Expert recommendations: Why haven’t we managed to eradicate polio from Pakistan?

Nearly 450,000 children under five die each year from the infection.

KARACHI:

Polio is close to a forgotten nightmare in most of the world. Four countries continue, however, to struggle with the age-old disease: Afghanistan, Nigeria, India and Pakistan. All but Pakistan have shown a marked decline in polio cases. This year, just one case was reported in Afghanistan and in India and five in Nigeria compared to 32 cases in Pakistan. Ten of the cases were reported from Sindh - Tando Allahyar, Sanghar, Badin, Tando Muhammad Khan, Orangi Town, Saddar Town and Gadap Town.

In order to discuss solutions to increase immunisation, a national vaccine seminar was held at the Aga Khan University (AKU) on Saturday. The seminar, the second of its kind this year, gathered doctors and medical professionals to hammer out a plan to combat a disease which results in the death of nearly 450,000 children under five each year.

AKU’s Dr Zulfiqar Bhutta led the charge. A third or about 150,000 children under five annually die due to this vaccine preventable disorder, he said. Malnutrition of children as well as of pregnant women is also a major cause behind the inability to control polio.

The chair for the National Immunisation Technical Advisory Groups and National Polio TAG, Dr Iqbal Haider Bhutta, shared data, marking Fata and Sindh as the provinces with the highest risk of polio. Punjab, for its part (till March 30) has no reported polio cases. Analysing the characteristics of the 144 polio cases in 2010, Dr Iqbal Bhutta said that 67 per cent of the cases are of children under two years of age with 62 per cent (81 patients) being male. Sixty-eight per cent did not receive any routine dose while 43 per cent received more than four OPV doses.

Dr Ghaffar Billoo of the Trust for Vaccines and Immunisations pointed to the trend of progressively pushing forward deadlines for the eradication of diseases with little hope of ever achieving the goals. According to Billoo, if polio is eradicated by the end of the year the country would save up to $1.5 billion in immunisation costs alone.

Chairing one of the sessions, Unicef Sindh chief Dr Andro Shilakadze said the problem was not being unaware of the issues or what needs to be done but actually doing it.

Immunisation recommendations

Children should be screened for routine expanded programmes on immunisation (EPI) coverage when their parents apply for their ‘B’ Form or birth certificates. Adults bringing children to hospitals must be asked to present a vaccination certification or have the child screened then and there. Morning as well as evening staff for screening need to be present.

Overcoming social
deterrents

A group chaired by Dr Iqbal Bhutta met to deliberate on recommendations to overcome social deterrents with a focus on improving health and nutrition, better hygiene and sanitation, empowerment of women in routine immunisations and greater positive involvement of religious and cultural leaders.

The group proposed a focus on education as a key to overcoming a major chunk of resistance to vaccinations. A change in attitude and great civic sense is needed. Fundamental changes are needed, Dr Zulfiqar Bhutta offered, “While they may not be the ‘sexy’ thing to do it is what is required primarily.” He was referring to clean drinking water and sanitation. Doctors need to also be involved as they could simply put up signboards or share an extra few minutes with their patients to educate them on the matter.

Vertical programmes were marked as a major deterrent as well. “If a worker is checking for a Vitamin A deficiency they should also check for polio as well, this will significantly reduce the burden,” they said. Bringing religious leaders on board who could exert a positive influence during their Friday sermons are a major resource that needs to be tapped. Taking the project to pharmaceutical companies and collaborating with them on campaigns through their corporate social responsibility programmes was another idea.

Published in The Express Tribune, April 24^th, 2011.