The Virus is Coming Back

By Asma Nisar | March 2020

Thanks to the global polio eradication program initiated in 1988, the number of reported polio cases has reduced by 99%, globally. Regions like the Americas, the western Pacific, Europe and South East Asia have long been declared polio-free. However, there are a few unfortunate countries where the polio virus still haunts the health of millions of children. These countries include Pakistan, Afghanistan and Nigeria. According to the World Health Organization, every child is at the risk of polio in the presence of a single polio infected child in the world. The report further laments that the failure of the global polio eradication program in the virus-prone states can result in 200,000 new cases every year globally.

t by the National Institute of Health, 104 new polio cases were reported in 2019 compared to only twelve in 2018. The Khyber Pakhtunkhwa (KPK) province of Pakistan leads the number of reported polio cases with 75 cases in the province. Other provinces follow - 6 in Punjab, 16 in Sindh and 7 in Balochistan. Gilgit-Baltistan and Azad Jammu and Kashmir region data has showed no new cases of polio in 2019. In spite of Pakistan’s substantial progress since 2014, an independent monitoring board which supervises polio eradication programs worldwide has recently declared Pakistan’s polio eradication program as a ‘disaster’ and, with the present data, it is clear that there is something seriously wrong with the program.

Pakistan’s endeavours to eliminate the endemic face multiple impediments, including cultural taboos, security concerns, abrupt political transitions, volatile borders, and false propaganda about the polio vaccine such as myths of a Western conspiracy to sterilize the Muslims.

According to the experts monitoring the polio program in Pakistan, culture is one of the biggest hurdles in the eradication of polio in the country. The trend of establishing illegal settlements without prior planning further adds to the spread of the polio endemic. Settlements lacking basic sanitation and drinking water facilities increase the probability of spread of polio. There are hundreds of slums in Karachi - the largest metropolitan city in Pakistan where drains are full of raw sewage. Similarly, the virus has been isolated from sewage of other urban centres. In addition, the conventional mindset of the masses, especially in the rural areas, raises doubts about the nature of polio vaccines and hence the spread of polio across the country.

Similarly, the worsening law and order situation and spread of terrorism has badly affected Pakistan’s polio eradication programme. As per conservative estimates, around 70 officials related with the polio eradication programme have been killed in Pakistan in the past 7 years. In addition to this, the abrupt political transitions and unexpected reshuffling of the civil bureaucracy results in the negligence of tasks related to polio eradication and result in the prioritization of political tasks. This hasty reshuffling of the bureaucracy leads to mismanagement and there is a blame game among the members of the program.

Misinformation and false propaganda against polio vaccination currently being spread by traditionalists and ultra-religious groups has further complicated the course of eradication of the endemic. Lately, parents in the rural areas of Pakistan have been found using false ‘pinky marks’ to deny polio vaccination. There is a false notion that the vaccine under use in Pakistan is manufactured by the western countries who are plotting to sterilize Muslims to decrease their population. Also, a number of people have been sharing misleading material about the polio vaccine, including a former bureaucrat known for his conservative approach, who has written and shared anti-vaccine views, impacting a huge fragment of conservative Pakistanis.

The lack of quality vaccine and poor training of the eradication team has resulted in the mishandling of polio vaccine hence resulting in increasing refusals from the community. In addition, the poor renumeration of the vaccinators also negatively affects the otherwise imperative polio eradication program in Pakistan.

Pakistan should learn its lessons about the eradication of polio from its immediate neighbouring countries India and Bangladesh who have successfully kicked out the disease in 2014. They were able to achieve this status because their leaders did not resort to gimmicks. They seriously engaged with the health issue and analysed available data to devise a strategy suitable for their communities. In 2009, India was reported to have 60% of global polio cases, but with an inclusive programme tailored according to its community needs, it was declared polio-free in 2014. Their policy ensured that no cases were ignored and no child was missed by vaccinators. Similarly, Bangladesh was declared polio-free in 2016 despite the overwhelming challenges it faced in the aftermath of separation from Pakistan. It was able to achieve the goal because its government was committed to eradicating the disease and successfully developing a strategy which included community awareness through youth involvement, routine immunization, sanitary reforms to interrupt the faecal-oral route of virus transmission and other micro-planning techniques.

Community engagement and national dialogue are the only way to untie this Gordian knot. The government should devise a strategy that includes women and youngsters in the polio eradication program to convince parents about the effectiveness of the vaccine. In addition, the Muslim clergy should be taken on board to motivate parents to immunize their children. In the past, the late Maulana Sami ul Haq, a prominent Islamic scholar, gave a religious ruling, approving the battle against polio. This helped in encouraging people to immunize their children. At present, Pakistan is under the dire need of another successful engagement like this to break the taboo created by the fanatics against the national polio drive.

After the change of government in Pakistan in 2018, the head of state Arif Alvi, hoped that the state would be polio-free the next year. However, due to propaganda, over-politicization of the polio drive and cultural taboos, such hope seems to be a distant dream. However, designing a proactive polio eradication policy linking multiple groups together and effective accountability of the program can pave the way for the realization of the dream of polio eradication in Pakistan.

The Virus is Coming Back

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