Farhat Begum, a lady health worker from Mardan district, has for years been going door to door, inoculating children against the polio virus. When the Covid-19 pandemic started earlier this year, she started fretting about its impact on the beleaguered immunization campaign. “The suspension is triggering an upsurge in polio cases,” she said.
Pakistan has been struggling with polio eradication for years. The polio campaign suspension earlier this year, on account of the Covid-19 pandemic, also dealt a blow to the drive.
Polio is a paralytic and highly infectious disease caused by human enterovirus called polio virus. There are three wild types of poliovirus – poliovirus type 1 (PV1), poliovirus type 2(PV2) and poliovirus type 3 (PV3). All the three types are extremely violent and produce the same disease symptoms. There are two types of vaccines that can prevent polio: the inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV).
During the current year, Pakistani officials have so far reported 70 new WPV1 cases and 59 new cVDPV2 cases. Transmission continues to be widespread according to the World Health Organization (WHO). These fears also triggered alarm bells, prompting authorities to speed up the immunization drive areas where the cases are being reported.
The Global Polio Eradication Initiative (GPEI) was created in 1988, with six core partners including the World Health Organization (WHO), the US Centers for Disease Control (CDC), United Nations Children’s Fund (UNICEF), Bill and Melinda Gates Foundation and Gavi Vaccine Alliance to eradicate polio worldwide and set out the roadmap to eradicate polio by 2023.
As the deadline for GEPI’s Polio Endgame Strategy 2019-23 looms, Pakistan is still struggling for virus eradication. Since 2015, the Pakistan polio program has performed admirably well, bringing 306 cases in 2014 to only 54 cases in 2015, 20 in 2016 and then an all-time low of 8 reported cases in 2017. There were 12 in 2018. However, a drastic increase was observed in 2019, where the reported cases surged to 147. And in 2020, 70 cases have been reported so far.
Farhat Begum, who has taken part in many polio campaigns in some highly dangerous situations, says that the increasingly harsh behaviour of people towards health workers and security threats were the two main challenges that they face. She says that the government needs to improve logistics and facilities for health workers assisting in vaccination programs. “It is necessary to improve education and make people believe in the benefits of OPV rather than following the conspiracy theories that lead them to refuse it.”
The WHO on March 26, 2020, suspended all anti-polio activities including house-to-house surveillance for the next six months to avoid putting communities and frontline workers at risk due to the coronavirus pandemic. However, after four months of suspension, WHO, GAVI and other health organizations decided that the routine immunization of individual children at clinics must continue as much as possible during the coronavirus pandemic.
Farhat Begum believes that the polio vaccination campaigns should not be suspended during the pandemic. “This is now triggering an upsurge of many other infectious diseases especially polio.”
The polio campaign activities were temporarily kept on hold during the global coronavirus eruption, keeping in mind the immunity and exposure of the children below five years of age, along with the low disease survival rate and lower ability to fight back as compared to the one who are aware and able to take safety measures and are adults. However, the government decided to bring in some safety measures and regulations before restarting the anti-polio campaign at the national level, in order to satisfy the parent and to counter both polio and coronavirus.
Education plays an important role: many of the local people refuse to believe in the very existence of either the coronavirus or polio: seeing vaccines as “unhealthy drops” for their children. This societal response actually took it for granted, thus putting the lives of children and themselves in danger. The challenge in Pakistan to the polio vaccinators is that the parents refuse to vaccinate for religious and superstitious reasons, which is the major threat to the success of the Global Polio Eradication Initiative (GPEI).
Pakistan is not the only country facing challenges with polio campaigns. But to address these challenges practically and effectively has not been easy: including the high number of children who miss vaccination campaigns due to refusal from parents, illiteracy, poverty, misconceptions related to its halal nature and uncertainty on administrative issues. On the other hand, the polio health workers are facing problems as parents mistreat them, physical security in the form of police is not provided, also they don’t know the real information regarding polio in order to convince the people to have their children with vaccines.
Muhammad Saqib, a resident of Peshawar, one of the districts of KP, says that he has not been vaccinating his children so far, since he had been under the misconception that it wasn’t allowed in Islam. “As a result, my six-year-old daughter was diagnosed positive for polio,” he adds.
The Covid-19 infection has already had a very serious impact on the world economy – especially in developing or under developed countries. Halting the immunization programme for polio might help in containing the COVID-19 transmission but it would also intensify the risk of attaining other infectious diseases that can be prevented by vaccination and that affect the marginalized poor countries that are struggling on other fronts.
Countries like Pakistan facing other health challenges will have to continue surveys and data collection related to disease that can be prevented through proper vaccination, needed to be gathered.
Considering the importance of vaccination and increase in the number of polio cases, government officials decided to restart a polio campaign in various districts and tehsils of Khyber-Pakhtunkhwa on the 21st of September 2020 with precautionary measures, SOPs and physical security arrangements. A total of 36,7675 children would be vaccinated, including those of five years of age and younger, as per online data taken from the website Voice of KP.