Pakistan remains as one of the three countries yet to eradicate the poliovirus along with Nigeria and Afghanistan on the list, according to the World Health Organization (WHO). In the last decade, Pakistan has come a long way towards the eradication of Polio. The aggregate of the virus is seen to be declining from 306 cases in 2014 to 54 cases in 2015 to 8 cases in 2017 and 12 cases in 2018. Alarmingly, Pakistan polio eradication programme reports an increase in cases this year at 64 cases as for September 2019.
The core reservoirs for Polio in Pakistan are identified to be Peshawar-Khyber, Karachi and the Quetta block (NEAP) of which only Quetta reported a polio case in Killa Abdullah in December 2016 while this year again 5 new cases have surfaced, two of which have been reported from Jaffarabad and Killa Abdullah.
Despite the dedication of authorities and taskforces to the eliminate poliovirus, it remains a difficult task in Pakistan because of certain parameters that hinder the polio vaccinations campaigns.
The most important reason – the lack of awareness among the community towards polio vaccination, which has led to the growth of political unrest, mistrust, increasing militancy and deteriorating security conditions which are now acknowledged as common factors that threaten polio eradication efforts in Pakistan. In this context, there have been many attacks on the polio workers, law enforcers and UN agencies involved in the anti-polio campaigns.
Religious opposition stands as another very important factor for the drop-out rates of polio immunization in Pakistan. There is still a big need to gain the support of the religious authorities and Muslim influencers to play their special role in helping Pakistan eradicate Polio and stand parallel with the world that has already swiped polio.
Other strong factors to postulate are incompetency in provision of healthcare facilities that include parental difficulty to access healthcare and inadequate supervision of healthcare staff such as for vaccinations.
There have been very few researches to explain why Balochistan has drop-outs in polio vaccination campaigns. However, some recent studies point out some reasons for failure of Polio immunization campaigns in Balochistan that include poor infrastructure, low literacy ratios, political unrest and inaccessible population distribution in most areas of Balochistan.
A 2015 study coauthored by a researcher from University of Balochistan highlights rigid attitude and bad perception towards the disease among residents of Quetta and Peshawar. Considering the tribal lifestyle of people in Balochistan, the need to aware the elders of the family is still prevalent since the elders are the decision makers in the socio-cultural norms of the region. Moreover, religious and social beliefs of the residents of the area appear to be the major hurdle preventing the disease from eradicating from the region.
Another important reason in context of Balochistan is the lack of taskforce for the door to door campaign in the form of LHWs and LHVs, according to local Public health experts. The workers who are engaged with the health department’s polio campaigns are often seen protesting for their genuine demands of finance and security etc. In 2018, few students from Bolan Medical College, Quetta researched on finding specific issues faced by LHVs in Quetta and they indicated the following: victimization and harassment by pedestrians and public, character calling, lack of trust among public towards LHVs labeling them as agents, delay in provision of pay to the LHVs and non-cooperation of departments in solving their issues.
A year ago, the Prime Minister Imran Khan was seen promising decreasing childhood mortality as a top priority of his government. Yet, no changes or new strategies have been seen to come for child health services delivery or improvements in routine vaccination including the polio eradication strategy. Public health experts in Pakistan are now suggesting new plan of actions to tackle with the Polio issue such as collaborating with neighboring country Afghanistan. Collaborative efforts could help in breaking the reservoir chain of polio virus that for known reasons of migration effect both sides of the border causing spikes in polio cases.
Very recently in August 2019, the PM has shown huge concern over polio statistics in Pakistan and has ordered the Federal Ministry to campaign further starting from November 2019. It is also notable to mention that PM’s interest on the matter of polio eradication was praised by Multimillionaire Bill Gates in a letter of appreciation on behalf of the Bill and Melinda Gates Foundation.
Nonetheless, it will be an overestimation to say that Pakistan is coming close to its goal of eradicating polio considering this year’s huge spike in number of cases. However, with proper implementation of eradication strategy and incorporation of new plan of actions, the goal can be achieved in near future.