Pakistan’s polio struggle

According to the Global Polio Eradication Initiative, after more than 43 million children in Pakistan were vaccinated against polio in 2022, the country achieved the historic milestone of being declared polio-free on January 27, 2022.

Unfortunately, on April 23 the same year, Pakistan reported its first case of polio after being rid of it for 15 months straight and the second nationwide Polio Campaign of 2022 was initiated by the then prime minister. In November (2022), a suicide bombing targeted a police van in Quetta, protecting polio workers. The attack killed three and injured 27 people.

As of June 28, 2024, it was reported by the Pakistan Polio Eradication Programme that the number of polio cases in the country has risen to.

While many countries have successfully eradicated polio, as the high-spread season approaches in Pakistan, a burning question remains in the minds of many: why, despite tireless and widespread polio drives by dedicated workers across the country, has polio returned?

For those wondering what exactly the polio virus is and how such a tiny organism can paralyze a person, it belongs to the picornavirus family, consisting of a protein coat and an RNA genome.

The polio virus targets the brain stem or spinal cord, triggering paralysis once it spreads to the Central Nervous System (CNS). As the virus destroys motor neurons (nerve cells), skeletal muscles lose their ability to respond. This loss of mobility due to lack of innervation leads to a condition known as acute flaccid paralysis (AFP).

Usually, polio affects the leg muscles of the patient rather than the arm muscles, though extensive cases have also been recorded where quadriplegic effects were noticed, meaning that patients were found paralyzed neck down.

In extremely severe cases, also known as bulbar polio, the virus infects the brain stem of the human body, causing difficulty in swallowing, speaking and even breathing. As the body slowly gives up on providing respiratory support, bulbar polio can also result in death.

Pakistan has combated the polio virus with its efficient polio eradication initiatives and campaigns, having polio workers go door-to-door to vaccinate children.

Up until 2005, efforts to combat polio in Pakistan were progressing smoothly, and hopes for eradicating the disease were high. However, the onset of US drone attacks in Fata changed the situation. Military action against these strikes, including the killing of TTP leader Baitullah Mehsud in a 2005 strike on South Waziristan, and a sharp rise in attacks – peaking in 2010 with 122 strikes – made it extremely difficult for polio workers to access these areas for their campaigns.

Mistrust in polio vaccination efforts also grew after a fake vaccination campaign, staged with the help of Dr Shakil Afridi, was used to gather intelligence on Osama bin Laden’s location. This faux campaign caused severe outrage in many areas of northwest Afghan border, leading to the deaths of more than 200 polio workers.

As myths and doubts spread among the Pakistani population in response to these events, they eventually hardened into strong beliefs, fueling fear and refusal to vaccinate children against polio.

One of the myths surrounding the polio vaccine is that is it now allowed in Islam. To counter this, the Pakistan Polio Eradication Programme has stated that: The “Oral polio vaccine (OPV) is safe and has been declared halal by Islamic leaders all over the world – the Grand Sheik Tantawi of Al-Azhar University, the Grand Mufti of Saudi Arabia and the Majelis Council of Ulemmas in Indonesia as well as muftis from all sects in all provinces of Pakistan.”

Another myth is that the vaccines affects the fertility of a person. To counter this, a test conducted by the National Control Laboratory for Biologicals, which was regulated by the Drug Regulatory Authority of Pakistan (DRAP) in 2015, assured that the polio vaccine being used in Pakistan does not contain any hormones or chemicals that may affect the fertility or health of a person.

Unfortunately, despite rigorous efforts, local media sources recently reported that over 215,119 cases of refusal occurred in contrast to the 154,736 parents who agreed to vaccinate their children.

In recent updates, the Pakistan Polio Eradication Programme launched its latest house-to-house initiative in July, aiming to vaccinate over 9.5 million children. The campaign covers five districts in Punjab and Islamabad, eight districts in Sindh, 11 districts in Khyber Pakhtunkhwa, and 16 districts in Balochistan.

Given the complex history surrounding polio vaccinations and the persistence of myths and assumptions that have solidified into deep-rooted beliefs, it is time to couple vaccination drives with awareness campaigns. These efforts should target those who lack access to accurate information or have been swayed by misinformation, providing them with reassurance and understanding.

While the world commends Pakistan’s efforts to eradicate polio, without the discussion and implementation of new ideas and approaches, one can only hope Pakistan will not continue to be one of the last two countries where polio still poses a serious threat.

The writer is a sub-editor at Geo.tv, as well as an aspiring medical journalist and science enthusiast.