Pakistan Reader# 666, 12 September 2023
Shamini Velayutham
What is happening?
Recently, a wild poliovirus, which is linked to Afghanistan, has been detected in the sewage system in Lahore which has indeed caused speculations in the region. The Pakistan Polio Laboratory at the National Institute of Health (NIH) confirmed it as the third positive sample recorded in the Lahore district. It is to be noted that Pakistan and Afghanistan are the only states in South Asia that still have considerable polio cases. Polio eradication efforts in Pakistan and Afghanistan are threatened by a lack of awareness and the unrestricted movement of people across the border. Currently, Polio virus cases have started to increase in both bordered regions of Afghanistan and Pakistan.
What has been the case so far?
Since polio has been rife in the area for a considerable amount of time, India has successfully eradicated it through its proactive actions. Pakistan and Afghanistan are still being eradicated, although at different rates. Poliovirus transmission in Pakistan is only present in Khyber Pakhtunkhwa province out of the country's 171 districts as of 2020. Before the COVID-19 pandemic, Pakistan and Afghanistan had an increase in polio cases from just 12 and 21 cases recorded in 2018 to 147 and 29 cases in 2019. In Pakistan and Afghanistan, respectively, there were fewer occurrences of polio in 2020. The lowest level ever recorded for wild poliovirus-1 (WPV1) cases occurred in 2021, when there were only five cases total (4 in Afghanistan and 1 in Pakistan). The detection of two wild polioviruses in environmental samples taken from the D.I. Khan and Bannu Districts in the fourth quarter of 2021 led to the designation of the southernmost portion of KPK province bordering Afghanistan as an area at high risk. As of now there have been 2 to 3 cases reported in both regions.
What are strategies for polio eradication in the country
UNICEF and partners of the Global Polio Eradication Initiative (GPEI) are stepping up efforts, working with Pakistan’s government to launch catch-up vaccination campaigns. A lot of the focus is on communities that are close to the border with Afghanistan in western Pakistan, where there’s a larger population of displaced children who are at higher risk of contracting and spreading the disease. The government of Pakistan and Afghanistan along with the international health organizations are actively implementing urgent immunization activities along with active surveillance in high-risk areas. Pakistan has implemented polio vaccination drives and has appointed health care workers to facilitate vaccines in the remote areas of the region.
Latterly, the operational polio leadership of the WHO and the US Centers for Disease Control and Prevention (CDC) traveled to Pakistan in recognition of the crucial role Pakistan plays in the global polio eradication effort in order to observe firsthand operations, the most recent advancements and innovations, and meet with newly appointed political leadership. When the team met with Dr. Nadeem Jan, the recently appointed interim Federal Health Minister, who made a trip to the polio National Emergency Operations Centre (NEOC) on his very first day in office in August, they were given the assurance that polio eradication is a top operational priority for Jan's tenure.
Jan stated: “It is important for us that our country and global partners and donors stand together in this final leg of the eradication journey. I am a polio worker at heart. I will ensure that not only does polio remain a priority at all tiers of governance, but efforts are more targeted and intensified.” The interim administration assured to take full-fledged initiatives to overcome area-specific challenges by providing ceaseless flow of vaccination to high and low risk regions of the country.
Why polio continues despite the efforts of the government
Pakistan's inability to eradicate polio puts the world's eradication efforts in jeopardy and is quickly growing into a major source of serious concern. Eradicating Polio, a dreadful disease amongst children is a challenging task for a developing country like Pakistan. The government’s ambitious effort to suppress the spread of polio among the children has indeed helped miniscule population. However, the efforts are not operative for the elimination of the disease.
Firstly, the immunization services and health care centers provided by the government are not fruitful enough for the public to access. Although Pakistan’s government provides vaccination drives, nevertheless, the geological structure of certain areas is regarded to be inaccessible. The inaccessibility overlaps with the security concerns as well. The tough geology of Pakistan, which includes the Himalayan mountain range and glaciers in the north and the rough terrain of Balochistan in the south, adds to the country's difficulties in providing adequate public health care.
Secondly, the regional eradication effort has lagged because of the inadequate management and operational shortcomings. Many areas of the country badly lack a sufficient health infrastructure and service delivery system since less than 2 per cent of the Gross National Product (GNP) is spent on healthcare. Although the Global Polio Eradication Initiative's (GPEI) Pakistan operation is rather well funded, its effectiveness is jeopardized by a lack of governance transparency, a service for delivering public health that is underfunded, and a private health sector that is not adequately controlled.
Thirdly, the poor strategy of the government regardless of the party, for the elimination of polio is at stake. The failure of implementing strong policies due to the disruption and changing regimes has caused the disease to resurface in the region. Although the cases in other districts are imperceptible, the government’s reach in the high-risk area is limited.
Fourthly, security plays a significant role in the vaccination drives. Government’s lack of security has made people stay indoors rather than taking vaccines. Limited health care workers with limited security in the remote regions has significantly resulted in the low vaccination rates.
Fifthly, the low production of vaccines has engendered polio cases amongst children. Despite the international funding, the government expense over the health care sector in the production of polio vaccines are comparatively lower than the expense spent on the military. Due to the low production of vaccines, the children are not able to get their immunization dosage in the stipulated time.
Finally, In Pakistan, vaccine apprehension has been influenced by factors such as illiteracy, socioeconomic status, culture, and religion. Despite the government efforts, the preconceived notion about the vaccine among the people of Pakistan defer themselves from being vaccinated. Pakistan’s Taliban began an anti-polio campaign more than 10 years ago by spreading rumors that the vaccination was linked to fertility problems and calling it anti-Islamic. The Taliban has attacked vaccinators and the security officials protecting them. Illiteracy overlaid with lack of awareness has made people refrain from taking vaccines.
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