Polio Challenge

Despite the fact that the polio eradication program has been going on for so many years, the number of cases doesn’t seem to be abating. Among other stumbling blocks, three main hurdles can be identified.

The first and foremost is vaccine hesitation. According to Dr. Fazal Ather, an expert working with WHO, vaccine hesitation is the most important reason underlying the failure of the program in Pakistan. He is of the opinion that if this problem is not addressed in a timely fashion, it may hamper the progress of the program and pose challenges to the completion of the disease’s eradication and elimination.
Secondly, security issues for polio workers and concerns regarding the efficacy and safety of the vaccines, weak routine immunization and a high prevalence of malnutrition; all these conditions are allowing the poliovirus to survive and paralyze vulnerable children with low immunity levels.

Thirdly, lack of poor civic amenities in over-populated major cities like Lahore and Karachi present the risk of rapid faeco-oral spread, as has been seen with environmental samples collected from these cities after polio outbreaks.

Additionally, the lack of transparency in governance juxtaposed with an under-resourced public healthcare system and an unregulated private health sector are further compounding the situation.

Vaccinator satisfaction and security have been major concerns -- due to the targeted killings of vaccinators as well as the lack of financial incentives, low salaries and lack or delay of payments. The result? The polio program has become politicized, leading to institutional malpractices, poor accountability, pilfering of resources and polio inspectors appointed on political grounds.

The dynamics of the polio program are multifaceted. The successful eradication of the disease has been hampered by conflicts and insecurity, especially in KP and FATA regions, where a dramatic rise in polio cases was seen in 2014 when the number of reported cases increased from 91 in 2013 to more than 300 in just a year.

In addition to these operational challenges, the program faces the huge issue of fallacy and negative propaganda by the vested interest group, which has contributed to the increasing number of vaccine refusals. Concerted propaganda campaigns by militant outfits operating in these areas further damage the program.

The wide range of challenges also include poor health infrastructure, operational and managerial deficits and a myriad of security-related issues. Commitment to the cause is needed at all levels with over-arching government support.

This can be achieved by strengthening Pakistan’s health infrastructure. Increasing the number of immunization centers in rural and far-flung areas is crucial for effective service delivery. Effective health communication strategies by engaging religious leaders and influential public figures can shift negative perceptions about the polio vaccine campaign, which took a huge blow after the CIA’s fake hepatitis B vaccination campaign in its bid to identify Osama bin Laden.

Global health initiatives are becoming intertwined with foreign policy and diplomacy of donor and recipient countries. Hence, the role of religious and social norms and their wider economic, security and diplomatic repercussions should not be underestimated in this era of globalization.