50.0% to 71.4%, and misconceptions decreased from 64.9% to 35.1%. Recommendations by health care providers (85%), social media campaigns (76%) and advocacy by religious leaders (55%) contributed to the improvement in knowledge. CONCLUSION: Parental knowledge increased, with more positive attitude towards polio vaccination, due to the COVID-19 pandemic. Building on this, further improvements can be achieved through strategic community engagement with health workers, religious leaders and social media, towards overcoming vaccine hesitancy and achieving polio eradication.