Elusive Polio Eradication

Elusive Polio Eradication

By Fayyaz Ahmad Khan
Monday, April 29, 2013 
Published in Daily News

The eradication of polio from Pakistan, which seemed a possibility eight years ago, is looking increasingly difficult with each passing day. The worsening security situation and recent attacks on vaccination teams notwithstanding, the failure to eradicate the poliovirus from the country has many policy and political dynamics.

Public health experts throughout the country had been warning about the dangers associated with a single-disease-focused approach towards fighting polio. The results of not paying heed to such voices have been devastating.

While polio remains a challenge, thousands of Pakistani children are exposed to five equally deadly infections including measles which has already claimed over 400 lives in the last few months. Our children could have been safer had Pakistan’s routine immunisation programmes had not been compromised.

Close to 80 percent of Pakistani children used to be fully vaccinated from six infectious diseases ten years ago. The immunisation programme in Pakistan, despite its challenges, was among the most organised in the country. The routine vaccination drives were part of daily life and parents would work with local vaccinators to ensure that their children were given all vaccines to be safe from deadly infections.

The situation changed when the government decided to declare a war on polio. Having successfully eradicated smallpox decades ago, Pakistani health authorities were confident about ending polio. The nature of the poliovirus fits into the parameters of eradicable disease and hence starting special immunisation campaigns made good sense.

The results of earlier polio campaigns were encouraging. From around 25,000 reported polio cases in 1994 when the campaign was formally started, the figure dropped to less than a hundred in 2002 and then to just 28 in 2005. This convinced the authorities that Pakistan was at the brink of eradicating polio and hence more resources were pumped into the system to reach the desired goal.

However, it soon emerged that the zeal to get rid of the poliovirus had badly affected the routine immunisation programme of the country. Repeated polio campaigns (at least four every year) were pumping in monetary incentives for health workers that trigged corruption at all levels. Each campaign would cost 8-10 days of district and field health workers during which all community health initiatives would come to a grinding halt.

Any reported polio case would be accounted for at the highest levels, making the district health authorities paranoid about a single disease. The fatigued workers would hardly feel motivated to work for routine immunisation, which by the mid-2000s was pushed to the backburner at every level. The percentage of children fully vaccinated against the six diseases dropped to just 47 percent in 2006 as reported by the Pakistan Demographic and Health Survey (2006-7).

Repeated campaigns also attracted the attention of conservative elements who got suspicious at the zeal of donor agencies in fighting only one disease while children remained vulnerable to many others equally deadly viruses.

The religious lobby, terming the polio eradication drive yet another design to render Muslim population infertile, launched a vicious propaganda campaign. In 2008 the number of reported polio cases rose to 117 and the figure jumped to 198 in 2011 — shattering the dream of making Pakistan polio-free.

Dr Shoaib Khan, who has supervised scores of polio campaigns as district health officer in Rawalpindi many years ago, says “Until and unless we improve routine immunisation programme, we cannot eradicate polio even in the next 100 years”.

Dr Khan has also highlighted the need for universal birth registration in Pakistan and for working with health authorities in Afghanistan since without ending polio in the neighbouring country its eradication in Pakistan is difficult owing to our porous borders. Another key step according to Dr Khan was vaccine safety.

With all other factors constant, 35 percent of the polio victims in 2012 had received more than seven doses of vaccine. This requires immediate attention to the quality as well as management of the cold chain. When a vaccinated child is hit by polio, the entire neighbourhood loses trust in the vaccine, says Dr Khan.

Polio eradication campaigns suffered a further setback in 2012 when vaccinators and volunteers were attacked by militants in Karachi, Punjab and Khyber Pakhtunkhwa.

The government has finally vowed to strengthen routine immunisation and combine polio vaccination with other mother-and-child health initiatives to ensure that Pakistani children were safe from polio as well as other deadly infections.

The saga of polio eradication in Pakistan has had mixed results. Millions of children who received polio drops during the last 20 years and can walk on their feet today thank the efforts of thousands of health workers who have been carrying out polio eradication campaigns. Scores of others, however, may still wish that the polio campaigns had not paralysed other primary health initiatives by taking the focus away from them. An integrated immunisation strategy could have saved millions more in Pakistan.