Pakistan And The Curse Of Poliovirus

     

              A BATTLE WITHIN REACH

We are among the three remaining polio-endemic countries in the world still being haunted by this century-old curse. The sad part? The witches have already cooked up the potion, they have come across the solution and tried it successfully. Pakistan's battle against poliovirus is multifactorial. The intersection between health illiteracy, religious extremism, and violence against the vaccinators have all put a halt to this chapter's conclusion. 

THE ENDLESS CAMPAIGN

In 1974 Pakistan launched its Polio Immunization Program, but efforts for eradication officially started in 1994. WHO backed the program to combat the six-vaccine preventable diseases. Since then, the battle against this crippling disease has seen many ups and downs. The endemic remained active despite hundreds of rounds of vaccination. Regardless of having one of the largest networks of skilled polio workers in the world, the virus persisted. 

Despite WHO's prediction to uproot the virus by 2000, the rate of vaccination staggered. Inadequate national strategies for immunization were the cause of the vaccine failure as per the research conducted by the Center of Disease Control (CDC). Organizations such as WHO, UNICEF, and the Bill and Melinda Foundation joined hands and devised extensive eradication campaigns including door-to-door vaccination. 

The endless campaigns led to many conspiracy theories and made the public weary. Each round of immunization drive to rid Pakistan of poliovirus lasted usually three days but we still haven't reached our goal of polio-free Pakistan. 

POLIO RESURGENCE IN THE SHADOW OF WAR

The reign of terrorism in Pakistan in 2010, hindered the progress made in the protracted polio eradication program. When the CIA confirmed the hideout of Osama Bin Laden in Abbottabad by using the hepatitis vaccination campaign as a ruse, the militant groups that were already against the vaccination got the green light on their suspicions. The aftermath of that global chasedown was that the Taliban’s assassins started targeting polio vaccinators as a retaliation, killing at least 70 polio workers.  

The strongest opposition came from the areas that took the worst burn of the terrorism. Tragically those areas were also the highest hit by the polio endemic. The militant groups continue to thwart the success of vaccination program in Quetta, Pishin, Kila Abdullah Districts, FATA (Federally Administered Tribal Area), Khyber Pakhtunkhwa and the neighboring areas of Mardan, Charsaddah and Lakki Marwat. The result of regional instability was that in 2014, the number of polio cases reached 306, the highest it has been since 2000. The fallout of Operation Neptune Spear was that it sowed a seed of suspicion in a population that already considered vaccination unimportant

MISINFORMATION AND CONSPIRACY THEORIES

Despite the global demonstration of the vaccine’s efficacy, the misinformation and hesitancy persist. The assertions that vaccine drops are part of an elaborated Western plot to sterilize Muslims or the cleric's erroneous claims that they contain ingredients derived from pigs or alcohol have adversely affected the vaccination process.  

Despite being the ultimate key in the public inoculation drives, the woman healthcare workers faced brutal violence in their efforts to eradicate the virus. The idea of female workers going door-to-door was offensive to not only the Taliban but also many Islamic preachers in mosques who shared and echoed their opinions. Many clerics delivered fatwas against it. 

To keep a close check on the radial availability of vaccines to far-flung areas, health authorities cooperated GPS trackers on the vaccine coolers. This backfired in 2004 when the U.S. began its drone strike in tribal areas. The vaccinators were regarded as spies, collecting information for the West. In 2019, midst of a mass panic, over 20,000 children were rushed to hospitals due to baseless rumours of vomiting and fainting caused by the vaccination. The recent revival of polio in 2022, was due to the false marking of children’s fingers by the vaccinators, an attempt to help the parents avoid the vaccination. 

To counter the misinformation, a documentary, Polio True Stories, was aired on multiple television networks to make people aware of the life-saving effect the vaccination has. In 2015, multiple arrest warrants were issued against parents and guardians who opposed vaccine administration. The government launched the Pakistan Polio Eradication Initiative, to advocate the importance of vaccination. 

POLIO FREE: A DREAM WITHIN REACH

In January 2022, we clocked in a year without any case of Poli-virus. A historic moment that lasted only a few months. Polio resurfaced and a 15-month-old’s fate was sealed with this brutal reality in North Waziristan. 

Despite aggressive efforts to eradicate polio, it remains a haunting truth for many in Pakistan. There are many factors that have played a pivotal role in the ineffective removal of poliovirus from our society. Malpractices in intuitions, leaching of resources, poor public-sector funding, and lack of transparency are among the many causes that have promoted the spread of poliovirus. In addition to that, last year’s catastrophic deluge and the flash floods that followed disrupted the nationwide polio camping. In the wake of the natural calamity, many healthcare facilities were damaged beyond repair. Poor health and water sanitation infrastructure added fire to polio’s transmission. 

Although these complex challenges created hurdles in the path, polio eradication remained a priority with a uniform consensus to get the country free from its shackles. Efforts are being made to ensure social mobilization and community engagement against poliovirus. To improve the trust in the Pakistan Polio Eradication Programme strategies have been devised to engage the stakeholders and influencers to dispel the misconception surrounding the vaccine efficacy and safety. A synergy is built with the Expanded Programme on Immunization with the broader perspective of providing expanded packages of health, nutrition, and WASH services. 

Despite the shortcomings of having a fragile healthcare system, complex conflicted territories, and a conservative societal thinking pattern, the battle against Poliovirus needs a nationwide sense of urgency. The exhaustion after committing to this fight for three decades is understandable. But we must witness the end of this cruel and crippling chapter once and for all. We can only move forward and choose perseverance as our weapon of choice and hope for a future where no child must live their lives in a world disadvantage with a disease that is easily preventable.