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Last month, Pakistan reported its fifth case of the deadly virus. Experts say the large movement of people and “considerable vaccine hesitancy” are hampering progress in tackling polio.
The polio eradication drive has been thrown into disarray in Pakistan, a South Asian country of 240 million, as a fifth case of the highly infectious virus was reported this year, dealing another blow to the country’s efforts to wipe out the debilitating disease.
Also read: Polio: Everything you need to know about this viral disease
Four polio cases were reported in the southwestern Balochistan province bordering Afghanistan, while a fifth case was reported in the southern Sindh province, raising concerns over the feasibility of polio eradication in the near future.
Malik Mukhtar Bharat, Prime Minister Shahbaz Sharif’s coordinator on national health services, said: “This year’s cases are a reminder that until Pakistan succeeds in completely eradicating polio, no child can be completely safe from this deadly disease.”
According to the World Health Organization, polio, which most commonly occurs in children under age 5 and can cause paralysis or death, remains endemic in two countries — Afghanistan and Pakistan.
Last year, six cases of polio were reported in Pakistan. According to the Global Polio Eradication Initiative (GPEI), Pakistan came very close to eradicating polio after only one case was reported in 2021.
Conspiracy theories hinder progress
Experts believe that the cases being reported in Pakistan are due to various reasons.
“Pakistan and Afghanistan are working in a highly complex and challenging environment,” Dr. Hamid Jafari, director for polio eradication in the World Health Organization’s Eastern Mediterranean region, told DW.
“The primary drivers of risk include large population movements, insecurity compromising access and quality of vaccination in key infection areas, as well as communities with significant vaccine hesitancy and persistently low routine immunization coverage in polio-endemic geographic areas.”
“All five cases reported in Pakistan this year are linked to two genetic clusters belonging to YB3a following extensive cross-border transmission from Afghanistan. These cases have been reported from Chaman, Dera Bugti, Qila Abdullah, Shikarpur and Quetta,” Jaffrey said.
The polio workforce is frequently targeted in Pakistan, where Islamic militants and radical clerics denounce government vaccination campaigns as a foreign agenda to sterilize Muslim children and a cover for Western spies.
“The widespread cases at this time are particularly worrying because we have just entered the high infection season. The virus has become reestablished in our historical reservoirs. It is spreading from there. We can expect further spread during this high infection season,” Natalia Molodecki, who works with GPEI at the Polio Emergency Operations Center in Islamabad, Pakistan, told DW.
“The main reason for this is the unexpectedly large movement of population, which resulted in the detection of the virus in areas that had been polio-free for years. The unusually large movement of population was partly related to the repatriation of Afghan migrants,” Jafri underlined.
However, the five cases reported are not in a cluster and have been reported from five different districts in two provinces.
“Natural disasters such as heavy rains, heat waves and floods create a snowball effect, where internal displacement leads to lower vaccination rates, while poor sewage allows the poliovirus to enter water bodies. Lack of clean drinking water forces people to drink dirty water, increasing the risk,” Dr. Fareeha Irfan, a public health physician and policy expert working with the Punjab Health Services Commission, told DW.
Sporadic cases likely to continue
Experts have warned that polio cases may increase in the future and that there is a real risk of the virus re-emerging in high-risk areas.
“Continued detection of poliovirus in environmental samples and sporadic cases will delay the peak of polio transmission until late 2024, and possibly the next peak season in the first half of 2025,” Jaffrey said.
Molodecki agrees. “As polio spreads beyond the main reservoirs during this high transmission season, we may see an increase in case burden outside of these historic reservoir areas,” the health expert said.
Despite significant progress in the global effort to eradicate this deadly virus, both Pakistan and Afghanistan continue to grapple with sporadic outbreaks, particularly in remote areas where access to healthcare is limited.
“The programme in Pakistan has reached a high level of sophistication and has the flexibility, capabilities, resources and support needed to get the job done,” Jafri said.
In the past, the increase in polio cases has been attributed to the diversion of human and infrastructural resources to more important cases.
“Vaccination hesitancy has always been a factor in the low uptake of vaccines in Pakistan, and while this trend was limited to the less educated sections of society, now even educated families are reluctant to get their children vaccinated, especially in the case of oral vaccines,” Dr Irfan said.
How to deal with this?
Experts recommend that urgent and diligent work to eradicate polio must continue this year, with careful identification and re-classification of migrants and all unvaccinated children.
“We need to ensure that the missed children are vaccinated, to prevent outbreaks and contain the virus as quickly as possible in the historical reservoirs, major population centres that have been polio-free for more than two years,” Jaffrey suggested.
The pattern of virus detection clearly shows that the population living in border districts is contributing to the persistence and spread of the virus.
“When we’re talking about the source versus the sink of the virus — the source of the virus is usually our historical reservoirs — tackling things at the source is critical to continued success. We know how to eliminate polio from these areas, and we’ve done it before,” Molodecki underscored.
“Greater coordination and cooperation in efforts is needed in the coming months in the border areas of Afghanistan and Pakistan, known as the ‘virus corridor,'” Jafari stressed.
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