Illiteracy, superstition, poverty mar Pakistan's fight against polio

Scores of police and health workers were killed on polio duty. But security has improved significantly.

We had just returned from our village after a Spring break in the early eighties. My youngest siblings - aged a year and a half then - looked fatigued with flu-like symptoms. We took him to a doctor who after the check-up, declared the ailment as polio, a contagious disease caused by a virus that attacks the nervous system. The World Health Organisation (WHO) had started the Expanded Programme of Immunisation (EPI) in the 1970s in Pakistan to combat deaths from six vaccine-preventable diseases. Yet, the EPI had vaccinated just two per cent of the population against polio by the early 1980s and we, living far from the covered areas, were not among the ones immunised against the crippling disease.
Since the launch of Pakistan's Polio Eradication Programme in 1994, the number of polio cases has dropped from about 20,000 a year in the early 1990s and 306 in 2014 to only 12 in 2018. Two polio cases have been reported so far this year making Pakistan one of three remaining polio-endemic countries in the world, along with Afghanistan and Nigeria, largely because illiteracy, militant threats and deep-rooted superstition hamper vaccination efforts. "We have been getting 95 per cent results in our campaigns for a long time. The only problem is, the five per cent of children that are missed," a television channel quoted Babar Atta, the Prime Minister's Focal Person on Polio Eradication, as saying.
According to a research by Shoaib Fahad Hussain, illiteracy, poverty and difficulty in accessing community health and immunisation services and a difficult geography, from the Himalayan mountain range and glaciers of the north to the harsh terrain of Balochistan in the south, contribute to poor public health delivery. A video of an anti-polio worker in Pakistan walking through waist-deep snow to administer vaccines to children went viral on social media gathering praise from humanitarian groups. Yet the amateur video showing the health worker in a remote area of Swat district, northwestern Khyber Pakhtunkhwa province, also highlights the odds health workers face to reach children during the anti-polio drives. Militants have frequently targeted anti-polio vaccinators who go door-to-door in several parts of Pakistan claiming that the drops to immunise children against the crippling disease are a Western conspiracy. Scores of police and health workers were killed on polio duty. But security has improved significantly.
Vast differences in the country's population density also present challenges to the polio eradication campaign - with densely populated cities such as Lahore and Karachi presenting the risk of a rapid spread juxtaposed with the sparsely populated and heavily mountainous Balochistan province. In December last year, the poliovirus was discovered in the sewage of Karachi and seven other populous Pakistani cities.
Parental refusal also hinders the vaccination campaign due to misconceptions that vaccines can harm or sterilise children, or contain monkey-derived products. While the clergy has recently been coming out forcefully in support of immunisation, the provincial governments have also introduced strict measures to enforce the mandatory vaccination of all children. Yet, a recent province-wide vaccination campaign in Sindh failed to immunise 175,000 children; with 86,000 parents denying vaccination and parents at 88,472 houses announcing their children were not home. Frequent power outages and the scarcity of equipment in Pakistan also make it difficult to maintain the cold chain necessary for the vaccine's efficacy.
Attitudes and perceptions towards polio vaccination are shifting. For my brother, the doctor prescribed a drug that is now used as a dietary supplement for children. I might sound a bit orthodox, but my brother would chew garlic cloves while our mother prepared food for us. I am not sure what worked, but by the grace of God, he recovered. He doesn't let pass the vaccination dates of his children. Nor does he miss any immunisation campaign!
Waqar Mustafa is a journalist and commentator based in Lahore, Pakistan