The polio battle

After 54 cases of the Wild Polio Virus 1 (WPV1) in 2015, the number of polio cases had started declining in Pakistan – thanks to the efforts of the National Emergency Operation Center (NEOC) and by the end of December 2018, only 12 cases had been reported from all of Pakistan.

In October 2018, the prime minister not only appointed one of the party’s “communications and advocacy specialists” as his focal person for polio eradication but is also alleged to have sidelined Dr Rana Muhammad Safdar, considered a ‘champion’ by international donor agencies.

The hope was that the new team would be able to get rid of the polio virus from Pakistan once and for all. However, by November 2019, The Guardian accused Pakistan of covering up an outbreak of P2 strain of polio, 22 cases of which were reported in the country while cases of WPV1 jumped to 147 from 18 in the previous year.

Officials associated with the Polio Eradication Initiative in Pakistan as well as abroad believe that the year 2019 proved to be a disaster for polio eradication efforts in Pakistan. Pakistan had the last successful campaign in February 2019 and after that the entire technical team of the polio eradication initiative in Pakistan was replaced. In April 2019, the infamous Peshawar Drama came to surface, when a social media video was prepared and circulated against the Oral Polio Vaccine. It proved to be the last straw and within weeks, people started to refuse to get their children vaccinated against polio. By the time, the previous team was restored at the NEOC in December 2019, WPV1 cases had jumped to 147 in 2019 from 12 in the previous year.

The year 2019 was so disastrous for polio eradication that between February and December 2019, six million children lacked immunity against the polio virus and became the breeding ground for the virus, which attacked the weakest and paralyzed around 147 of them. With poor or no polio vaccination drives, substandard routine immunization whose ratio is around 50 percent across Pakistan, there were millions of children who either had no immunity or sub-optimal immunity against polio by the end of 2019.

But the misfortune was not over. The Covid-19 pandemic gripped the country like the rest of the world and all immunization activities including door to door campaigns and routine immunization halted all over the country. The Covid-19 outbreak was a difficult time for people and their children in Pakistan as they were not getting any vaccine against most preventable diseases in addition to the Oral Polio Vaccine (OPV) drops.

Perplexed as to what to do to prevent children from vaccine-preventable diseases including polio and to save polio vaccinators from contracting the coronavirus infection, the coordinator of the NCOC, who was also the chief of the polio eradication initiative in Pakistan, highlighted the importance of vaccination against polio as well as other vaccine preventable diseases. The national leadership was told that there was an immediate need to resume vaccination activities or it would prove to be a worst disaster along with Covid-19.

By May 2020, it had become evident that in addition to newborn babies, around 1.3 million of Pakistani children had missed one or two vaccines due to suspension of vaccination activities. And in these circumstances, Pakistan became the first country in the world that resumed its vaccination activities in the middle of Covid-19 as it had no other option left but to reach out to millions of children to prevent them from death and paralysis.

In July 2020 when there was a strict lockdown in place in most of the countries in Pakistan, polio vaccinators trained by the NEOC covered 169 high risk union councils in six districts using new operating modalities in the Covid context. The following month, polio eradication efforts were expanded to 130 districts during the sub-national campaign, targeting 32 million children under the age group of five years and in September, 40 million children were given OPV drops during a nation-wide campaign.

At the moment, polio eradication initiative officials are trying to reach 31.7 million children in 128 districts while they have planned two more national campaigns in November 2020 and January 2021, hoping that the success of these large scale campaigns would squeeze the virus back to small area where all tools (routine immunization, basic health services, nutrition, water and sanitation etc) will be used to push it towards zero cases in 2021.

Despite challenges, officials believe that Pakistan’s polio eradication initiative is back on track as thousands of vaccinators have been trained to vaccinate children despite the pandemic, by visiting door to door all over the country without infecting them and their parents as well as staying safe themselves. It is due to an effective communication strategy and community engagement that the resistance by the parents against polio vaccination has reduced 37 percent and now refusals by the parents are reducing with each passing day.

National Emergency Operation Center (NEOC) officials say that despite 79 cases of WPV1 this year, they believe that this year will be a year of transformation and 2021 would be a year of interruption for polio in Pakistan. Vaccinators have been trained to deal with the challenges of this era and more than 275,000 vaccinators, mostly women, are ready to reach millions of children in far flung areas of Pakistan.

For polio eradication initiative officials of Pakistan, failure is not an option. Even the failure of Afghanistan in polio eradication is not an option for them as free movement of people between the two countries makes it all one block where the virus is circulating.

The polio virus has to be eradicated simultaneously from both Pakistan and Afghanistan. But in order to wipe out polio from this region, peace and political stability is a must. The world must help both the countries achieve lasting peace and political stability or the polio virus will continue to be exported to other parts of the world.

The writer is an investigative reporter at The News, covering health, science and environment and water issues.

Twitter: @MWaqar_Bhatti