The World Health Assembly (WHA), the annual meeting of the Ministers of Health of all WHO member states, first committed itself to polio eradication in 1988. 350000 cases /year in 125endemic countries in 1988. The assembly called for the worldwide eradication of the disease by 2000.
Poliomyelitis (Polio) is a highly infectious viral disease, which mainly affects young children. The virus is principally transmitted by oral-fecal route or through the contaminated food and water. It invades nervous system and causes permanent paralysis. Unfortunately there is no cure for polio; it can only be prevented by immunization.
After the discovery of polio vaccine in 1950s, polio virus was successfully eliminated from the world especially in the developed world. Yet, polio virus is endemic in three countries i-e Afghanistan, Nigeria and Pakistan. Meanwhile, only seven cases reported in war-torn Afghanistan and Nigeria is on the verge to become polio-free soon, the number of polio cases reported in Pakistan in 2019 is staggering 77 with more than 50 cases in Khyber Pakhtunkhwa (KPK) alone. KPk is also named as the largest reservoir of wild-polio-virus (WPV) in the world. In a country where population growth rate is highest (2.4%) and around 2.47m children are under the age of five years, the devastations by the polio virus are becoming inevitable.
However, the main causes for the widespread polio virus in Pakistan are unplanned urbanization and housing schemes, poor sanitation and hygiene conditions, worst sewerage system, open defecation in rural areas where 2/3rd of population resides. There is the sheer paucity of education and awareness among the general population about the polio virus spread, symptoms, impacts on body and vaccination schedule essentially.
Despite, Pakistan is spending much on the polio-vaccination programs i-e 7.83 billion allocated for EPI last year; we are far from having any tangible results. Therefore, there are no monetary obstacles in this regard. When other Muslim countries (KSA and Iran) can work through the effective vaccination campaigns with the help of religious intellectuals and more culturally similar countries (i-e Bangladesh) can be among the world’s vaccination stars, we have nothing to blame for our title of the most dangerous country in the world for the newborns as 95% polio cases are reported in the children of less than five years of age.
The main problem lies in the political will, continuity of the policies and setting the priorities right. We have leadership vacuum, weak surveillance system, absence of focus on the prevention rather than spending on the disease treatment, low quality vaccination, ill-trained and under paid vaccination staff, limited access to the far-flung areas due to severe weather or security reasons etc. Further, the clandestine use of fake vaccine campaigns in the past has damaged its credibility at large.
There is no concept of educating parents about the after-effects of the vaccine like mild fever etc. There are no proper vaccination follow-up centers to stay in touch with the people. Factually, we have failed to address the fear of vaccine-led-infertility, concerns about effectiveness of vaccines and its cold-chain delivery system. One must not wonder why the polio-vaccine refusal cases are continuously on the rise in the state.
One cannot doubt the importance of prevention of a disease. Thus, in case of polio, prevention stratagem must be outlined first. This goal can be achieved by providing low cost housing, revamping sewerage system, assuring safe drinking water, building latrines in villages and mass awareness etc. Apart from that engagement of social and print media to counter the negative-propaganda, providing proper vehicle system and incentives for the vaccinators during the hot weather would also be helpful. Authorities rather than pushing must pull the people in this drive through the prudent monitoring policies, risk-analysis and regular surveys to allay the atmosphere of mistrust between state and the people pertinent to the polio vaccination programs.
We have to consider our own socio-cultural aspects while adopting and executing the successful international policies. We can implement the so-called “Think Globally, Act Locally” formula of Bangladesh. We can mobilize our community and religious scholars to shape the public opinion. The use of Information Technology and Artificial Intelligence in health sector for mapping and micro-planning at the sub-district level to target the poorest and remote and conflict areas in the first place. The EPI centers from the community level to BHUS, RHC to the teaching level & Integrated with Polio Monitoring information system (PMIS) for the nation-wide coverage. The regular immunization with the constructive strategies and involving the young volunteers and media to educate the populace could serve the purpose. Parent education must be at the heart of the polio eradication programs. Additionally, the vaccinators must be recruited from the local community and trained to inculcate the strong commutation and public dealing skills. The importance of post vaccination surveys and routine National-immunization-Days (NIDs) cannot be overruled to earn the polio-free status.