With nearly all of the rest of the world on the brink of being free of polio, the disease’s persistence in Pakistan has long challenged health experts both inside and outside the country. Last year, the 51 cases of wild poliovirus reported here represented the bulk of all 70 cases reported throughout the world.
Even so, last year’s count is cause for optimism, since it was a huge drop from the 294 cases reported in Pakistan in 2014, and because it seems to be a product of some clever adjustments the country has made to its longstanding polio eradication program, with help from the Pakistani Army and smartphone-based technology.
Since 1978, the country has had an official Expanded Program on Immunization, in which vaccinators go door to door to immunize against many childhood and other diseases – tuberculosis, hepatitis, meningitis, measles and more. But when the goal became finally stamping out the last traces of polio, the regimen had to be ramped up to include more than these periodic household visits.
As part of the World Health Organization’s Polio Eradication and Endgame Strategic Plan 2013-2018, for example, the government announced that April 25 will be a National Switch Day for updating the kind of vaccine used, to account for the fact that Types 2 and 3 of the polio virus appear to have already been eliminated in Pakistan, with only Type 1 remaining. Recognizing that, the WHO recommended a switch from a trivalent oral polio vaccine to a version that can target Type 1 more effectively.
The next milestone will be phasing out the oral vaccine, which is built from a weakened live virus, and replacing it with an inactive polio vaccine administered by injection. Starting in Punjab, that strategy will supplement the live-virus vaccine schedule with one dose of the inactive version, which eliminates even the small risk of contracting the disease from the live virus vaccine. One reason the inactive vaccine is coming into use only now is that it is five times more expensive than the live oral type. To overcome that obstacle, GAVI, a public-private organization funded by various countries, charities and international institutions, will help cover the cost. On Tuesday, GAVI and Unicef tweeted that the inactive vaccine is now available in all of Pakistan’s provinces.
At the same time, Pakistan’s government has supplied vaccinators with motorcycles, for which Britain’s Fund for International Development, along with Unicef, will provide fuel allowances. Lack of fuel has been a popular excuse for vaccinators who miss their vaccine targets because they don’t want to travel to the far-flung areas where they are most needed. Security for vaccinators is an even bigger issue, illustrated by the bombing last Wednesday of a polio eradication center in Quetta that killed 14 policemen during an immunization drive.
Indeed, a long campaign of disinformation spread by the Taleban helps explain why Pakistan’s polio eradication program has not yet wiped out the disease. In 2006, the extremist group declared vaccination to be a Western plot to sterilize Pashtun children and stunt their growth. It threatened to kill parents who had their children immunized, and attacked polio vaccinators in Pakistan’s tribal areas and in metropolitan Karachi. Celebrities joined campaigns to counter the propaganda, and religious leaders issued fatwas declaring that Islam permitted the immunization of children, but those efforts did nothing to stop the attacks.
In 2012, Taleban commanders and clerics affiliated with the movement also halted the immunization program in North Waziristan, in protest against American drone attacks that had followed the killing of Osama bin Laden by American Special Forces; subsequent revelations that the CIA had used a bogus vaccination program to capture DNA material from Bin Laden’s relatives gave the Taliban additional ammunition with which to besmirch all vaccinators as spies for America.