The unfortunate case of polio eradication in Pakistan
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Polio is a social and public health crisis. A few decades earlier, the virus was endemic in 125 countries across five continents, paralyzing 350,000 children every year.
The World Health Assembly launched the Global Polio Eradication Initiative in 1988, which resulted in the reduction of global annual incidences by 99 percent. By 1999, the virus was successfully eradicated from the world except for in Pakistan, Afghanistan, and Nigeria.
Due to their complex and ever-changing geopolitical landscapes, most cases in recent years have been reported primarily from Pakistan and Afghanistan.
Last year, 91 new cases of the polio virus were reported from various parts of the country, especially the provinces of Sindh and Khyber Pakhtunkhwa (KP)-- a sharp increase from the 12 cases reported in 2018. In addition, 11 new cases of vaccine-derived polio virus were reported from KP, Gilgit Baltistan and one case from Islamabad between July 7 and Nov. 3, 2019, whereas the last such case was reported in Pakistan in 2016.
Pakistan’s polio eradication program has come under scrutiny from all quarters due to its position as the main driver of the global polio virus spread in recent years. The problem is deeply rooted not only in organizational and financial deficits but also in the conflict and insecurity surrounding the program which has resulted in the failure of effective immunization campaigns and Supplementary Immunization Activities to reach all parts of the country.
Effective health communication strategies by engaging religious leaders and influential public figures can shift negative perceptions about the polio vaccine campaign, which took a huge blow after the CIA’s fake hepatitis B vaccination campaign in its bid to identify Osama bin Laden.
Dr. Mehreen Mujtaba
Despite the polio eradication program ongoing now for so many years in Pakistan, what are the major issues in the way? Among others, three main hurdles can be identified.
The first and foremost is vaccine hesitation. According to Dr. Fazal Ather, an expert working with the WHO, this is the most important reason underlying the failure of the program in Pakistan. He is of the opinion that vaccine hesitancy, if not addressed timely and effectively, can hamper the progress of the program and pose challenges to the completion of the disease’s eradication and elimination.
Other causes are security issues for polio workers and concerns regarding the efficacy and safety of vaccines. The problem is further compounded by negative socioeconomic conditions such as poverty, illiteracy and a weak health care system. With less than two percent of GNP spent on health care, and adequate service delivery systems and health care infrastructure are lacking in many parts of the country.
Lack of proper civic amenities in over-populated major cities like Lahore and Karachi present the risk of rapid faeco-oral spread, as has been seen with environmental samples collected from these cities after polio outbreaks.
In addition, the lack of transparency in governance juxtaposed with an under-resourced public health care system and an unregulated private health sector are further compounding the situation.
Vaccinator satisfaction and security have been major concerns-- due to the targeted killings of vaccinators as well as the lack of financial incentives, low salaries and lack or delay of payments. The result? The polio program has become politicized, leading to institutional malpractice, poor accountability, pilfering of resources and polio inspectors appointed on political grounds.
The dynamics of the polio program are multifaceted. The successful eradication of the disease has been hampered by conflicts and insecurity, especially in KP and FATA regions, where a dramatic rise in polio cases was seen in 2014 when the number of reported cases increased from 91 in 2013 to more than 300 in a mere year.
Along with this, concerted propaganda campaigns by militant outfits operating in these areas further damage the program.
The polio eradication campaign in Pakistan is facing a wide range of challenges due to poor health infrastructure, operational and managerial deficits and a myriad of security-related issues. The only will power needed is the commitment to the cause at all levels with over-arching government support. This can be achieved by strengthening Pakistan’s health infrastructure. Increasing the number of immunization centers in rural and far-flung areas is also crucial to effective service delivery.
Effective health communication strategies by engaging religious leaders and influential public figures can shift negative perceptions about the polio vaccine campaign, which took a huge blow after the CIA’s fake hepatitis B vaccination campaign in its bid to identify Osama bin Laden.
Global health initiatives are becoming intertwined with foreign policy and diplomacy of donor and recipient countries. Hence, the role of religious and social norms and their wider economic, security and diplomatic repercussions should not be underestimated in an era of globalization.
*Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health.
