2014 darkest year in terms of polio eradication

ISLAMABAD: The year 2014 was one of the darkest years in terms of polio eradication in Pakistan with around 300 polio cases, highest in last 16 years, and killing of dozens of polio workers across the country but the government is hopeful that its National Action Plan against terrorism would also help the country in defeating polio.
Also in 2014, the World Health Organisation (WHO) declared it mandatory for Pakistanis travelling abroad to receive at least one dose of anti-polio vaccine, since the country was accused of exporting the virus to other regions. According to the UN health body, Pakistan accounts for 94% of the world polio cases while the country has recorded a 300 percent increase in these cases during 2014 from 93 to 295 so far while hundreds of samples are still being tested in National Institute of Health (NIH). Nigeria and Afghanistan are the only two other countries with endemic polio but both have recorded decrease in polio cases in 2014. Nigeria recorded 450% decrease in polio cases last year as the number went down from 50 to 12.
Pakistani health official claims that polio has largely become a security related issue as 85 percent of the polio cases have been reported from security compromised areas where vaccination teams cannot immunise the children owing to fear of attacks. According to official figures 74 polio workers have been killed so far in Pakistan since 2012.
An official working with polio eradication programme said it was a massive communication failure on the part of the authorities as around 50,000 families have refused to vaccinate their children against polio owing to doubts about the programme despite huge media campaign by the government and Unicef. He said 50,000 is recorded figure of refusal cases while rough estimates suggest that over 150,000 families have refused polio vaccination, but the polio teams are reluctant to record these refusal cases as it would indicate their power performance.“It is a communication failure as almost all segments of society have doubts or concerns about polio vaccine,” said a top official with polio eradication programme requesting anonymity.
He said upper class has doubts about polio workers’ hygiene and quality of the vaccine so they may opt for private vaccination. The middle class is angry with government’s lack of focus on development and other health needs of people so they doubt why polio is given priority, he said adding that lower class think polio vaccine is a conspiracy against Muslims hatched by West to reduce the population of Muslims. They also cite the example of Central Intelligence Agency (CIA) spy Shakeel Afridi who used a fake polio campaign to trace Osama Bin Laden in Abbotabad.
The official said the authorities have failed to devise an effective communication strategy to convince all three segments of society about the need, utility and efficacy of polio vaccine.“Ulema have been used on TV advertisements to support polio vaccination, but a large number of people who refuse polio vaccine on religious grounds do not watch TV at all. There is a need of localized communication strategies with cultural consideration of each area to effectively eliminate doubts about polio programme,” the official said.
He said Unicef is brining foreign communication experts to devise communication plan for the rural areas of Pakistan, but these experts are not aware of indigenous culture.However, when contacted by The News, the head of Prime Minister’s Polio Monitoring and Coordination Cell, Ayesha Farooq, said the government has re-devised its strategy against polio which will show results in next few months.
She said the Prime Minister Nawaz Sharif has expressed personal resolve to eliminate polio from the country and drastic measures have been taken during last few months in this regard.She said 85 percent cases of polio have been recorded in security compromised areas of Waziristan, Khyber Agency, Peshawar and Karachi.
“As many as 241 polio cases (81.7 percent) were reported this year from Khyber Pakhtunkhwa and Fata which indicates a direct correlation between incidence of polio cases and access issues due to security,” she said.
Ayesha Farooq, who is also the legislator of ruling Pakistan Muslim League (Nawaz), said innovative measures have been taken by the government with the involvements of provinces.“Routine immunisation will also be increased as a part of new strategy. Media is being used to spread the message, and the help of parliamentarians and civil society is being sought for this national cause,” she said.
“During 2014, a total of 17 National, Sub-National and short interval polio campaigns were conducted to immunize the target population of 34.6 million children below five years of age for each national campaign,” she added.
The official figures show that on an average 92 percent of the total target population were reached during these campaigns. In addition more than 16 million children travelling within and from outside the country were vaccinated through Permanent Transit Posts (PTPs) working in multiple shifts throughout the country at key points during the year. At present only wild polio virus Type 1 is circulating in Pakistan while Type 2 was eradicated several years ago and no case of Type 3 virus has been reported from anywhere in the country since April 2012.
The most recent official data puts the total number of confirmed polio cases at 295 in 2014 with 174 cases reported from Fata, 67 from Khyber Pakhtunkhwa, 29 from Sindh, 22 from Balochistan and 03 from Punjab.
Also important to note is that of the 73 wild poliovirus cases in Khyber Agency, 59 are from Tehsil Bara, 12 from Jamrud and two from Tirah. Also, all wild polio cases except one from Khyber Agency this year have been reported from May onwards. Furthermore, vaccination activities have been considerably inconsistent in Bara Tehsil of Khyber Agency since June 2009, missing a significant number of children.
All except 10 polio cases reported from North and South Waziristan agencies in 2014 did not receive any dose of oral polio vaccine (OPV). It is important to mention that no supplementary immunisation activities have been conducted in North and most of South Waziristan agencies since June 2012, leading to an ongoing explosive polio outbreak with 37 wild polio cases in 2013 and 93 so far in 2014.
The district of Peshawar has reported 29 wild poliovirus cases in 2014 so far. The reintroduction of wild polio virus with the identification of polio cases from the districts of Swat, Kohat, Naseerabad, Pishin and Larkana is a concern which also reinforces the fact that the presence of polio virus anywhere is a threat everywhere.
Of all the polio affected children in 2014 as many as 92 percent came from families that speak Pashto and more than 84 percent children are below the age of 2 years. It would also be important to add here that 85 percent of the polio cases this year are from insecure and security compromised areas and 86 percent of the children did not receive any routine dose while 64 percent did not receive any routine and Polio campaign dose.
Ninety-nine percent of parents across Pakistan come forward and vaccinate their children every time Polio vaccine is offered while the refusals, which are below 1 percent of the target population, are based on repeated campaign, religious belief or other misconceptions. According to experts the current low transmission season is critical to fighting polio as the virus is less active and its transmission can be stopped through repeated high quality campaigns.