Jaffarabad
Lost Battle
Pakistan recorded its 55th polio case in 2024. Why does it fail to curb this endemic?
At the time of filing of this piece, the number of polio cases in Pakistan in 2024 has reached 55, with the latest three cases reported from Zhob and Jaffarabad in Southwestern Balochistan and one from Dera Ismail Khan in Northwestern Khyber Pakhtunkhwa. This year, Balochistan remains the most affected province, with 26 reported cases, followed by Khyber Pakhtunkhwa with 14, Sindh with 13, and Punjab and Islamabad with a case each.
Pakistan, one of the last two polio-endemic countries in the world, began its polio eradication efforts in 1994 by launching the Pakistan Polio Eradication Programme. From around 20,000 wild poliovirus cases reported in the early 1990s to six cases reported in 2023, the country has been unable to wipe the virus off its territory.
Despite fighting polio for decades, what challenges hinder Pakistan’s case study of success? SouthAsia Magazine speaks to experts to understand the challenges that have prevented the country from being polio-free.
Battle against polio
“In Pakistan, polio vaccinations started in 1994. To sabotage smooth polio vaccinations, conspiracies never stopped in all these years. Targeting and killing of front-line polio workers and even doctors in the battle against polio continued because there is less knowledge, a low literacy rate, and communities that can easily attract anti-polio publicity,” says Tayyaba Gul, Polio Advisor and Former President of Rotary Club of Islamabad Metropolitan, Pakistan.
Highlighting the 2,600-kilometer border with Afghanistan, a country that isn’t polio-free, along with Pakistan, Gul stresses the frequent movement along the border, thus hampering the control of the virus transmission in Pakistan. “Along with the border with Afghanistan, land of civil war and insurgency, Pakistan has hosted millions of High-Risk Mobile Population (Afghan Refugees) for more than decades. Afghanistan’s infrastructure is ruined, and the health sector is significantly compromised. As a result, polio vaccination in Afghanistan remains poor, with a cluster of refusals. Due to frequent movement, controlling virus transmission in Pakistan has become too difficult.”
Zia Ur Rehman, Spokesperson of the Pakistan Polio Eradication Program (PPEP), underscores the challenge due to the porous border with Afghanistan. “We have a porous border with Afghanistan, so if Pakistan has to eradicate polio, it will not be alone in doing so because the virus keeps coming and going on both sides of the border. We can’t blame Afghanistan, and Afghanistan can’t blame Pakistan; both countries have to work together to eradicate polio; that’s why, in the current strategy, the Governments of Pakistan and Afghanistan are working together, trying to synchronize all of our campaigns. If the campaign is happening on one side of the border, it is happening on the other side of the border simultaneously.”
Regarding the synchronized campaign calendars of the two neighbours, Zia specifies, “In Pakistan, the campaign is carried out door-to-door, while in Afghanistan, vaccinations mostly take place in community-based centres.”
Misinformation and vaccine refusal – significant hurdles?
With misinformation and vaccine refusal often cited as major hurdles in the fight against polio, what are some of the deeper sociocultural or systemic issues that fuel the resistance?
For Zia, spokesperson for PPEP, misinformation remains the main challenge. “The communities in some parts of the country, on both sides of the border where we have Pashtun communities, had this misconception about the vaccines, vaccinators, and the vaccination campaigns. Through surveys, we found out that more than 20% of the community members mistrust the vaccines and the campaigns, and that is not just religious misbeliefs, but they also had some medical misbeliefs. If they were thinking that the polio vaccine could be haram on the one side, on the other, they were thinking that, you know, this can create infertility as well in the males.”
To counter these misconceptions and mistrust of the program, Zia mentions the engagement of religious scholars to support it. “We engage ulema at the provincial and national levels through conferences to address the common myths and misconceptions.”
Administering polio vaccines in high-risk areas
While polio vaccine myths continue to get busted, what about the security concerns in high-risk areas like Balochistan and Khyber Pakhtunkhwa?
Gul, Former President of the Rotary Club of Islamabad Metropolitan, Pakistan, speaks about compromised security in some areas. “In Khyber Pakhtunkhwa and Balochistan, some areas have compromised security due to internal disputes and external conspiracies. Peace has always been a problem in the tribal areas. Sometimes, the militant group fights for months in tribal areas, and the movement of the communities becomes very difficult. One tribe rules the entire people and remains dominant in all the communities’ decisions. Democracy and freedom of expression are considered a rebellion. In recent reforms by the government, the existing issues will be resolved, as Pakistan did during the COVID-19 pandemic.”
Challenges in Pakistan’s Fight Against Polio
Despite efforts to eradicate polio, Pakistan faces persistent challenges:
- Weak Routine Immunizations: High numbers of zero-dose children and clusters of missed vaccinations remain a significant concern.
- Cold Chain Issues: Maintaining vaccine potency is difficult in some areas due to inadequate cold chain infrastructure.
- Inadequate Monitoring: Campaigns often need better supervision, and there have been reports of fake figure marking in areas like North Waziristan and Khyber Pakhtunkhwa.
- Underpaid Frontline Workers: The stipend for polio workers lags behind Pakistan’s inflation rate. These workers tirelessly go door-to-door vaccinating children, yet their compensation does not reflect their critical role.
- Lack of Awareness: Illiteracy and misconceptions about polio persist, with many refusals linked to poverty and unmet basic needs.
- Conspiracies and Misinformation: Anti-state elements spread false narratives about the vaccine to undermine eradication efforts.
- Security Threats: Polio workers in parts of Khyber Pakhtunkhwa and Balochistan face significant risks, often targeted by anti-state groups.
Gul feels that apart from some security-compromised areas, polio vaccination in Pakistan remains successful. “However, the Government of Pakistan needs to carry out more efforts in some areas of Balochistan and Khyber Pakhtunkhwa to reach the unreachable areas and vaccinate the targeted children. Quality training for polio workers and security must be provided to every worker in the field, especially in unstable regions.”
Polio-free Pakistan by 2025?
With deadlines for eradicating polio repeatedly being missed, is it the case that deadlines hinder or help in long-term eradication goals? Gul, the Polio Advisor, notes that Pakistan is committed to this fight, but sometimes uncontrolled circumstances do damage and slow the process. “International stakeholders are well informed about the efforts made by Pakistan to eradicate polio. Deadlines for polio eradication are helpful, and indeed, they enable all polio stakeholders to work hard and reach the goal; however, ground reality must be considered, and we should always keep going even when we are very close to polio eradication. Failure to meet the deadline must be considered a challenge until polio is eradicated.”
Zia, the spokesperson for PPEP, mentions that “under the National Emergency Action Plan (NEAP), we aim for Pakistan to get to zero polio cases by the end of 2025. All campaigns and program activities are being implemented according to that plan. There were some successes in the past, like in 2021-2022, there were 14 months when there were no polio cases, but then, unfortunately, there emerged new cases. We almost eradicated the Pakistani virus, which was YB3C, which was our indigenous virus. We don’t have any indigenous virus at the moment. The only virus currently coming into these environmental samples and the cases are those from Afghanistan and the YB3A, and we are working to eradicate that as well. That is why we are closely working with Afghanistan to synchronize campaigns, and the top leadership of Pakistan is also highly committed and engaged with the program.”
The writer is a communications professional and a UN Volunteer. She can be reached at mariaamkahn@gmail.com
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