Why Pakistan has been unable to immunise its population against polio

HIMANI CHANDNA 

Pakistan saw 69 new cases of polio until September. It is one of the 3 remaining nations, including Afghanistan and Nigeria, where polio is still endemic.

Pakistan’s battle against the deadly poliovirus seems to have hit a roadblock, with the nation reporting 69 new cases until September this year. It is one of the three remaining countries, including Afghanistan and Nigeria, where polio is still endemic.

Pakistan’s attempts to stamp out the crippling disease, however, has many obstacles — public ignorance, myths about a Western plot to sterilise Muslims, attacks on health workers and resistance from parents to getting their children vaccinated.

Rise of the viral infection this year was seen even as the country’s anti-polio campaign had neared its goal of total eradication in 2018. A World Health Organization (WHO) report published last week said the increase in polio cases in Pakistan has been monumental — there were only 12 reported incidents in 2018.

“This was a golden opportunity for Pakistan to achieve its long sought-after goal of interrupting poliovirus transmission. The increase in cases in 2019 shows that the momentum and opportunity created at that time has now been lost,” WHO’s technical advisory group had said in August, after concluding a meeting on polio eradication in Pakistan.

The Independent Monitoring Board (IMB), which oversees global polio eradication efforts, had similarly declared Pakistan’s efforts at eliminating the disease a “disaster”. In its 2018 report titled ‘How to cut a long story short’, the body had remarked, “Some would say that the Pakistan Polio Programme is fooling itself into thinking that it has made any progress at all since 2017.”

The Bill and Melinda Gates Foundation, one of Pakistan’s international polio eradication partners along with WHO, Rotary International and UNICEF, had stated that the nation accounts for 80 per cent of global wild polio cases.

Sterilisation bid, cover for spies

Sample this data by the IMB. There was an increase of only one polio case in 2018 compared to 2017 but more sites across the country were found to have been contaminated by the deadly virus. The agency had also noted an increase in vaccine-derived poliovirus cases — 75 till October 2018 from 63 in 2017.

It further said rumours and anti-polio sentiments had turned people against polio vaccines in Pakistan. There were rumours circulated of the vaccine being “harmful to children”.

“Frontline workers, especially females, are often harassed and abused within communities in Pakistan,” the report said.

Coupled with this were also fears of fake vaccination drives, with radical Islamists believing them to be part of a Western plot of sterilising Muslims. There are also fears of the campaign being a cover for spies to catch militants.

People still recall the Abbottabad incident in 2011, when a Pakistan doctor had visited homes for a fake vaccination drive as part of the US intelligence effort to locate Al-Qaeda leader Osama bin Laden. The incident is alive in the memory of parents who often find excuses to avoid vaccinations.

“This one time, I kept going back to a woman’s house to convince her. Every time she said the drops gave her grandson a stomach ache. After a month, I gave up,” a public health was quoted saying.

Political, administrative reasons

IMB had also expressed concern that the Pakistani leadership wasn’t “listening to people on the ground who are best informed by local realities”. Not surprisingly then that the agency’s report also notes how elections in the neighbouring country jeopardise its efforts at eradication.

Another report states that “in 2013, when Pakistan went to the ballot, the tally of polio cases was 93. The next year, these shot up to 306. Then again, the year of the 2018 elections, a total of 12 cases were reported from across the country. Now, the newly-elected Pakistan Tehreek-e-Insaf (PTI) government is grappling with 69 cases.”

IMB terms “delays, rejections of travel authorisations and visas” as another big hindrance to Pakistan’s polio eradication movement. Similar concerns were voiced by the WHO too which said that the positive environmental samples were symptoms of a programme in crisis.

“There are serious problems in coordination and implementation and to-date unresolved issues with campaign quality, monitoring, accountability and community engagement.”

Areas affected by poliovirus

As many as 13 WPV1-positive environmental samples were reported — one each from the districts of Dadu, Karachi Orangi, Hyderabad, Karachi Baldia and Karachi Saddar and two each in Sukkur and Karachi Gadap districts, Sindh province.

“One sample was also reported in Quetta district, Balochistan province, one in DG Khan and two in Lahore, Punjab Province.”

According to the IMB study, the country’s southern and northern corridors continue to display strains of the virus on both sides of the border. Outside these corridors, the virus continues to circulate in central Pakistan (eastern Balochistan, northern Sindh and southern Punjab). There is also intense circulation of the deadly virus within and surrounding the core reservoir of Karachi.“No claim can credibly be made that the Polio Programme is firmly on track to interrupt transmission… The poliovirus is seen in the same reservoirs over and over again,” IMB had said last October.