Polio case count touches 53

Islamabad : With 18 districts infected with wild poliovirus, Pakistan’s national polio count touched 53 here on Wednesday with the confirmation of five new cases. A total of 30 boys and 23 girls have been crippled by polio so far this year as the ominous virus comfortably retaliates to undo the gains of yesteryears—gains achieved through decades of hard work, injection of mammoth human and financial resources, and the sacrifices of over 60 martyred workers and security personnel deputed on polio vaccination duties.

The five new cases include a 22 year-old girl from Charsadda; a 3 year-old boy and two girls aged 30 months and 7 months respectively, from Bannu; and a 2 year-old boy from North Waziristan.

Where exactly is Pakistan heading in its fight against polio? Eradication data of the last five years is an eye-opener; Pakistan closed 2014 with 306 cases, which declined to 54 in 2015 when the National Emergency Operation Center (NEOC) for Polio Eradication was established. Thereafter, the country reported 20 cases in 2016, eight in 2017, and 12 cases in 2018. This year, 53 cases have already been reported, and as the virus transcends the traditional hotspots, projections for the future are nothing but intimidating.

‘The News’ spoke to several polio officials to seek their views. “The EOC in KPK has engulfed the Expanded Programme on Immunization (EPI). This is not healthy; EOCs are emergency settings while programmes are here to stay and should hence be further strengthened,” a senior official who has remained associated with the polio programme in the past stated, adding, “There is too much donor money involved in polio eradication and it is time that the focal persons of EOCs and of the Bill and Melinda Gates Foundation are either held accountable or are shown the door.”

When asked whether it is the new government that is responsible for the current mess, the official said, “I don’t think the government has messed up. Case are cases, and with genetic linkages, they know exactly where cases have been lurking and for how long.” Commenting on recent accusations of data having been fudged in the past, missed cases not having been reported, and finger-markings having been done without administration of polio drops, he said, “You never know but whatever the case, facts need to come out.” Asked if there are any chances of cases declining in 2020, he said, “One can only hope, but with wild poliovirus still around, you cannot be predictive.”

A senior international staff member who has previously worked on polio eradication in Pakistan believes that the reasons for rapid deterioration are being wrongly linked to data issues. “There may be challenges vis-a-vis reporting refusals and silent community resistance. Nevertheless, highest standards have been maintained in surveillance, both for AFP cases as well as sewage sampling. Low case counts in 2017-18, low proportions of positive sewage samples, and shrinking genetic diversity of the identified viruses tell that interventions during this time were delivering results.”

A local polio official associated with the programme believes that the actual problems are being overlooked. “With around 20,000 newborn children every day, herd immunity gets quickly diluted even with one bad campaign. Remember the virus gets 700,000 new guts anyway (within a 5-week interval between door-to-door campaigns) where it can proliferate if not readily protected through high-quality campaigns as well as good routine immunisation coverage, which also continues to be a major reason for persistent immunity gap,” he stated.

Another official stated that in addition to restoring community trust, an equal amount of effort is required to revive the confidence of frontline workers. “They need space to report issues to the senior management, rather than covering up for fear of being reprimanded,” he stated. It is also essential, that the polio predicament be overcome with a sense of collective responsibility, rather than throwing the blame on each other.