Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue

Abstract

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 the global incidence of poliomyelitis has fallen by nearly 99 %. From a situation where wild type poliovirus was endemic in 125 countries across five continents, transmission is now limited to regions of just three countries – Pakistan, Afghanistan and Nigeria. A sharp increase in Pakistan’s poliomyelitis cases in 2014 prompted the International Health Regulations Emergency Committee to declare the situation a ‘public health emergency of international concern’. Global polio eradication hinges on Pakistan’s ability to address the religious, political and socioeconomic barriers to immunisation; including discrepancies in vaccine coverage, a poor health infrastructure, and conflict in polio-endemic regions of the country. This analysis provides an overview of the GPEI, focusing on the historical and contemporary challenges facing Pakistan’s polio eradication programme and the impact of conflict and insecurity, and sheds light on strategies to combat vaccine hesitancy, engage local communities and build on recent progress towards polio eradication in Pakistan.

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial

“…This approach is now being expanded to high-risk areas in Baluchistan with persistent poliovirus circulation. This experience also has implications for addressing the challenges in the three residual pockets of polio globally, which also happen to be geographies affected by conflict and insecurity 30, 31…”

Health system barriers and levers in implementation of the Expanded Program on Immunization (EPI) in Pakistan: an evidence informed situation analysis

“…Religious beliefs and lack of knowledge about the benefits of the vaccines still dictate many pockets of this highly diverse and populated country [ 35 ]. Targeted community awareness programs, a robust surveillance network, and engagement with the dominant religious entities can help to root out the issue [ 36 , 37 ]. Better understanding of the religion and soliciting local support for vaccination campaigns may assist in negotiating access in the areas where refusal is an issue [ 38 ].…”

Current Status and Underlying Problems of Eradication of Poliomyelitis in the Remaining Endemic Countries

“…In Nigeria, Pakistan and Afghanistan, vaccine skepticism is linked to the unfounded theory that immunization is a coordinated attempt by westerners to render their citizens impotent. Also, lack of adequate awareness on the advantages of getting vaccinated and vaccine-related misconceptions such as the ability of polio-related paralysis to be cured by herbal therapy; exposure of lone females to the alleged immoral advances from male vaccinators and the possibility of vaccination teams being spies of foreign governments [6], also play significant roles in fueling decrease in vaccine confidence.…”

“…These countries serve as exporters of the virus to other parts of the world where polio has been eradicated thus necessitating the need for polio to be stamped out in these countries before there can be certification of a polio-free world. Through the Global Polio Eradication Initiative (GPEI) of the World Health Organization (WHO), there has been a significant drop of 99% in the number of detected polio cases from 1988 when the global action was initiated [4,5], but as the Bill and Melinda Gates foundation enthused, the last 1% is the most important and crucial in the final quest to rid the world of polio [6].…”