Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the global incidence of poliomyelitis has fallen by nearly 99 %. From a situation where wild type poliovirus was endemic in 125 countries across five continents, transmission is now limited to regions of just three countries – Pakistan, Afghanistan and Nigeria. A sharp increase in Pakistan’s poliomyelitis cases in 2014 prompted the International Health Regulations Emergency Committee to declare the situation a “public health emergency of international concern”. Global polio eradication hinges on Pakistan’s ability to address the religious, political and socioeconomic barriers to immunisation; including discrepancies in vaccine coverage, a poor health infrastructure, and conflict in polio-endemic regions of the country. This comprises focusing on the historical and contemporary challenges facing Pakistan’s polio eradication programme and the impact of conflict and insecurity, and sheds light on strategies to combat vaccine hesitancy, engage local communities and build on recent progress towards polio eradication in Pakistan.
Pakistan’s polio eradication programme has come under international scrutiny due to its position as the main driver of global wild poliovirus spread in recent years. This is rooted in financial and organisational deficits, as well as active conflict and insecurity, which has resulted in the persistent failure of effective immunisation campaigns and SIAs to reach all areas of the country.
Two types of vaccine protect against polio: oral poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV). Poliomyelitisis a crippling and potentially deadly infectious disease. It is caused by the poliovirus. The virus spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis (can’t move parts of the body).
Most people who get infected with poliovirus (about 72 out of 100) will not have any visible symptoms. About one out of four people with poliovirus infection will have flu-like symptoms that may include—sore throat, fever, tiredness, nausea, headache, stomach pain. These symptoms usually last two to five days then go away on their own.
A smaller proportion of people with poliovirus infection will develop other more serious symptoms that affect the brain and spinal cord: paresthesia, meningitis, paralysis or weakness in the arms, legs, or both, occurs in about one out of 200 people with poliovirus infection
Paralysis is the most severe symptom associated with polio because it can lead to permanent disability and death. Between two and 10 out of 100 people who have paralysis from poliovirus infection die because the virus affects the muscles that help them breathe.
Even children who seem to fully recover can develop new muscle pain, weakness, or paralysis as adults, 15 to 40 years later. This is called post-polio syndrome. People with the paralytic infection are considered to have polio only.
Poliovirus only infects humans. It is very contagious and spreads through person-to-person contact. The virus lives in an infected person’s throat and intestines. It enters the body through the mouth and spreads through contact with the faeces of an infected person and, though less common, through droplets from a sneeze or cough. You can get infected with poliovirus if you have faeces on your hands and you touch your mouth. Also, you can get infected if you put in your mouth objects like toys that are contaminated with faeces.
An infected person may spread the virus to others immediately before and about one to two weeks after symptoms appear. The virus can live in an infected person’s faeces for many weeks. It can contaminate food and water in unsanitary conditions. People who don’t have symptoms can still pass the virus to others.
Polio vaccine protects children by preparing their bodies to fight the polio virus. Almost all children (99 children out of 100) who get all the recommended doses of vaccine will be protected from polio.
The best way to protect against polio is to get the polio vaccine, also called IPV (or inactivated poliovirus vaccine). Doctors recommend all children get the vaccine.
Pakistan is the most populous country in the WHO’s Eastern Mediterranean Region and one of the least developed, with a large population of approximately more than 200 million people including 30 million children under five years old and 70.2 million children under 15 years old, making it critical to polio eradication efforts.
There is a strong correlation between low immunisation completion and negative socioeconomic factors, in addition to conflict, such as illiteracy, poverty and difficulty accessing community health and immunisation services. Pakistan faces all of these challenges coupled with a difficult geography, from the Himalayan mountain range and glaciers of the north to the harsh terrain of Balochistan in the south, contributing to poor public health delivery. Additionally, less than 2 % of the Gross National Product (GNP) is spent on healthcare.
There are concerns regarding OPV efficacy. There is also vaccine hesitancy. Cultural issues such as the presence of all-male vaccinator teams when the mother is alone, or when family or community elders have not given consent for vaccination have also been cited as important barriers to immunisation in some communities. In spite of conflict, militancy and the multitude of challenges facing Pakistan’s polio eradication campaign, the annual number of polio cases has declined by more than 90 % since 1994. Conflict and insecurity in KP and FATA led to a dramatic rise of reported paralytic polio cases in Pakistan.
However, different strategies can improve the polio eradication campaign like: strengthening Pakistan’s health infrastructure; community engagement and education; prioritising vaccination in polio-endemic regions and by adhering to global health policies.