Polio &Vaccine Bill Brieger | 23 Aug 2024 09:18 am
Polio Eradication in Pakistan, an Update
On August 20, 2024, Yasir Ahmed Posted this blog about polio challenges in the class blog of the course, Social and Behavioral Foundations of Primary Health Care at the Johns Hopkins Bloomberg School of Public Health
Pakistan and Afghanistan are the only countries in the world reporting wild type polio virus cases. Polio is a crippling disease that does not have any cure but it is preventable through immunization. The detection of wild-type virus in wastewater suggests 2024 target of ending all wild virus transmission will be missed. 6 cases were reported in 2023 and 14 have been reported this year so far. According to a report by IMB, an estimated 300,000 children have been consistently missed in vaccination activities in Pakistan and in the East region of Afghanistan. Disinformation, false beliefs and mistrust on the government and administration, refusal, not understanding the importance of vaccines, and low general literacy and health literacy etc. are among the important factors contributing to these missed opportunities.
In addition to the above-mentioned factors, insecurity, movement across the porous 2400 kilometers long Pakistan-Afghan border, and poor water and sanitation and waste management are the contributing factors. I believe that the missed opportunities to reach and vaccinate these children has a major role in the spread of poliovirus along with poor water and sanitation in these areas.
The program uses four distinct risk tiers to classify areas according to the risk they present and to devise risk appropriate strategies. Core reservoir districts (or Tier 1 districts), high-risk districts (or Tier 2 districts), vulnerable districts (or Tier 3 districts), and low-risk districts (or Tier 4 districts). Most of the tier 1 and tier 2 areas are located on the western border aka Pakistan-Afghan border (upper parts on the map).
Pakistan Polio Eradication Program is an initiative that is driven by the largest surveillance network in the world (up to 339,521 trained and dedicated polio workers), quality data collection and analysis, behavioral change communication, laboratories, and epidemiologists and public health experts in Pakistan, working with experts and local and international stakeholders. The government started National Emergency Action Plan for Polio Eradication in 2010, which runs supplemental immunization activities on regular basis to reach every child in Pakistan. As a result, a huge decline in the number of polio cases is seen since the 90’s. The World Health Organization (WHO) and UNICEF along with other key partners of the Global Polio Eradication Initiative, has been a very supportive to the Government of Pakistan in polio eradication. Gavi the vaccine alliance, the Center of Disease Control (CDC), Rotary International, and Bill and Melinda Gates Foundation are important stakeholders that provides major financial, technical and field support.
A Polio-worker is pictured giving an oral polio vaccine during an immunization campaign.
Innovative approaches are required to reach the children missing vaccinations including:
- Expanding the network and improving data collection and surveillance, targeting the areas of high density with polio cases e.g., the tribal areas along the porous Pak-Afghan border.
- Mandatory vaccination at border crossing.
- Increased security for the polio workers.
- Taking local religious and community leaders and scholars on-board to counter disinformation and false beliefs.
- Continuation and strengthening of National Emergency Action Plan for Polio Eradication by the government of Pakistan.
Continued efforts and support from the local and international stakeholders as we are getting very close global polio eradication.