WHO, Pakistani officials cite ‘immunity gap’ as key factor behind surge in polio cases

This photograph taken on October 5, 2024 shows health workers walking during a door-to-door poliovirus vaccination campaign for children on the outskirts of Peshawar. (AFP/File)
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Updated 19 November 2024
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WHO, Pakistani officials cite ‘immunity gap’ as key factor behind surge in polio cases

  • WHO official says resurgence developed over time due to ‘compromised campaign quality’
  • Pakistan has reported 49 cases this year, mostly from Balochistan and Khyber Pakhtunkhwa

ISLAMABAD, PESHAWAR, KARACHI: The World Health Organization (WHO) and Pakistani officials have identified “immunity gap” as a key factor behind the resurgence of polio in the country, as Pakistan on Friday reported its 49th case this year from the southwestern Balochistan province.

Polio is a highly contagious disease that can cause irreversible paralysis, particularly in young children, and remains incurable, posing a persistent threat as long as the virus is not eradicated.

Most cases in Pakistan have emerged from the conflict-hit Khyber Pakhtunkhwa and Balochistan provinces. Along with neighboring Afghanistan, Pakistan remains one of the last two countries in the world where polio is endemic. After significant progress in reducing cases, Pakistan has seen a resurgence since late 2018, underscoring the fragility of earlier gains.

Health officials explain that an “immunity gap” occurs when a large segment of the population lacks sufficient resistance to the poliovirus, leaving communities vulnerable to infection and outbreaks despite immunization efforts.

“The ongoing transmission and resurgence of the poliovirus was largely attributed to a widespread immunity gap that has developed over time,” WHO told Arab News.

The global health body attributed this “to a compromised campaign quality because of security-related challenges, community resistance, boycotts and demands of local communities, suboptimal routine immunization coverage and internal displacement of mobile and migrant populations.”

It added that high-quality vaccination campaigns were needed to bridge the immunity gap, highlighting that the WHO had organized back-to-back large-scale campaigns in September and October that vaccinated around 45 million children.

“These will follow another campaign in December to effectively plug the immunity gap,” the WHO said. “The mobile and migrant populations were redefined and mapped with revitalized focus on their vaccination.”

Health officials from the restive Khyber Pakhtunkhwa and Balochistan provinces also echoed the same concerns, saying that immunity gaps played a major role in the resurgence of poliovirus.

KP’s Special Health Secretary Abdul Basit said the provincial government was undertaking efforts to “plug remaining immunity gaps” from the region by ensuring timely immunization of children.

A tribal elder from South Waziristan, Malik Anwar Wazir, told Arab News the increasing number of polio cases raised question about the government’s polio eradication efforts.

He termed the decades of infighting and unrest in parts of KP and tribal areas responsible for “inconsistent health care initiatives.”

“Mass exodus or displacement of families because of militancy hinder vaccination drives,” he added. “Most of the families in the tribal belt and parts of KP move for safer areas due to constant war, which creates problems for full immunization dose.”

Dr. Aftab Kakar, a health official in Balochistan, said international donors funding Pakistan’s polio eradication program had expressed concerns and given the authorities in the province new targets to prevent poliovirus transmission by June 2025.

“After being declared a polio-free province for almost years, we received the first transmission of poliovirus from Kandahar [Afghanistan] in September 2023,” he said. “If our children were immunized and well nourished, the virus would not have survived and spread all over the province.”

This year, 24 polio cases have been reported in Balochistan, 13 in Sindh, 10 in Khyber Pakhtunkhwa and one each in Punjab and the federal capital, Islamabad. In the early 1990s, Pakistan recorded approximately 20,000 cases annually, but the number dropped to eight in 2018, six in 2023 and only one in 2021.

Pakistan’s polio eradication program, launched in 1994, has significantly reduced the number of cases over the years. However, the country continues to face major challenges, including militancy, with polio workers frequently targeted in attacks, particularly in the northwestern Khyber Pakhtunkhwa province.

The program has adapted to address climate disasters, such as floods, but continues to experience disruptions. Additionally, there are gaps in supplementary immunization activities, particularly in areas where the virus remains active.


In Pakistan’s Bannu, people start their day with a sugar rush

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In Pakistan’s Bannu, people start their day with a sugar rush

  • While much of Pakistan favors savory breakfasts, residents of Bannu prefer a sweet, caramelized halwa
  • People line up before sunrise at the decades-old Speen Sar restaurant to cherish its signature dish

BANNU, Pakistan: Before sunrise, the narrow lane outside Speen Sar, a modest restaurant, fills with customers waiting for halwa, a dense sweet made from wheat starch, sugar and clarified butter, that serves as breakfast for many people in this northwestern city.

Inside the restaurant’s kitchen, the morning air is thick with the scent of caramelized sugar and heated ghee. A chef leans over a large metal vat, dissolving sugar into the hot fat before adding a slurry of flour and water. With rhythmic, heavy strokes, he stirs the mixture until it thickens into a glossy halwa.

He pours the sweet onto a tray and rushes toward the counter, where a crowd of patrons has already gathered. Three cooks work in quick succession to keep pace with demand, turning out batch after batch during the breakfast rush in Bannu, a city in Pakistan’s Khyber Pakhtunkhwa province.

While halwa is widely eaten as a dessert or festival sweet across South and Central Asia and the Middle East, Bannu stands apart for turning it into a morning staple. Across most of Pakistan, breakfast tends to be savory, typically consisting of omelets, parathas or puris, and in some places nihari, a slow-cooked meat stew. Here, however, halwa is not a side dish but the meal itself, eaten plain or with bread before the workday begins.

“We open the shop at the time of morning prayer, and after prayer, we start preparing,” says Zahid Khan, whose grandfather Akbar Ghulam opened the restaurant over six decades ago.

The shop’s name, Speen Sar — Pashto for “white-haired man” — dates back to its earliest days. Khan said the business began as a small stall run by his grandfather. As he grew older and his hair turned white, customers began directing others to the “speen sar” shop, the place where the white-haired man sold halwa. The nickname endured, eventually becoming the shop’s official identity.

Speen Sar relies on a labor-intensive process of extracting starch from wheat flour.

“In our halwa, we use ghee, sugar, flour and other ingredients. From the flour, the starch that comes out is what we use to make the halwa,” Khan explained before examining the cooking process in his kitchen.

Bannu sits at the crossroads between Pakistan’s former tribal areas and the settled plains of the northwest, and the halwa shop serves as a rare social equalizer, drawing laborers, traders, students and travelers to the same counter each morning. For many passing through the city, stopping for halwa is not optional.

“Whenever I come from Waziristan ... the first thing I do is start with halwa,” says Irafullah Mehsud, an expatriate worker. “I eat the halwa first, and only then move on to other things.”

The popularity of the dish is partly due to its shelf life and to what the owners call good quality. At Rs500 ($1.80) per kilogram, it is an affordable luxury as well.

“Our halwa is widely consumed with breakfast, and it does not spoil quickly. If you want, that you will eat it tomorrow, you can even set some aside for the next day,” Khan said, pointing to a tray of nishasta halwa, a variety made by extracting wheat starch before cooking.

While the region offers variations including sohan halwa, milk-based recipes, and carrot-infused batches, this halwa offered by Speen Sar remains the undisputed king of the breakfast table in this city.

“This is a tradition of the people of Bannu. Early in the morning, everyone eats it and comes here,” says Razaullah Khan, a student at a local college. “Eating halwa is a common practice here ... but this one is the most popular. People eat it for breakfast.”

For the elders of the city, the habit is as much about routine as it is about flavor.

“This tradition has been going on for the past forty to fifty years ever since I can remember,” says Sakhi Marjan, a local elder in his late sixties. “We first come to the Azad Mandi market and then come here to eat halwa. We really enjoy this halwa. It is delicious.”

As the sun rises over Bannu, this ‘sweet’ trade shows no sign of slowing. For those like Gul Sher, a regular from Jani Khel, a town in a neighboring tribal district, a day without the local sweet is a day started wrong.

“As soon as I step into Bannu, I start my day with halwa. After that, the rest of the day goes well,” Sher said before finishing his plate of halwa.

“It is a sweet dish, and it makes the day better. It is a good thing.”