Our polio failure

The continued transmission of the poliovirus in Pakistan has become a major public health problem, as it is one of only few remaining polio-endemic countries in the world along with Afghanistan.

Nigeria, a third polio-endemic country, has gone three years without a reported infection, placing it on track to be certified polio-free by 2020. On the other hand, unfortunately Pakistan is today reporting more cases than the past numbers of identified cases.

An analysis of data on confirmed polio cases in the last decade shows that the situation was relatively better after the launch of the World Polio Eradication Initiative in 1988 and shows a decrease of 70-75 percent in number of polio cases than before.

The situation was under control but the condition got worse in 2008, when the number of cases jumped from 32 in 2007 to 117 and after that there has been a continuous increase till now. Unicef Pakistan, in collaboration with the WHO and the Government of Pakistan, has taken the lead to implement and intensify communication and social mobilization interventions in the country to counter the threat Pakistan poses to the goal of polio eradication under the Global Polio Initiative.

The initiative is the multinational partnership between the WHO, the United States Centers for Disease Control and Prevention (CDC), Unicef, Rotary International and national governments. It aims to address polio-affected countries to undertake all eradication activities with major strategic planning, coordination and data collection carried out by the WHO.

Many factors are attributed to the persisting situation of polio in Pakistan. Insufficient EPI coverage, reduction in vaccination campaigns and influx of population from areas with low immunity underlie this resurgence of the disease. Unmonitored cross-border movement between Afghanistan and Pakistan is also considered a major cause.

The worst outbreak of polio in Pakistan occurred in 2014, when 2020 victims of the disease were identified. The government alleged free movement of residents of both endemic countries responsible for the increase of the disease. Moreover, the Taliban declaring the polio vaccination as a Western agenda, prohibiting it and attacking vaccination teams’ further worsened the situation. Though making a fence along the border of Pakistan and Afghanistan in 2017 is a political agenda, at the same time the government also claimed it as a preventive measure to gain the objective of limiting free cross-border movement – hence avoiding the spread of the disease. Conspiracy theories that consider polio vaccines as a Western agenda also persist in communities, leading to refusal of receiving vaccination in varying intensity all over the country. High refusal rates are observed in Khyber Pakhtunkhwa and Balochistan.

Failure to eradicate polio is a symptom of system-wide weakness of management. It shows that, despite providing financial resources, failure may occur at any of the multiple levels of authority to direct staff and achieve results. It seems that a wide range – from deficiency of capacities in public staff to lack of political commitment with low coverage in the media are eluding the efforts.

The recent outbreak of dengue fever also reflects the same level of effort and interest at different points. These frequent occurrences show a desperate need to address the endemics on an emergency basis, otherwise they may worsen if appropriate measures are not adopted. Reviewing the past reports, surveys or researches, it is clearly shown that either information triggers were not activated or because of some political issues or low response by the government, many cases are coming to the surface now.

In order to eradicate the disease completely, there is a need for evidence-based and planned communication strategies – including efforts like sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy which should be focused to make the country polio free.

Strategies are required to overcome gender barriers and resistance of vaccination and special initiatives to reach out to marginalized communities. At the same time, increasing accountability of health authorities is also likely to provide positive gains. And these efforts should be continued and sustained even if zero cases are achieved.

Polio is a highly infectious, disabling and potentially deadly disease. The medium to spread is the poliomyelitis virus in areas with poor hygiene and sanitation. It occurs through contaminated food and water. In order to fight with the disease, there are only preventive interventions with immunization at an early age and no curative measures.

It mainly impacts young children and can disable them for their whole lives. Pakistan, one of the only two countries left with the disease should have top priority to combat the disease for a healthy population in the future.

The writer is a public health consultant.

Email: fauziawaqar_28@hotmail.com