Recent Surge in Polio Cases in Pakistan Necessitates Urgent Review of Strategy

by
Pakistan is one of the three polio endemic countries and recent surge in cases shows that eradication of the disease demands an urgent change in strategy. A look at previous five year cases in Pakistan shows a positive progress in reduction of new polio cases; from 307(2014) to 12(2018), but new cases still appeared in almost every province. The reasons behind this country wide presence of disease can be attributed to internal displacement due to conflicts, weak health systems and operational and resource risks. But the alarming increase in number of new polio cases during 2019 has reversed the whole progress made so far as the number of new cases as of today stands at 53. 32 out of 53 cases are reported from KPK region, which had observed massive internal displacement during last decade but the number of IDPs has decreased from last two years due to stability in the region. This recent surge in polio cases in the the province is mainly due to increase in vaccine refusals due to rumors regarding side effects caused by the vaccine on social media. Official sources reported that after rumors refusals to vaccinate increased by 85% in the province. But high number of cases in other provinces when compared with last year cases indicate that multiple factors are hindering the progress towards containment and eradication of the polio virus disease from the country, which can be attributed to homelessness and poor sanitation, operational issues for vaccine delivery, conflicts, cross border movement etc.

This situation demands urgent review of existing strategy for polio eradication as number of new cases are increasing rapidly. There is a need to work on multiple aspects to make the anti-polio drive successful; some key aspects include detailed geo-mapping of the population at basic level and identification of missed areas to ensure every child is vaccinated, involving community and religious leaders, NGOs, CSOs for confidence building and education of the community, expansion of partnership with nutrition, hygiene, water sectors, and robust rebuttal of rumors and strict action against those involved in such heinous activities etc. There is a new political government of helm, which is sensitive to the social sector issues and taking measures to provide homes, health facilities and education to the disadvantaged sections. International agencies (GPEI, WHO) shall coordinate with the political government to review the existing strategy for revamping it, so that not only the current surge can be contained but the disease can be eradicated from the country to achieve the target of polio free world.

screen-shot-2019-08-18-at-9.26.13-am poliopolio 2

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3 Responses to “Recent Surge in Polio Cases in Pakistan Necessitates Urgent Review of Strategy”

  1. gjanjesmith Says:

    Thank you for highlighting this important issue. I think refusal to vaccinate because of fear of side effects is a very difficult hurdle: It is very challenging to convince parents who truly believe that they are protecting their children from something harmful to change direction and expose their children to that very thing. Even if the operational and resource issues are resolved, the challenge remains if the parents/families still believe to their core that vaccines are harmful.

  2. Recent Surge in Polio Cases in Pakistan Necessitates Urgent Review of Strategy | Tropical Health Matters Says:

    […] part of the course on Social and Behavioral Foundations in Primary Health Care, Muhammad N Asghar posted in the class blog. We have shared these thoughts […]

  3. nefltas Says:

    Thank you for this fascinating read!

    I noted in your introduction that you had mentioned Nigeria among the countries where global polio elimination efforts have been unsuccessful. On a positive note, it was encouraging to see numerous news outlets this week celebrate that Nigeria has just marked its third year without reported cases of wild-type poliovirus: https://www.bbc.com/news/world-africa-49426886.

    Your thoughtful research on vaccine refusal among communities in Pakistan also reminds us of the importance of community diagnosis, and how community distrust is often about so much more than just the vaccine itself. As we’ve learned the hard way with vaccine refusals in the context of the current eastern DRC Ebola response, for example, the poorest and worst off who are the beneficiaries of campaigns for free vaccination sometimes understandably wonder why, amidst their wide-ranging problems from lack of clean water and sanitation to no basic, available primary health care, and where children are dying daily from other preventable diseases like pneumonia and diarrhea, has someone suddenly showed up at their door to offer a single intervention? While not always possible due to resource and logistics constraints, some initiatives have aimed to respond to such concerns by adding a single, low-cost, routine intervention (e.g., Vitamin A supplementation for children) or coupling campaigns (e.g., bednet distribution), to help build community trust in the government’s concern for broader health and development needs. There are also many lessons learned from contexts like (esp. urban) India, which once faced many similar challenges to those of Pakistan in the fight against polio. This 2018 CSIS report (https://www.csis.org/features/social-mobilization-polio-eradication) summarizes some of those critical lessons from the India experience—including around the impact of using a Social Mobilization Network of thousands of community-based women volunteers to individually meet with caregivers, not just to explain the vaccine but also to host health counseling groups on issues beyond just polio, as well as leveraging social mobilizers to recruit respected local influencers from those communities (e.g., religious leaders and teachers) to serve as champions for polio vaccination (also noted by one of the commenters above). With the India experience—just as with the current eastern DRC Ebola experience—it was critical that community engagement and ownership of vaccination campaigns, not simply community awareness-raising, were driving these efforts (https://coregroup.org/wp-content/uploads/2018/07/Polio-Learnings-in-DC-7-17LB1.pdf). Equally important was that the “face” of these efforts not be that of “outsiders,” which might mean not only international NGOs but even government/Ministry of Health staff from outside that community or district.

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