Disease control: Insecurity pooling up the ‘last polio reservoir’

Persistent wild polio virus transmission concentrated in Karachi and districts of Balochistan, FATA and K-P.

Ppi August 24, 2011


Pakistan has seen a rising number of polio cases since 2007, with 69 reported so far this year as against 37 in the same period of 2010. Insecurity is believed to be a major cause.

UN Children’s Fund (UNICEF) head of communications at the Polio Eradication Unit, Cathy Williams, told Integrated Regional Information Networks (IRN), “Essentially the problem is security, which makes the movement of vaccination teams difficult. The movement of populations, for instance from the militant-hit Federally Administered Tribal Areas (FATA) area to Karachi, also adds to the spread of the virus.”

In 2007 only 32 cases were reported, but that number rose to 144 in 2010.

The migration of people also means it is more likely that children will be left out during vaccination drives, she said.

There are also other problems. Williams said it was sometimes “difficult to recruit women for vaccination teams”, and due to cultural reasons, in the absence of a female, teams were in some cases denied access to households and to the women and children. She said UNICEF and the World Health Organization were working with the Pakistan government to improve the management of vaccination drives, and to ensure involvement at the lower tiers of the administrative structure, so that no child was left out.

UNICEF said that in Balochistan 22 cases had been reported up to August 9, which is higher than in any other province. The disease had spread beyond the five districts considered at high risk to those from where no infection had been reported for the past five years, including Khuzdar, Noshki and Kohlu.

Since then four new cases have been reported from the province and two more from Fata, taking the total for Fata to 22 this year.

Persistent wild polio virus transmission in the country is concentrated in three areas: Karachi city, some districts of Balochistan and districts in Fata and Khyber-Pakhtunkhwa (K-P).

UNICEF regional director for South Asia, Daniel Toole, after meeting senior government and UN officials, acknowledged that reaching every child with the two drops of polio vaccine is a challenge, but emphasised that with firm commitment from local authorities, close follow-up, and by taking direct responsibility for reducing the number of polio cases, the disease could be eradicated.

UNICEF says Pakistan “could potentially be the last polio reservoir worldwide, standing in the way of global polio eradication, unless progress is accelerated”.

(Read: Polio cases need attention, says UNICEF)

The increase in cases is disturbing for health workers. “I worked as a vaccinator with government teams for two years until 2009, when my parents said it was too dangerous and asked me to quit,” Fatima Bibi, 27, told IRIN from Peshawar. She now works with an NGO in the city, but says, “I am always depressed when I hear about the growing number of cases and wish I could do more to prevent them.”

Apart from the other issues, health practitioners also point out there is still a need for greater awareness. “People still do not realize how important it is to have children vaccinated, and to complete all the doses, while myths about ill-effects from polio drops such as high fever are also widespread,” said Shazia Awan, who works at a clinic in a rural area close to Islamabad.

Media stories such as one about the death of a 16-day-old baby after receiving polio drops also add to public fear. The results of the inquiry into the incident launched by local health authorities in Lahore have not yet been made public, though a health department official, who asked not to be named, said it seemed “the baby was sick and died of other causes”.

However, such reports add to public uncertainty and also to the many difficulties Pakistan faces in eradicating a disease which has been taking a higher and higher toll over the past few years - with no evidence yet that the situation has been brought under control. 

Published in The Express Tribune, August 24th, 2011.