Fighting Pakistan’s lingering polio problem

Last December, I traveled to Peshawar, ground zero in Pakistan’s fight against polio. As the capital of Khyber-Paktunkhwa (KP) and the Federally Administered Tribal Areas (FATA), this is where the debilitating disease needs to be stopped in order to prevent an explosive outbreak, one that can nonetheless be easily prevented by a cheap and safe vaccine. Of the 144 children across Pakistan paralyzed by polio in 2010, over half were from FATA, and 17 percent were from KP.  As a senior program officer at the Bill and Melinda Gates Foundation, my goal in going to Peshawar was to hear firsthand what was being done to bring polio under control, and see what more could be done to ensure that it disappears altogether, as it has in much of the rest of the world.

Over the past two decades, polio has been reduced by 99 percent globally. Yet the disease continues to paralyze children in Pakistan because the vaccine is not getting to every child. Why? In KP and FATA there are two main reasons. First, more than 25 percent of children in FATA are not being reached consistently because of a protracted and deadly conflict with insurgents. Another 10 percent of children are missed either because vaccinators fail to reach every home or parents refuse to immunize their children.

On January 25, however, the federal government stepped up its fight to end polio. Pakistan’s President Asif Ali Zardari launched a National Emergency Action Plan for Polio Eradication, laying out a national blueprint to eliminate polio from the country. This includes formal plans for tracking progress on polio objectively and regularly, setting up national and provincial task forces, and engaging Pakistan’s leadership in polio eradication activities. Two days later, His Highness Sheikh Mohammed bin Zayed, Crown Prince of Abu Dhabi, and Bill Gates announced a partnership to help polio vaccines reach 32 million children in Pakistan. Then, British Prime Minister David Cameron announced that his country would double its contribution to polio eradication, helping vaccinations reach an additional 45 million children around the world.

Despite all this good news, however, eliminating polio in Pakistan is not going to be easy. An incident that occured January 22nd offered a stark reminder of why, when a health worker in North Waziristan was kidnapped and killed while returning home from promoting polio immunization, demonstrating that security remains a daunting challenge to anti-polio efforts. And even a few small gaps in the vaccination campaign can undermine progress across the board. To keep the disease in check, Pakistan needs to achieve and sustain high levels of immunity in the population; any pockets that are left unvaccinated will serve to re-ignite the epidemic. Avoiding such holes requires that health workers who administer the vaccine are well trained and supervised, that vaccines arrive on time, and that immunization activities are closely monitored. When coverage falls below 90 percent, special efforts will be needed, either to re-vaccinate a given area or determine which children were left out the first time around.

One key component in both these efforts will be political will at all levels. In FATA and KP, I’ve seen important progress as the top political and administrative leadership have come solidly together behind a plan to stop polio. In FATA, the Pakistani Army’s medical corps is closely involved in helping to support immunization activities, and committees have been set up to liaise with other civilian health workers. The next step will be to lay out detailed micro-level plans that get vaccinators into areas where they could not go before. In areas controlled by insurgents, their leaders are also being approached in the hopes that they will allow vaccinators to safely and easily access children.

The Pakistani government and its U.N. partners are also working closely with religious leaders to ensure polio vaccines and other immunizations are accepted by the population. Some parents have refused polio vaccines because of misconceptions about the effects of polio vaccination — for example that they could cause infertility. But the outreach is yielding results: The proportion of families in accessible areas who refuse vaccination dropped from 3 percent to 0.06 percent in the December 2010 campaign.

The benefits of the polio program go beyond preventing the spread of just this crippling disease. Following the "super flood" in Pakistan last year, polio eradication staff and resources helped track and prevent the spread of communicable diseases such as cholera in affected areas. Polio teams also help prevent other diseases, communicating with families on why immunization can save their children’s lives. As more children get immunized from diseases such as measles, hepatitis and pneumonia, thousands of lives are saved each year.

Globally, there is also quite a bit at stake. Fighting polio is like fighting a fire. If it is not completely put out, it can spread fast and reappear in places where it was previously eliminated. Afghanistan, which faces similar challenges to those in Pakistan, has made tremendous progress on eliminating polio, so we know it can be done even in the most challenging environments. Since December 2010, vaccinators in Afghanistan have reached 25,000 more children who were previously inaccessible. The number of polio cases country-wide is down to a near record low, and contained within just two provinces – Helmand and Kandahar.

Launching an aggressive effort to finally eliminate polio in Pakistan is a necessary precondition to a polio-free world. The tools and strategies are in place, now more than ever, and Pakistan has the opportunity to build on international support to eliminate polio once and for all.

Michael Galway is senior program officer at the Bill & Melinda Gates Foundation.