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Social attitudes need to change for Pakistan to be polio-free

Mass misinformation campaigns urging parents to refuse to give the drops to their children for fear of health concerns have gone from oral to digital now.

Pakistan has recorded at least 134 cases of polio in 2019, a sharp increase from 12 in 2018 and eight the year before. Rumours about adverse effects of polio vaccine and attacks targeting vaccination teams have hampered the country's efforts to eradicate the debilitating disease, which targets children and can cause paralysis or loss of limb function.
Mass misinformation campaigns urging parents to refuse to give the drops to their children for fear of health concerns have gone from oral to digital now. Anti-vaxxer videos from Europe are dubbed in Urdu, and then promoted online. Last year, Pakistan successfully removed at least 174 pieces of content promoting misinformation by social media websites.
Since 2012, at least 98 people - seven out of them last year - have been killed in attacks targeting vaccination teams. Suspension of the anti-polio drive last year after attacks on polio teams made around 250,000 children miss their vaccination. Population mobility internally and across Pakistan and Afghanistan too has made it hard to reach all children for vaccination.
And so, despite more than 260,000 staff, guarded by 100,000 security personnel, taking part in each drive to reach more than 35 million children across the country of 207 million people, the disease remains endemic in Pakistan, alongside Afghanistan and Nigeria. Nigeria has had no case since 2016 though.
Pakistan's government says it will place more focus on 40 super high-risk polio-endemic union councils - 18 in northwestern Khyber Pakhtunkhwa and 14 in southwestern Balochistan province and eight in Pakistan's largest city of Karachi in southeastern Sindh province - and is planning an integrated package of anti-polio services to them. Last year, the government formed the National Strategic Advisory Group (NSAG) with representatives from leading political parties who have worked on polio eradication programmes in previous governments. The United Arab Emirates (UAE) is helping Pakistan eradicate polio through its Emirates Polio Campaign, implemented through the UAE-Pakistan Assistance Programme (UAEPAP). The campaign targets 16 million Pakistani children every month.
But the challenge is getting complex. The Global Polio Eradication Initiative reports Pakistan is the only country with consistent barriers preventing vaccination and the eradication of the disease. Vaccinating children requires a well-thought-out plan. A casual approach has not delivered. The National Institute of Health in Islamabad has confirmed presence of polio virus in two female children from Dera Ghazi Khan who had received multiple doses of oral polio vaccine (OPV), yet they failed to develop immunity against the virus. They, however, were not given inactivated polio virus (IPV) injections.
Experts say first four doses in routine immunisation are vital and these cannot be covered through multiple doses at a later stage. Also, malnutrition and co-morbidities such as diarrhoea, dysentery, and fever also cause children to get affected by polio even after receiving multiple doses of vaccine. With weak immunity, they fail to produce antibodies (shield against polio) from the vaccine. Not immune, they can get polio if attacked by the virus. Maintaining cold chain, improving diet, and monitoring condition of children before and after administering polio vaccine are a must. Vaccine is useless if administered to a child with bad stomach or if they vomit after getting the dose. Training of vaccinators is vital here.
Hesitation of a large proportion of the general population to vaccinate their children is still a major hurdle. Data from the Khyber-Pakhtunkhwa Health Department show that in 2019, 1,089,087 parents refused to allow health workers to administer the polio vaccine to their children. The highest number of refusals - 694,984 - occurred in April, likely attributed to an outbreak of hysteria over the vaccine after rumours spread of children being poisoned by the vaccine, resulting in vomiting, and loss of consciousness. The since-debunked rumours led to thousands rushing to hospitals to get their vaccinated children examined, while those who were yet to receive vaccinations rejected them en masse. Authorities said dozens polio workers were beaten, stoned, and harassed following the spread of the fake news, with rioters even burning one health clinic to the ground. The government managed the matter by arresting the key conspirator involved in rumour-mongering. However, the government has to fight off people's mistrust in several other areas based on the lack of awareness.
Such behaviours need to change, as a part of a holistic strategy addressing misperception, insecurity, ill-planning, and malnutrition, before the country kills the virus that continues crippling its kids, its future.
Waqar Mustafa is a Pakistan-based journalist and commentator associated with Jang Group of Newspapers