Yesterday, another polio case was discovered in Pakistan’s Khuzdar district, bringing this year’s total to at least 57 for the country. Although Pakistan is now just one of four countries still with endemic polio transmission, the other three countries have reported much lower disease burdens – with 11 cases in Nigeria, 5 in India, and 4 in Afghanistan for the same period. Most concerning is the discovery of cases in regions within the country long-believed to be polio-free. Last week, a 2 year old was found to have polio in Diamer District of northern Pakistan, an area that has not reported cases for over 12 years. Many believe that internal displacement, problem with the vaccine cold chain, and refusal by parents to have their children vaccinated as a result of misinformation have all contributed to the resurgence of cases within the country. Pakistan now is subjected to much international pressure as many European countries are considering imposing travel restrictions on Pakistani citizens and the World Bank has warned that it will convert a grant on polio vaccination for the country into a loan if Pakistan fails to eradicate by 2012.