Polio remains an endemic in Pakistan

COVID-19 or novel coronavirus, which emanated in Wuhan, China, in December 2019 has taken a huge toll of lives but the brave Chinese are trying their utmost to contain it. Unfortunately, some people afflicted by the virus, slipped through the cracks and the contagion has spread beyond China but has not become a pandemic yet. Sporadic cases have been reported in Pakistan too.

The World Health Organization (WHO) is taking a serious note of the epidemic and has raised the global virus risk for COVID-19 to maximum level. Pakistan, however, remains threatened by another health challenge, being one of the three remaining countries in the world where polio is still categorized as an endemic viral infection. The other two countries endangered by polio are Afghanistan and Nigeria. As of 11 February 2020, there have been 144 documented cases in 2019 and 12 cases so far in 2020. The total count of wild poliovirus cases in the country in 2018 was 12.

It is ironic that the polio immunization campaign in the country started way back in 1974, but serious efforts for the eradication of polio officially started in 1994. The infection remains endemic despite over 100 rounds of vaccination being carried out in the past decade. Pakistan had the world’s highest number of polio cases in 2014.

Despite serious efforts by WHO, United Nations Children’s Fund (UNICEF), CDC, Rotary International, and the Bill and Melinda Gates Foundation, who organized and developed fund intensive eradication campaigns, including door-to-door vaccinations, the endemic still persists, threatening the future of children in Pakistan. There are various reasons why anti-polio immunization campaigns failed in Pakistan. Let us briefly examine some of them.

Besides poor health infrastructure and government negligence, the biggest threat to health workers entrusted with the task of vaccinating young children against polio has been from militants especially in the tribal belt. Polio teams have been attacked and even killed by the terror mongers, which caused the polio eradication teams to abandon the immunization program or seek protection. Another factor has been disinformation. Some misled clerics spread rumours that polio inoculations cause impotency and future generations will cease to multiply.

Since the vaccines are primarily produced in western countries, militant groups like the Tehreek-e-Taliban Pakistan (TTP) propagandize that they are made out of pig fat or contain alcohol, both items being forbidden in Islam. Some clerics have also denounced the vaccines. In early 2012, it was reported that some parents refused to get their children vaccinated in Khyber Pakhtunkhwa and FATA on religious grounds but overall religious refusals in the rest of the country have “decreased manifold”.

One incident that badly affected polio eradication campaigns was the assassination of Al-Qaeda chief Osama bin Laden in 2011. The U.S. Central Intelligence Agency (CIA) employed the services of Pakistani doctor, Shakil Afridi, and local health officials to stage a fake vaccination campaign in an attempt to confirm Osama bin Laden’s location in Abbottabad. This subterfuge was organized in an effort to gain more knowledge on Bin Laden’s whereabouts prior to Operation Neptune Spear. While it is still unknown if Afridi was aware of the implications for his services in the campaign, the main goal of the CIA was to collect DNA samples of Osama bin Laden’s children from blood left on the needles used to deliver the Hepatitis B vaccination. The CIA’s fake vaccination campaign has had severe lasting effects on the North West region of Pakistan. Since 2012, at least 70 polio workers have been killed in Pakistan. Many of the attacks have been claimed by the Taliban who, quoting Dr. Shakil Afridi’s case, forward claims that the vaccination campaigns are a facade for intelligence gathering. The fake Hepatitis B campaign has caused people to question the motivations behind all vaccination campaigns, leading to a spike in poliomyelitis cases from 198 in 2011 to 306 cases in 2014. Many citizens of both the US and various other nations have criticized the CIA’s vaccination campaign for the effects that it has had on Pakistan’s public health.

The factors of malnutrition, lack of hygiene and sanitation, low parental — specifically, maternal — literacy and knowledge regarding vaccines and immunization schedules, poor socioeconomic status, and residence in rural areas all are attributable to decreased rates of immunization completion.

It is heartening that the first nationwide polio vaccination drive of 2020 commenced on 17 February, aiming to vaccinate approximately 39.6 million children. The campaign will involve nearly 265,000 polio workers going door-to-door to inoculate children under the age of five. A major aspect of the anti-polio immunization strategy is educating the semi-literate parents. Fatwas have been issued by religious leaders to have local mosques and community centers promote vaccination, emphasizing that the sanctity of life is foremost in Islam. The eradication of polio programme has also launched “Sehat Tahafuz Helpline 1166” with local language capacities through which the public can report children who have not been vaccinated due to any reason.

Let us hope that the campaign is successful and future generations are saved from the trauma of life-long paralysis.