Pakistan has come a along way in its struggle to eradicate polio. In the early years of the 1990's the annual incidence of polio was estimated at more than 20,000 cases a year, but over the last 5 years an average of only 100 cases per year have been reported. The national polio eradication effort has made major strides in reaching children with immunization in all parts of the country over the past 15 years. Now the tremendous progress towards the eradication of polio in Pakistan is threatened by stagnation due to difficulties in access in areas affected by security problems and managerial & implementation failures and lack of accountability. Recent floods have posted an additional challenge in terms of mass displacement of population and damaged health infrastructure especially in the Northern Sind and South Punjab. The failure to reach all children, especially in high risk areas, with sufficient doses of vaccine is leading to continued transmission of poliovirus in Pakistan. As on 24 November, Pakistan has reported a total of 119 cases in 2010, more cases than any year since 2000.