Understanding Polio Eradication Campaign in Pakistan

There is no cure for polio, it can only be prevented by immunization. OPV (Oral Polio Vaccine) and IPV (Inactivated Polio Vaccine) are the vaccines used for immunization.

The Government of Pakistan announced that polio certificate will now be mandatory for all international Pakistani travelers after the directives of WHO (World Health Organization) to prevent the international spread of wild poliovirus. So far in this year, 80 polio cases are reported worldwide, and out of those, 60 cases of polio (75% of total) were reported in Pakistan.

Vaccine failure and failure to vaccinate are two important factors which have affected the national polio campaign -Prof AtharNiazRana

Failure to Vaccinate

Polio vaccination campaign in Pakistan was started in 1994 when there were thousands of Polio cases every year. At the start of the Polio campaign, rumors were spread by some religious factions that this vaccination campaign is a conspiracy of the West and that this vaccine is being used to control the birth rate and decrease women’s fertility; due to which the people of Pakistan, especially in the rural areas, show hesitation in vaccinating their children. Later, these rumors were overcome by sincere efforts of the Polio workers and intensive eradication campaigns such as the door-to-door vaccinations by the Government of Pakistan in 1999.

Drone Attacks

In 2005, the number of Polio cases was brought down to only 28 with the continuous efforts of health workers and support of Government of Pakistan. The hopes were high that soon Pakistan will become a polio-virus-free country, but the drone strikes in FATA and the rise of different militant groups as a reaction of the drone attacks in FATA made it difficult for the health workers to continue their vaccination campaigns in these areas.

 CIA Fake Vaccination Campaign

After Abbottabad operation on 2^nd May, 2011,in the bid to kill Al-Qaida leader Osama Bin Ladin, it was found that a fake vaccination campaign was conducted in Pakistan by the CIA for which different NGOs were used to trace Osama Bin Ladin. This fake campaign rigorously dented the efforts made by the polio workers and the Government of Pakistan to eradicate Polio since 1999. Different militant groups in Pakistan started targeting Polio vaccination teams, especially in FATA and KPK. After several attacks on vaccination teams and killings of several polio workers of the vaccination team, the campaign was stopped in FATA. As a result, millions of children remained unvaccinated in these areas; the number of cases heaved to 198 in 2011 and around 52 polio workers are killed so far.

Pakistan Army Operation in FATA and IDP (Internally Displaced People)

In 2009, Pakistan Army started operation Rah-e-Nijat in South Waziristan (FATA) to eliminate TTP militants from FATA. Most of the area in FATA is cleared by the Army now, but due to these operations, millions of people migrated to the Internally Displaced Persons (IDP) camps and different settled areas like Peshawar, Banu, Tank, and Dera Ismail Khan District. This resulted in the spread of Polio virus from FATA to the rest of Pakistan.

Vaccine Failure

In some areas, the Government of Pakistan failed to provide vaccination because of security reasons, but in many cases, thevaccine failed to protect the children from Polio. According to a research done by the polio eradication section of the National Institute of Health, it was discovered that around 78% of confirmed polio cases in Pakistan involved children who had been administered multiple polio vaccinations.

OPV (Oral Polio Vaccine) and IPV (Inactivated Polio Vaccine)

According to WHO (World Health Organization), Polio is caused by a wild polio virus that invades the nervous system and causes paralysis or even death. Polio virus enters the body through the mouth, in water or food that has been contaminated with faecal material from an infected person. The virus multiplies in the intestine and is excreted by the infected person in the faeces, which can pass on the virus to others.

There is no cure for polio, it can only be prevented by immunization. OPV (Oral Polio Vaccine) and IPV (Inactivated Polio Vaccine) are the vaccines used for immunization.

OPV consists of a mixture of live, undermined (weakened) poliovirus strains of all three poliovirus types. OPV produces antibodies in the blood to poliovirus, these antibodies protect against paralysis by preventing the spread of poliovirus to the nervous system and limit the replication of the wild poliovirus inside the intestine. Three doses of OPV produce long lasting or possibly life-long immunity in 95% of the recipients. As OPV is administered orally, it does not require trained health workers or sterile equipment.

IPV consists of inactivated (dead) poliovirus strains of all three poliovirus types. IPV also protects against paralysis in the same manner as OPV does, but IPV induces very low levels of immunity in the intestine. Secondly, it is over 5 times more expensive than OPV. IPV is given by intramuscular injection and needs to be administered by a trained health worker.

Why OPV is recommended by WHO

There are different kinds of conspiracy theories in Pakistan regarding OPV. Some say that Europe itself stopped using OPV and shifted to IPV because OPV was not effective to eradicate Polio or because IPV is more effective than OPV. Some also say that OPV contains anti-fertility agents and that is why Europe stopped using this type of vaccine.

OPV is used as the recommended vaccine in Pakistan and other developing countries that did not manageto eradicate Polio, because IPV does not stop the transmission of the virus. OPV is used wherever a polio outbreak needs to be contained, even in those countries that exclusively use IPV for their routine immunization program; because IPV is not recommended for routine use in polio-endemic countries because of the risk of poliovirus importations. Once the polio has been eradicated, these countries can switch to IPV for routine use.

Secondly, IPV is five times more expensive than OPV and requires trained health workers and sterilized equipment. Developing countries may face difficulties in making all these arrangements in polio eradication campaigns.

The reason behind the high number of polio cases in the children who had been administered multiple polio vaccinations could be the ineffectiveness of OPV because of storage at incorrect temperatures or the usage of expired vaccine. It is recommended that OPV should be stored at -20 degree centigrade, but the vaccine can remain effective between the temperature of 2 to 8 degree centigrade. As the rural areas of Pakistan are suffering from regular load shedding of 12-18 hours, this can affect the storage of OPV.

 Recent Measures to Eradicate Polio

After the recent concerns shown by the WHO over the polio eradication program and the high number of polio cases, the government of Pakistan took some steps to make the polio campaigns more effective.

National Assembly Resolution on Polio Immunization

The National Assembly of Pakistan unanimously passed a resolution forwarded by the Minister of State for National Health Service Saira Afzal, urging all lawmakers to ensure the implementation of the polio immunization program in their respective constituencies.

Polio Vaccination Must for Travelers from FATA

As 45 out of 60 cases of polio were reported in FATA and the other cases were also linked backed to FATA in one way or the other, the Government of Pakistan made it mandatory for each person travelling from the tribal areas to be vaccinated before entering the settled areas to prevent the spreading of polio virus in the settled areas of Pakistan.

Similar kind of measures should also be taken for the travelers moving towards from the settled areas from Afghanistan. Last month, WHO found polio virus from Afghanistan’s Kunar province in two of the six samples taken from Peshawar.

Army to Provide Security in Polio Campaign

The polio campaign was stopped in FATA because of security reasons in 2012, leaving almost over 300,000 unvaccinated children in only Waziristan where the militants had banned vaccination in mid-2012. According to a press release of the ISPR, the Army will provide security to the health workers and parents in FATA during the Polio vaccination campaigns.

These new measures would definitely reduce the number of cases in Pakistan and possibly eliminate this disease from Pakistan if implemented properly in the affected areas.

Terrorism and power shortage not only dented our economy in the last decade or more but also seriously affected other aspects of our life, including health. All the actions taken by the Government are highly appreciated, but a sincere effort is required to eliminate terrorism and resolve the energy crisis which are the root cause of many problems in Pakistan.