This Viewpoint contends that the principal obstacles to polio eradication in Pakistan are no longer technical but operational and contextual, rooted in insecurity, governance constraints, population mobility, and persistent vaccine hesitancy. We identify critical evidence gaps in implementation fidelity, community engagement, and adaptive service delivery, and propose an embedded operational research agenda integrated within immunization programs. Such an approach would generate real-time, policy-relevant evidence to guide context-sensitive strategies and sustain interruption of poliovirus transmission in conflict-affected and high-risk settings.