Long road ahead

With recent unprecedented gains in Pakistan’s fight against polio, there is cause for cautious optimism. A report in this newspaper highlighted that Pakistan has not reported a single case of the wild poliovirus in the past six months, whereas there has been a substantial decline in positive environment samples as well as the geographic distribution of the virus. So far, only one WPV type 1 case has been reported in the country this year – in Balochistan – as opposed to 84 cases in 2020 and 147 a year before. Similarly, cases of the circulating vaccine-derived poliovirus type 2 stand at eight this year whereas the figure was 135 in 2020 and 22 in 2019. This is a much-welcome development, especially since routine immunisation campaigns were shelved for several months last year following the coronavirus outbreak, in line with recommendations of global health agencies. Nevertheless, we are back on track. Up till June this year, three nationwide polio vaccination campaigns have been held to inoculate 33 million children under the age of five with the participation of over 200,000 health workers and social mobilisers – an enormous challenge as it is but made more severe due to the coronavirus pandemic. Moreover, this month, the UAE government provided Pakistan $23 million for its polio campaigns, along with around $376,000 for personal protective equipment to safeguard health workers from the coronavirus.

Yet, despite the promising signs, several pressing challenges remain. The country has witnessed drops in cases earlier, only to see a resurgence later. In order to build on the recent gains, the government needs to fully implement recommendations made by the Polio Oversight Board of the Global Polio Eradication Initiative in June this year, such as strengthening government leadership of the polio eradication programme, ensuring regular engagement at the National Emergency Operations Centre for Polio Eradication, and taking part in review meetings with provinces following supplementary immunisation activities. The board stressed further that the leadership, drive, and use of real-time data witnessed in the country’s efficient response to the coronavirus pandemic, must be replicated. With the country’s civil-military leadership spearheading anti-polio efforts, it is hoped that the board’s advice will be heeded across the board. Similarly, serious field obstacles such as missed children, family refusals, and pervasive anti-vaccine propaganda have to be overcome to reach an acceptable level of immunisation. It is vital that people refusing vaccines or doubting the disease’s dangers be made aware of its consequences in a language they understand and from a person they trust. Then, there is the grave issue of security. In the year’s first polio vaccination drive in January, a police official guarding a vaccination team in Karak – an area that recorded 15 of the 22 cases in Khyber Pakhtunkhwa in 2020 – was killed by unidentified attackers, whereas two policemen were killed in similar circumstances in Mardan district of the province last month. The state must prioritise going after the perpetrators of these attacks so that healthcare workers can reach every corner of the country without fear.

With the rest of the world having eliminated the wild poliovirus – Nigeria was the last country to do so in 2020 after accounting for around half of global cases a decade ago – it is now found only in Pakistan and Afghanistan. Sustained national immunisation drives and effective virus surveillance in the neighbouring countries, along with substantial improvements in provision of clean drinking water and sanitation services, are essential if the region is to be free of polio. Until then, the whole world is at risk and hence must continue assisting the two countries’ polio eradication efforts.