The South Asia Channel
Pakistan’s war against polio
This week, Pakistani President Asif Ali Zardari put the fight against polio at the forefront of his domestic agenda, announcing emergency measures to vaccinate 32 million children at risk of the disease. Pakistan is one of four countries in the world to continue to suffer serious incidences of the disease, and this new attention to ...
This week, Pakistani President Asif Ali Zardari put the fight against polio at the forefront of his domestic agenda, announcing emergency measures to vaccinate 32 million children at risk of the disease. Pakistan is one of four countries in the world to continue to suffer serious incidences of the disease, and this new attention to polio eradication shows how far the world has come in battling the disease, while also showing the serious challenges standing in the way of eliminating it forever.
The global campaign against polio, a debilitating, paralytic disease, has been recently reinvigorated by the success of a new vaccine trial in India. This new vaccine garners an improved immune response than currently-used vaccines, known to be ineffective even with multiple doses. It also has a low risk of break-through wild-type strains that exists with contemporary vaccines. These results, published in the medical journal Lancet, mean that this vaccine is poised to be the weapon of choice to potentially close out the protracted global polio eradication endgame that has shaken the resolve of many in the public health community, some of whom have questioned the possibility, sustainability, even the ethics, of eradication.
The global campaign against polio is a poster child for the success of biomedical science and public health. Polio once paralyzed more than sixteen thousand children in the United States annually, a thousand children a day globally. Due to the advent of universal vaccination, the Western Hemisphere has not witnessed an indigenous polio virus infection since 1991. Yet on the other hand, polio continues to infect children in less-developed parts of the world; 1,604 were infected in 2009, and 747 cases have been reported this year. Polio remains endemic in four countries – Afghanistan, India, Nigeria and Pakistan. Of these four, Pakistan has accounted for 60 percent of cases this year, and it is likely, that any road to polio eradication passes through Pakistan, especially the restive war-torn tribal areas abutting Afghanistan.
One of the biggest challenges facing polio eradication in Pakistan has been the recent flooding in the country’s heartland, which has affected up to 20 million people, in a country of nearly 180 million. These floods have displaced millions of children from their homes, making them very difficult to access for vaccinators. In a recent epidemiological survey by the World Health Organization, half of reported polio patients were from flood-affected regions. Relief camps, now home to millions displaced from their homes, are dens of infection due to the close proximity quarters, poor sanitation conditions and a general disruption of hygienic measures. Children in these relief camps are particularly at risk for polio since polio, which, like diarrhea, is spread by contaminated food and water.
The war in the tribal areas bordering Afghanistan also remains a major hindrance to polio eradication. The Taliban have labeled vaccination as a means of sterilizing Muslim populations and have prevented vaccinators from accessing children in the tribal regions. After several incidents of beatings and violent threats failed to thwart vaccinators, the Taliban assassinated the head of the government’s vaccination. In doing so, they have provided a ‘safe haven’ for this disease to proliferate in the country, and half of all current cases have occurred there. Furthermore, scientists have noted that there is free movement of the polio virus between the tribal areas of Pakistan and Afghanistan that shadows the free movement of people on both sides of the border. It thus becomes clear that the fate of both the global war against terrorists, and that against polio, lies in the border regions on either side of the Durand Line.
After the successful eradication of previous infectious diseases such as smallpox, much hope was attached to the eventual eradication of polio. Since 1988, the global polio eradication initiative has reduced the incidence of polio by 99 percent. However, the eradication of that last one percent of polio cases has been much more exhausting than expected. This has led to several stake holders voicing the case for restricting the number of global cases to less than 500 annually as opposed to complete eradication, such as that for smallpox. However, several bright spots exist which allow great room for optimism for a polio-free world. Great progress has been made in Nigeria and India with a precipitous drop in cases since last year. The Global Alliance for Vaccines and Immunizations (GAVI), led by the Bill and Melinda Gates fund, have been a game changer, channeling billions into the immunization programs of developing countries and funding ground breaking research worldwide. Agencies such as the World Health Organization (WHO) and UNICEF have also been at the forefront of eradication efforts. In Pakistan, WHO has mobilized thousands of its workers to provide vaccination services in the 45 worst-affected districts, with routine national immunization going ahead as well. The aforementioned bivalent vaccine might be just the arrow in the quiver that the world was waiting for to finally put an end to polio.
The Pakistani government, however, must raise its game and arm their soldiers, amongst other things, with vaccines. Along with other misconceptions of the locals that must be confronted, fear of vaccination is of particular importance. While it is commendable that the global polio eradication initiative has made the world forget about the horrors of paralytic polio, they have a significant role to play in what is now effectively the final push to ensure no child lives a life terrorized by the horrors of this disease.
Haider Warraich, MD, is a research fellow at Harvard Medical School. He is a graduate of the Aga Khan University in Karachi, Pakistan, and the author of the forthcoming novel, Auras of the Jinn.