Why can’t Pakistan eradicate polio?

A health worker administers polio vaccine drops to a child sitting on a motorbike

After a four month hiatus, Pakistan is set to restart its polio vaccination drive in the highest-risk regions in the country. Health officials aim to vaccinate over 800,000 children over five days in the districts of Karachi, Quetta, Faisalabad, Attock and South Waziristan. The vaccination drive will start initially in these areas where the polio virus has been spreading rapidly, before further planned campaigns are set to take place across the country towards the end of the year. 

Lockdowns initially imposed in March to combat the spread of Covid-19 have adversely affected health service delivery and led to over 700,000 children missing their scheduled vaccine doses. “Two major nationwide anti-polio drives have been affected by the coronavirus pandemic, which damaged our months-long momentum built to stem out the notorious polio virus from Pakistan,” said Dr Rana Muhammad Safdar, the chief of the government’s polio eradication programme. According to UNICEF, these disruptions could lead to devastating polio outbreaks in 2020 and beyond. 

Polio worker on a door-to-door vaccination drive in Pakistan
A health worker marks the finger of a child after administering polio vaccine drops during a polio vaccination door-to-door campaign in Lahore on July 20, 2020. (Photo by Arif ALI / AFP)

What is polio? 

Polio is an infectious disease caused by the poliovirus. Infection results in muscle weakness and can lead to muscle paralysis and lifelong joint deformities. It is highly contagious and commonly transmitted via the fecal-oral route through ingesting contaminated food or water. Once infected, there is no cure and therefore the vaccine remains the mainstay of preventative treatment. Global eradication efforts began in 1988, led by the World Health Organization (WHO) and UNICEF. This has resulted in the reduction of worldwide cases by 99.9% mainly through use of the oral polio vaccine. 

Over 100 rounds of vaccinations have been carried out over the last decade in Pakistan with the country consistently recording the world’s highest number of polio cases. It remains one of only two countries in the world where polio is still endemic; the other being neighbouring Afghanistan. In addition to Covid-19, which presents the biggest challenge this year, Pakistan also faces some recurring hurdles on its way to eradicating polio for good. 

Health worker administers oral polio vaccine to child in Quetta, Pakistan
A health worker administers polio vaccine drops to a child during a door-to-door campaign in the outskirts of Quetta on July 20, 2020. (Photo by AFP)

Challenges facing eradication

Fake news, political unrest and now the emergence of another highly infectious disease in Covid-19 mean Pakistan faces a plethora of challenges as it aims to eradicate polio. The most affected areas in Pakistan have been those not under complete government control such as the former Federally Administered Tribal Areas in the north. Misinformation campaigns have been propagated by the militant groups in these areas spawning fear and distrust in vaccination drives. A commonly propagated myth is that the vaccines are made out of pig fat or contain alcohol; two substances forbidden in Islam. As a result, local influential clerics have denounced the vaccines and thus people have followed. 

Over the last decade the Taliban has banned polio vaccinations in the areas where they exert control and influence claiming they are a western plot to sterilise local children. This was not helped by the CIA (Central Intelligence Agency of the US government) setting up fake Hepatitis B vaccination programs with the aid of local health officials, in its attempt to collect information about Osama Bin Laden’s whereabouts. As a result, in subsequent eradication campaigns, vaccination workers have been attacked, injured and killed by militant groups. Last year Pakistani authorities suspended the anti-polio campaign “for an indefinite period” across the country amid increasing violent attacks on polio workers.

Policemen stand guard as a health worker administers polio vaccine
Policemen stand guard as a health worker administers polio vaccine drops to a child during a polio vaccination door-to-door campaign in the Pakistan’s port city of Karachi on July 20, 2020. (Photo by Asif Hassan / AFP)

Recent campaigns have also been hampered by fake social media posts claiming numerous children had been killed by the vaccine. This resulted in thousands of parents refusing vaccinations for their children. The speed at which the misinformation has been able to spread coupled with low literacy rates and a lack of knowledge about immunisations has been catastrophic for Pakistan’s polio eradication agenda. Health officials report a “a three-fold jump in refusals by parents to vaccinate their children” in the last two years.

The highly patriarchal and religiously conservative nature of society in Pakistan means the father’s knowledge and views often determines all health decisions. For Pakistan to completely eradicate polio, efforts must be made to educate the population on infectious diseases and immunisations, especially in rural areas. Those that wield influence must be educated first to stem the propagation of misinformation. Pakistan’s ability to eradicate polio is also intertwined with its ability to exert governmental authority. For as long as militant groups wield power and influence, vaccination drives will continue to be suspended, vaccination workers will continue to be targeted and Pakistan’s children will continue to suffer.