A polio-free Pakistan

Intense resistance to polio immunisation due to myths, low-literacy as well as social, cultural and political hurdles

It is very unfortunate that the polio immunisation program still has intense resistance in Pakistan due to certain myths, low-literacy as well as social, cultural and political hurdles. Hence, we are unable to achieve a polio-free country status despite immense international level endeavours of yesteryears.

The last meeting of the WHO Director General with the Emergency Committee of International Health Regulations on international polio spread revealed key challenges to the anti-polio drive in Pakistan. Those challenges include complex circumstances of security, resistance from communities, lack of female anti-polio vaccinators, sub-optimal routine immunisation and disturbed healthcare services infrastructure. Within a four-month gap of such consecutive meetings from June 2022 to October 2022, 12 wild poliovirus-1 (WPV) cases were reported from Khyber-Pakhtunkhwa province which raised additional concerns amongst international healthcare authorities for such fast polio spread in Pakistan. Moreover, wide flooding is another hurdle faced by anti-polio workers in reaching remote places. Pakistan is one of the only two countries in the world where polio is still categorised as an endemic viral infection. Although cases of polio decreased from 147 in 2019 to 84 in 2020 and a remarkable reduction in polio cases was recorded in 2021, but 20 cases of polio so far in 2022 and recent 31 additional positive environmental samples of WPV1 spoiled all past endeavours of about 25 years to make Pakistan a polio-free country.

Over 40 million children receive polio vaccination in Pakistan during each national immunisation campaign and approximately 285,000 frontline workers are involved in this activity, but fake finger-marking of children without polio vaccination, refusal of caretakers for polio immunisation without valid reason, and vaccination boycotts cannot be ignored. The misconceptions — that polio immunisation is a foreign programme that can have negative effects on health, immunisation sterilises local population, polio vaccines are manufactured from pig fat or contain alcohol — keep adding fuel to the fire. Certain worth-mentioning steps are taken at provincial and federal levels for polio eradication like: the Government of Pakistan adopted a strategy to tackle the polio taboos by including community and religious leaders to work with them for polio eradication; and education and awareness programmes for parents and other caretakers for health, hygiene and immunisation of children are publicised by print and electronic media.

On 27^th January 2022, Pakistan marked one year without any new case of polio. The incredible determinations by polio vaccinators as well as related healthcare workers despite death threats and hurdles contributed foremost to the declining polio cases in Pakistan, but the recent upsurge in WPV-1 is bringing all their efforts to naught. Advices can be taken from international experts on global strategy alignment, and local polio leadership staff must be provided authority to collect feedbacks through strict surveillance and take part in the development of advanced strategies for polio-free country status. The safety of polio vaccinators and their reach to the remote areas for immunisation must be ensured by the government. The number of door-to-door polio vaccinators both male and female must be increased to cover all the areas of the country for immunisation. Also, the provincial security authorities must come forward to play their respective roles in monitoring the anti-polio drive and they must safeguard the rights of frontline immunisation workers in their areas. The data of unvaccinated children must be checked periodically to ensure that the vaccination goals of these anti-polio immunisation campaigns are properly met. Myths regarding polio vaccination must be addressed by the local heads of tribes in collaboration with the Government of Pakistan.

 

Published in The Express Tribune, November 14^th, 2022.

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