Once on track for polio eradication, Pakistan now faces a setback as a result of inaccessibility, violence and misinformation

Pakistan is heading for one of its worst years for polio in recent times. According to figures from the global polio eradication initiative (GPEI), 166 cases of polio have been verified this year, compared with 28 at the same time last year.

This puts the country at significant risk of crossing the 199-mark officially recorded in 2000, or the 198 seen in 2011. It is a major setback for a country that as recently as 2005 saw only 28 cases in total, with everything seemingly on track for polio eradication. Last year there were 93 cases in the country, according to the GPEI.

The worst-affected areas, according to the state minister for the national health service, Saira Afzal Tarar, are the Federally Administered Tribal Areas (Fata) and Khyber Pakhtunkhwa province (KP), where militants often prevent vaccination.

“Pakistan presents one of the most complex polio eradication environments in the world,” said Ban Khalid al-Dhayi, spokesman for the UN Children’s Fund (Unicef). “In the areas that remain with poliovirus, there is inaccessibility, violence, misconceptions and misinformation that circulates every day, along with intricate tribal and cultural norms and systems.”

“Massive daily population movements” were also described as a major problem by Unicef.

Dhayi said the recent movement of more than 1 million internally displaced people (IDPs) following the military operation in North Waziristan Agency had raised fears of the virus spreading to areas that had not previously seen infections. More than 400,000 children were vaccinated at transit points as they moved out of the conflict zone in Fata and settled in host communities in KP, Punjab and Sindh. IDPs who settled in parts of Punjab due to floods could also increase risks.

While KP health officials based at the provincial polio control room (PPCR) in Peshawar agree that the IDP influx poses a polio risk, they disagree, according to media reports, that refusals (those refusing to be vaccinated) are declining, and blame UN communications authorities for this.

According to PPCR data, the number of refusals increased from 4,200 during the polio vaccination drive carried out between 6-8 June, to 12,043 during the vaccination campaign run from 23-25 June. Unicef, however, says they have separately seen a sharp fall in the rate of refusals, and claim successes for social mobilisation and awareness raising.

IDPs themselves appear keen to receive the drops: “I was desperate for my three young children to get them, and queued up with many others when vaccinators got here,” said Aziz Dawar, who fled North Waziristan in mid-June. His three children, aged between two and eight, had previously received no vaccinations.

Weak prevention systems

On 1 June, Pakistan enforced a World Health Organisation recommendation – seen as draconian by some – that anyone travelling overseas from Pakistan had to produce certification to show they had received polio drops, to prevent exporting the virus.

Before this move, the emergency coordinator for polio eradication in Pakistan, Elias Durry, explained, Pakistan had “informally been labelled” as an “exporter of polio” when strains of the virus originating from the country were found in China, Syria, Egypt, Israel and Palestine. “There needs to be no more import-export of polio virus for at least six months,” Durry said.

While officially polio teams are set up at airports to administer vaccination drops, in reality implementation has been reportedly patchy, with travellers saying they had been able to travel without receiving the drops.

“It’s all just on paper. No one really bothers with drops or certificates in reality,” said an official from Lahore airport, who asked not to be named. Shortages of vaccines have also held back campaigns.

Responding to this, Saira Afzal Tarar said: “A loan from the Islamic Development Bank that I had been campaigning for has now been obtained, so we should be able to deliver drops more efficiently.” The minister said the precise loan details, including the amount, were still being finalised.

Wrong approach?

“Our approach is not right,” said Anita Zaidi, head of paediatrics at Karachi’s Aga Khan hospital. She said the lone focus on polio had had a negative effect, and that the vaccine should be given alongside others.

At ground level, the message is still struggling to be heard.

“Why don’t we do something to stop our children from being crippled by this terrible disease?” asked Azra Bibi in Bannu. Her cousin’s infant son caught polio five years ago and can now barely walk. “We keep hearing of more and more cases.” She said she had to battle her parents-in-law to get her two daughters vaccinated.

“They said the drops would make them sterile, but I spoke to doctors and also schoolteachers who are educated, and I know this is a lie,” said Azra Bibi, who now visits an IDP camp to encourage mothers to vaccinate against polio. “I want to keep our children safe,” she said.