Pakistan said Saturday that two children in its southern Sindh province had been paralyzed by poliovirus, bringing the total number of cases nationwide to 39 for the year since March, when officials confirmed the first case.

The South Asian nation of around 240 million people reported six cases of paralytic poliovirus infections in 2023, following a period of more than a year without any documented cases, only to see the numbers rise again.

“Genetic sequencing of the cases is under way,” said a Pakistan polio eradication program statement Saturday while reporting the two new infections in Sindh. “The intense virus transmission and increase in polio cases are indicative of the harm that children suffer when they miss opportunities for vaccination.”

Pakistan and neighboring Afghanistan, with at least 20 cases this year, are the only two countries where the crippling disease is still endemic.

Pakistani officials are preparing to launch a nationwide vaccination campaign on October 28 to immunize more than 45 million children under 5 against the paralytic disease.

“It is critical for parents to open their doors to vaccinators during this drive and ensure that all children in their care receive two drops of the crucial oral polio vaccine to keep them protected from the devastating effects of polio,” the program emphasized in its Saturday statement.

Pakistan’s southwestern Balochistan province, which sits on the Afghan border, has reported 20 polio cases in 2024, while Sindh has detected 12 cases.

The Khyber Pakhtunkhwa province bordering Afghanistan has documented five paralytic poliovirus cases. Pakistan’s most populous Punjab province and the national capital, Islamabad, reported one case each.

The resurgence of poliovirus in Pakistan is blamed on boycotts of vaccination drives by parents in rural areas who allege the initiatives are a Western plot to sterilize Muslim children.

Anti-state militants in violence-hit districts bordering Afghanistan occasionally attack vaccinators and their police escorts, suspecting them of spying for the government. The violence has claimed the lives of dozens of security forces and vaccinators.

An independent monitoring board of the Global Polio Eradication Initiative noted in a report last month that more than 420,000 Pakistani children could not be inoculated in anti-polio campaigns in 2024.

The board reported more than 200 boycotts of the polio vaccination campaign in Khyber Pakhtunkhwa last year. “It is disturbing to realize that violence, insecurity, and boycotts are still as prevalent in Khyber Pakhtunkhwa as they were in 2023,” the report said.

It highlighted that residents in several impoverished districts of Pakistan also demanded electricity, gas supply, and road construction in return for getting their children vaccinated.

A representative for Pakistan’s Ministry of Health told a World Health Organization meeting in Doha, Qatar, earlier this week that polio eradication is the country’s “top priority,” and efforts have been intensified to halt virus transmission.

“Despite recent resurgence, a unified plan with provinces aims to stop polio transmission by 2025,” Safi Malik stated. “We’re focusing on quality campaigns, digital tracking of missed areas, and a strong Pakistan-Afghanistan collaboration for cross-border vaccinations,” he said.