Pakistan Reader# 181, 22 August 2021
Despite the Pakistani government making strides in its battle against polio, the recent attacks on polio workers and security personnel once again highlight the resistance from civil society.Abigail Miriam Fernandez
Pakistan is one of the two countries in the world that is still endemic to polio. Over the recent years, the authorities have worked towards eradicating polio and have promised to bring the rate down to single digits. However, achieving this is proving to be more challenging given the attacks on polio workers and security personnel highlight civil society's resistance.
Pakistan has been making substantial progress in its battle against polio. As of July 2021, there has only been one case of wild polio reported this year, compared with 66 in 2020 and 147 in 2019. Similarly, cases of the circulating vaccine-derived poliovirus type 2 stand at eight this year, whereas the figure was 135 in 2020 and 22 in 2019. The number of positive environmental samples and the geographic distribution of the virus has decreased. The declining trend of reported polio cases and negative environmental samples indicate a positive epidemiological outlook for polio eradication in Pakistan. Till June 2021, three nationwide polio vaccination campaigns have been held to inoculate 33 million children under the age of five with the participation of over 200,000 health workers and social mobilizers.
However, there are serious challenges from civil society. Along with illiteracy, poverty and difficulty accessing community health and immunization services, the widespread misconception about the polio vaccine is predominant in Pakistani society, which has all contributed to vaccine hesitancy. Many parents have refused the vaccination due to misconceptions; for example, there is a notion that the vaccines contain monkey- or pig-derived products, which are forbidden in Islam. The repeated administration of the oral poliovirus vaccine (OPV) was also cited as a barrier; with some parents suspecting that this was to ensure that their children were sterilized or that sub-standard vaccines were being used. Further, many have also been critical of the dosage, where the children in Pakistan are given a higher dose than the number recommended by WHO. Further, there have also been numerous conspiracy theories related to the polio vaccine in Pakistan, a major driver of refusals across the country, which centre on unspecified "Western" goals to sterilize Muslims or otherwise harm or oppress them.
Second, attacks on polio workers is a major problem in addressing the polio challenge in Pakistan. With a national immunization, drive beginning on 2 August 2021 to vaccinate over 23.6 million children, over 179,000 polio workers put themselves at risk yet again by going from door to door to vaccinate children. Polio vaccination teams have suffered several attacks since a countrywide vaccination drive with Polio workers, volunteers and their guards are frequently targeted in the South Asian country. Most of the terrorist incidents against polio workers this year have occurred in Khyber Pakhtunkhwa.
Third, the politicization of polio and governance issues. Until recently, the Polio Programme and the importance of delivering the polio vaccine according to the Independent Monitoring Board have become a political football. The Polio Programme in the country has remained particularly vulnerable in areas where the power structure is divided between different political parties, thus lacking political unity. The centre-province politics has left caused this fragmentation of power, leading to problems in efficiently carrying out vaccination campaigns. Additionally, most of the resistance in Pakistan against the immunization programme stems from the northern province of Khyber Pakhtunkhwa and parts of Balochistan, two provinces that already face several challenges.
Fourth, the challenges of "Last Mile" Vaccination Efforts. The primary underlying challenge in last-mile efforts to eradicate wild poliovirus transmission (WPV) is the missing children in the delivery of polio vaccines. The challenges which continue to persist apart from the social and cultural misconceptions are challenges faced by frontline workers in areas that are hard to reach due to geographical isolation, mobility and mass migration and this issue of inaccessibility.
To conclude, the State is serious about tacking polio but faces challenges from civil society. Polio eradication in Pakistan faces peculiar challenges, having programmatic, systemwide, socio-cultural and ethical dimensions. Despite efforts by the Pakistani polio program, vaccination bans, rumours, and conspiracy theories that polio eradication is enabling foreign bodies to destabilize the country continue to be a barrier to polio eradication. Additionally, the necessary fatwas from religious scholars that the polio vaccine does not contravene Islamic teachings has not helped combat the issue.
The polio challenge in Pakistan stems from ignorance, social misconceptions and conspiracy theories about the vaccine. The attacks on polio workers show the hostility with which people regard polio teams highlight the resistance and hesitancy from civil society, who would go to any extent to stop the drops from being administered to children. The most recent attack comes at a time when, according to official statistics, only one case of polio has been reported so far this year. Thus, now when the government has been able to get a hold of the vaccination programme, the resistance from civil society continues to be a challenge for the State.
About the author
Abigail Miriam Fernandez is a Project Associate at the School of Conflict and Security Studies at the National Institute of Advanced Studies (NIAS), Bangalore. As a part of her research focus at 'Pakistan Reader', she looks at issues relating to gender, minorities and ethnic movements.