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Why polio continues to be a health risk in Pakistan

Beenish Javed
September 15, 2020

After Africa was declared polio-free last month, Afghanistan and Pakistan are now the only countries in the world where the disease is found. Why is polio surging in Pakistan and what can be done to curb the disease?

A Pakistani health worker administers polio vaccine drops to a child during a polio vaccination campaign in Lahore on December 11, 2018
Image: Getty Images/AFP/A. Ali

Saira Qadir was only 11 months old when she contracted the polio virus. Now 44, she lives in Rawalpinidi city, near the capital Islamabad.

Qadir told DW that when they were kids, all her siblings received the polio vaccine except her. Apparently, it was a case of parental negligence that resulted in her being infected with the crippling disease.

Last month, the independent Africa Regional Certification Commission (ARCC) for Polio Eradication officially declared that the 47 countries in the UN World Health Organization (WHO) African Region are free of the virus, with no cases reported for four years.

"This is a momentous milestone for Africa. Now future generations of African children can live free of wild polio," said Dr. Matshidiso Moeti, WHO Regional Director for Africa.

Read more: Polio eradication in Africa points to challenges ahead

The disease is now only found in two countries — Afghanistan and Pakistan — with the latter struggling to cope with a surge in cases over the past few months. The Muslim-majority South Asian country has registered 68 polio cases since the start of the year.

The disease, which mainly affects children under the age of five, can infect the spinal cord, causing paralysis.

The government says it has adopted a new strategy to tackle the polio menace by including community and religious leaders to work with them. According to Dr. Rana Safdar, the national coordinator at Pakistan's National Emergency Operation Centre (NEOC), this strategy was effective in bringing down polio cases to as low as eight in 2017 and 12 in 2018.

However, things have changed since Prime Minister Imran Khan came to power in 2018. In 2019, cases rose to 148 from 12 in previous year.

Polio almost eradiceted by vaccine

COVID-19 takes priority

Any hope for bringing the numbers down in 2020 was dashed with the start of the coronavirus crisis in March. Experts fear that Pakistan could see more polio cases in coming months as the government suspended nationwide polio campaigns between April and July to focus on efforts to curb COVID-19.

Ahsan Ali, an official with the polio eradication program in the southern port city of Karachi, told DW in May that his vaccination work had not been well received amid the pandemic.

"My role has been changed and people are not tolerating us out of fear that we are potential carriers of the coronavirus due to our door-to-door work," he said.

In response to an enquiry regarding the suspension of vaccine campaigns in Pakistan, GPEI spokesperson Sona Bari told DW that the WHO has "noted several times that services such as immunization are suffering from the impacts of COVID-19 on health systems."

Campaign hampered by militancy

Pakistan started its first nationwide polio eradication campaign in 1994. At the time, the country was recording 20,000 polio cases each year on an average. By 2004, 10 years into the campaign, the number of cases in the country had dropped to only 30 per year. Health experts dubbed it a major achievement.

However, the campaign lost momentum after the September 11, 2001 attacks and the deteriorating security situation in the years following the US invasion of Afghanistan. The US-led war on terror in the Afghanistan-Pakistan region made it difficult for authorities to focus on polio eradication.

''By the mid-2000s, the security situation in the Afghanistan-Pakistan region had dealt a major blow to the campaign," Dr. Safdar told DW.

Read more: Amid Taliban threats, Pakistan hits record polio cases

The Taliban claim that polio eradication campaigns are being used by the West as a cover for spying. They allege that the drives are similar to a hepatitis vaccination program run by the imprisoned Pakistani doctor Shakeel Afridi, who allegedly helped the CIA find al Qaeda's former chief Osama bin Laden. Bin Laden was killed by the US Special Forces at his Abbottabad hideout in May, 2011.

Islamist militants regularly carry out violent attacks against anti-polio workers in northwestern Pakistan.

Pakistan suspends anti-polio drives

Policy issues

Besides militancy, experts also blame a flawed government policy for polio's continued existence in Pakistan.

Dr. Adnan Khan, an Islamabad-based researcher on infectious disease and public health, says bad governance is one of the reasons behind the failure of Pakistan's polio eradication program.

"Polio campaigns are basically part of mop up strategies; they are used to fill the gaps left through routine immunization (vaccines given to children at birth). But in Pakistan, door-to-door polio campaigns invariably take up more time and resources as compared to routine immunization," Khan told DW, adding that field teams often cannot cover the entire population in specified areas, which results in some children being left out.

Health officials complain that many people in Pakistan are unwilling to have their children inoculated at birth.

Rumors hamper anti-polio efforts in Afghanistan

Looking ahead

Countrywide polio eradication campaigns finally resumed last month. Authorities say that around 40 million children across Pakistan will be vaccinated by December.

"The National Emergency Operation Centre plans to invest in regular inoculations as well as health and nutrition programs for the vulnerable children in targeted areas. We hope to show progress in 2021," Dr. Safdar said.

But Dr. Khan says it will be difficult to contain the virus transmission without identifying problematic areas and vaccinating everyone there, including adults.

Read more: How far is Pakistan willing to go to fight polio?