Polio Resurgence in Pakistan After 15-Month Hiatus Is Big Setback to Eradication Aim 
A field worker in Pakistan administering polio drops

[ISLAMABAD] Despite gains made to end polio during COVID-19, Pakistan has  recently reported a resurgence of the virus after a gap of fifteen months. The sobering news comes just ahead of the start of the World Health Assembly in Geneva -which will review progress on polio eradication – including a recent polio wildvirus outbreak in Malawi; transmission of vaccine-derived polio elsewhere in Africa; and continuing challenges in war-weary Afghanistan.  

Pakistan has so far reported three wild poliovirus cases in the months of April and May from its western un-settled region of North Waziristan bordering Afghanistan and authorities fear more are to appear.

Reacting to the reports, Pakistan’s government officially reaffirmed its commitment to end transmission of the virus – and announced a new vaccine campaign. 

But senior officials attached with the polio program fear that the dream of eradicating the disease from Pakistani soil in the near future has been lost. 

Failed to maintain immunity wall created at height of pandemic

Pakistan is one of two countries where polio remains endemic.

“[The] program has miserably failed to maintain the immunity wall erected during the previous year,” lamented a senior official of Pakistan’s polio program wishing not to be quoted. 

He said the aggressive emergence of the virus in the high transmission season happening now, reflects gaps in the 2021-2022 anti-polio drive – which failed to keep up with the good record of the 2020-2021 campaign – conducted at the height of the COVID pandemic. 

Pakistan and Afghanistan were the only two countries left fighting to end the wild poliovirus from Asian region – although the outbreak in Malawi, reported by WHO in 2022, also is said to have originated in a Pakistani strain of the virus from an unknown source. The report of the wildpolio virus case in a young child in Lilongwe, has triggered a massive immunization campaign in both Malawi and neighboring states, which is still ongoing.  

Door-to-door immunizations need to maintain ‘immunity wall’ 

Children in Pakistan show proof of vaccination against polio.

In order to maintain the ‘immunity wall’, continuous immunization among vulnerable populations is needed, specifically in southern and central Pakistan, said the unnamed official, in reply to a query made by Health Policy Watch

“Polio authorities should have kept focus in the regions of South of Khyber Pakthunkhwa province, Central Pakistan and traditional core reservoirs of Khyber-Peshawar, Karachi and Quetta block,” he said. 

He said synchronised high quality door to door campaigns would also have to be conducted, not only across Pakistan but in Afghanistan as well.

After the COVID-19 interruption, the Pakistan programme in July 2020 restarted door to door campaigns along with enhanced outreach for essential immunisation across Pakistan. 

The efforts were undertaken in close coordination with Afghanistan through synchronised campaigns which resulted positively and the country reported zero polio cases for 15 months till April 2022. 

“Good approaches and efforts practiced during the low transmission season of August 2020 to March 2021 should have [been] replicated during August 2021 to March 2022,” he said.

Anti-polio drive for children announced 

A countrywide vaccination drive against polio has been announced in Pakistan, beginning next week.

In an effort to combat the further spread of polio, the ministry of National Health Services Regulations and Coordination (NHSR&C) has now announced a countrywide anti-polio drive beginning next week, to immunize around 43 million more children in Pakistan. 

Official statements say 340,000 polio workers will participate in the door-to-door countrywide anti-polio drive which was earlier limited to some regions. 

The ministry has also requested parents, civil society and religious clergy to cooperate with authorities in this campaign. 

Polio in Pakistan due to parents’ refusal to vaccinate 

Meanwhile, the Pakistani Medical Association (PMA) demanded stronger legislation regarding parents who refuse to immunize their children – which they say is a leading source of new cases. 

“There must be some law for those who refuse to immunize children,” said secretary general PMA Dr Qaiser Sajjad.

He also said it is the time to strengthen the screening system for polio cases along the Afghanistan border and within cities where polio samples are found, adding that such screening measures worked during COVID-19.

According to Dr. Sajjad there is also a need for aggressive media campaigns to create awareness and convince the communities to bring their children for polio drops. 

“All the hard work done to eradicate polio is on stake now,” he said.

Global Polio Eradication Initiative calls for nearly $5 billion in new funds 

To end polio, the Global Polio Eradication Initiative (GPEI) has also called for renewed commitments to meet a $4.8 billion global budget that would fund the implementation of a new strategy to eradicate the deadly infectious disease. 

However, money is not the only issue. The Pakistan polio program has been struggling for decades to overcome the social and security challenges that immunization campaigns face, especially in ‘war on terror’ areas. That is despite sponsorship of campaigns by global donors  including the Bill and Melinda Gates Foundation – whose co-founder Bill Gates visited the country only recently.

Polio campaigns in Pakistan were heavily disrupted after al-Queda leader Osama Bin Ladin was killed in an operation carried by US forces in the Khyber Pakthunkhwa province in May 2011.  Following that, al Queda groups also started attacking polio workers as perceived representatives of U.S and western influence. 

Since then, both US and Pakistan military forces also have committed to a ‘war on terror’ which has further impeded the work of polio campaigns. 

The North Waziristan region of Khyber Pakthunkhwa province, where all three recent polio cases in two boys and a girl were confirmed, was one of the hotbed ‘war on terror’ areas where Pakistan military carried operations while US forces held drone attacks. 

After the resurgence of polio cases in North Waziristan, Gates even reportedly called Pakistan Army Chief General Qamar Javed Bajwa to discuss the situation. 

In a statement, the Inter-Services Public Relations (ISPR) reported that the billionaire philanthropist had expressed his appreciation to the army for supporting the country’s polio drive and ensuring proper reach and coverage. The army chief responded that polio eradication was a national cause, adding that “credit goes to all involved in the process”.

Downsides of downsizing program 

Minister Patel and WHO Pakistan Palitha Mahipala

Some  polio workers believe that downsizing of lower staff also brought harmful results for the program.

Anil Kumar, one polio worker interviewed by Health Policy Watch, said that around 800 Union Council Polio Officers (UCPOs) are registered across the country. But many of them were not offered contracts for the year 2022 – he among them. 

“Indeed uncertainty and job insecurity in lower staff can impact reporting and surveillance in the polio program,” he said.   

Meanwhile, the Pakistan federal health minister Abdul Qadir Patel and the World Health Organization’s representative in Pakistan, Palitha Mahipala met in the wake of the three polio cases, reaffirming their commitment to work together to end polio. 

The head of WHO’s Pakistan country office welcomed the decision of Pakistan’s health minister to visit the affected families as a move to underline the government’s support for ending the disease. 

Human cost of not eradicating polio in Pakistan 

Minister Patel meeting families affected by polio

“Every polio case is a huge tragedy,” said Patel in a statement about the outbreak.  

“Since January, Pakistan has taken emergency measures in the southern districts of Khyber-Pakhtunkhwa to save children from wild polio and these measures have been further extended and intensified,” he added.

Every child must be reached by polio vaccine 

Political map of Pakistan. The KP province has reported a resurgence of polio.

Despite the setbacks, rank-and-file officials say they remain determined to vaccinate all children in the country against the virus. 

Polio workers on the frontlines continue to reach out to children in North Waziristan in spite of  challenging circumstances in hard-to-reach areas, said Dr. Shehzad Baig, National Coordinator for Emergency Operations Centre (NEOC), adding, “We fear that more children from the same area may be affected as the virus circulates.”

Additionally, to address the challenges in Southern KP – unsettled and settled tribal areas that include North Waziristan, South Wajiristan, and Bannu, the Pakistan government and global polio partners had already initiated an emergency action plan to address the challenges in this part of the province.

Federal health secretary Aamir Asharaf Khawaja, in a statement from the health ministry, said after the first child was paralyzed [in Pakistan], “we feared that there would be more polio cases because of how infectious this virus is.”

Environmental samples of wild poliovirus in Khyber-Pakhtunkhwa have also been found in the Dera Ismail Khan and Bannu divisions of the region, he noted adding:  

“Unfortunately, there may be more until every child is reached by the vaccine.”

Image Credits: Sanofi Pastuer/Flickr, Pakistan Polio Eradication Program, UNICEF Pakistan.

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