The fight against polio is a global health success story, yet the journey remains unfinished. Since the launch of the Global Polio Eradication Initiative in 1988, the world has seen a 99% reduction in polio cases. At its peak, wild type polio virus paralyzed 350,000 people annually across 125 countries. Today, the virus persists in only three countries: Afghanistan, Nigeria, and Pakistan. Among these, Pakistan has emerged as a critical battleground, with significant progress but persistent challenges to achieving complete eradication.
Pakistan’s polio programme has made remarkable strides in recent years. In 2014, the country reported 306 wild type polio cases. By 2015, this number had plummeted to 54, and by 2016, it stood at just 20 cases. By mid-2017, only three cases had been reported. Notably, the core reservoirs of Peshawar-Khyber and Karachi did not report any new cases over the past year, a testament to targeted immunization efforts.
In a recent vaccination drive, over 38 million children under the age of five were immunized. However, despite this monumental achievement, gaps remain. The biggest challenge is the high number of missed children, 858,000, in the low season of 2017 alone—posing a serious threat to the eradication goal.
Barriers to Eradication
Here are the most important barriers that are holding back Pakistan from becoming polio-free:
1. Persistently Missed Children
Missed children during vaccination drives can be categorized into three groups. The first category is local children, who are present in their locality but unavailable during the campaigns.
The second group includes district-wide children, who are located in other parts of the district. Lastly, far-afield children are those who have traveled to other regions of Pakistan or Afghanistan.
While the first two groups can often be reached through follow-ups, the third group, comprising nomadic and traveling populations poses a significant challenge. Pakistan and Afghanistan have initiated cross-border vaccination campaigns, vaccinating children under 10 at border points and coordinating vaccination schedules to address this issue.
2. Misconceptions and Vaccine Refusals
Cultural and religious misconceptions about the polio vaccine remain prevalent. Common myths include claims that the vaccine is non-Islamic, causes infertility, or is of substandard quality. Encouragingly, surveys show a decline in the circulation of destructive rumors, dropping from 59% to 44% between 2016 and 2017. Efforts to counter these misconceptions include:
- Religious endorsements: Fatwas from Islamic scholars and laboratory validation declaring the vaccine Halal.
- Community engagement: Mobilization of tribal elders, teachers, and local female health workers.
- Media campaigns: Promoting vaccine safety and dispelling myths.
3. Violence Against Polio Workers
The security of polio workers remains a pressing concern. Over 100 workers have been killed in attacks since 2012. While the military operation Zarb-e-Azb has significantly improved the security landscape, isolated attacks continue to threaten the programme. Despite this, the resilience of health workers and government support remains steadfast.
4. Environmental Challenges
Environmental surveillance reveals that 18% of water samples in 2017 tested positive for the wild type polio virus, underscoring the virus’s persistent presence. These samples were collected from Islamabad, Punjab, Sindh, KP, and Baluchistan, indicating the need for stronger environmental controls and sanitation measures.
5. Regional Disparities
Certain regions, such as the Quetta block, lag behind due to socio-political and logistical challenges. These include:
- Large population movements
- High refusal rates
- Limited resources
- Conservative cultural norms
- Strategies for Overcoming Barriers
Initiatives to Address these Challenges
To address these challenges, Pakistan has implemented innovative strategies:
1. Improved Micro-Planning
This involves maintaining accurate and validated records of nomadic children, newborns, and children who are persistently missed during vaccination drives. By keeping these records up-to-date, health workers can better target these groups and ensure no child is left unvaccinated.
2. Enhanced Follow-Ups
Aggressive revisits are conducted to ensure that children who missed earlier vaccination rounds are reached. These efforts are complemented by community-based vaccination campaigns that take healthcare directly to underserved areas, improving overall coverage.
3. Entry and Exit Point Vaccination
Vaccines are administered at transit points, such as bus terminals and border crossings. This strategy helps capture children on the move, ensuring that those traveling between regions or countries are not missed.
4. Targeted Community Engagement
Community engagement is strengthened through initiatives such as mosque announcements, discussions in local Jirgas, and household visits by trusted community influencers. These activities aim to address vaccine hesitancy and reduce refusal rates by fostering trust and understanding.
5. Divisional Task Forces
Divisional-level task forces are established under the leadership of commissioners. These task forces enhance accountability and monitor performance, ensuring that vaccination campaigns are effectively implemented and achieve their goals.
The Role of Leadership and Commitment
Strong political commitment has been instrumental in Pakistan’s fight against polio. Prime Minister Shahid Khaqan Abbasi’s declaration that polio eradication is vital for the next generation reflects the government’s prioritization of this issue. Health authorities, provincial secretaries, and independent monitoring boards have all lauded the country’s efforts, emphasizing the need for sustained momentum.
Conclusion
Pakistan’s journey toward polio eradication is a testament to resilience and determination. While challenges persist, the country’s progress highlights the power of coordinated action, community engagement, and political will.
To gain a deeper understanding of their sacrifices and commitment, we encourage you to watch Rava Documentary Films’ inspiring production, “The Dreamers“, available on YouTube. This powerful documentary offers a glimpse into the lives of these unsung heroes and their pivotal role in striving for a polio-free future.