The rocky road to victory against polio in Pakistan

Victory is finally in sight. For the first time in its public health history, Pakistan is on the verge of defeating the poliovirus type 3 (P3). It is one of the two globally continuing strains of the wild poliovirus, which had crippled several thousands of children all over the world. The country’s last P3 case was reported on April 14, 2012, and if no case is reported till April 14 this year, a major breakthrough would be achieved in the fight against polio. Despite great difficulties, Pakistan has managed to make solid progress in its battle against polio and is on the right track to eradicate polio from the country.
The World Health Organization (WHO) had launched the Global Polio Eradication Initiative in 1994 to fight a disease which paralyzed an estimated 0.4 million children in 125 countries every year. According to the WHO, type 2 strain of the poliovirus (P2) was eradicated globally in 1999. However, the P3 strain has dodged health authorities all over the world and continues to prevail, especially in the developing world. Nigeria alone has reported 19 cases of the P3 strain, with the most recent case coming to limelight in November last year. Compared to 2011, Pakistan showed impressive gains to reduce the number of reported cases by more than 70 percent and emerged as a global success story. A significant decrease in the polio cases was seen even during the high transmission season. On the other hand, India is on course to be removed from the list of polio endemic countries and will most likely be declared polio free by 2014.
Pakistan had to confront considerable social, economic and religious obstacles in its fight against the polio virus. Even though Pakistan assured the global community of eradicating polio by 2000, new cases continued to surface and embarrass the country. Thereafter, Pakistan again missed the extended deadlines of 2004 and 2012. In its long drawn battle against polio, Pakistan missed key vaccination targets and often restrategized to counter the virus in some of the worst affected areas of the country. As donor agencies accused health authorities of lacking political will to fight polio, they excused themselves from further funding of polio eradication programs. It is estimated that the donor agencies had been pumping about US$ 100 million in Pakistan every year to eradicate polio but no significant achievements could be recorded. As a result, Pakistan was recently forced to develop its own polio eradication program for the period 2013-15. The three-year program is expected to cost the government $ 300 million, out of which $ 49 million would be funded by the government. The remaining amount would be financed by a loan provided by Islamic Development Bank (IDB) to ensure there is no delay in the launching of polio eradication campaigns.
Unfortunately, Pakistan’s polio eradication campaign has been maligned by accusations of supporting hidden Western agendas. According to Rizwan Ali, a campaign manager with the WHO, “people refuse these drops for a variety of reasons. These include misconceptions or the notion that they are being promoted as part of an agenda against Islam or they believe that the drops could lead to infertility and are thus intended as a secret form of birth control.” At the same time, some smear campaigns aimed to discredit polio vaccination programs and develop a sense of insecurity in the society.
To disrupt the momentum of anti-polio campaign, hardliners have also targeted health workers and forced international bodies to even suspend the program. Recent attacks in Karachi, Peshawar, Charsadda and Nowshera have caused the death of more than a dozen health workers in different acts of violence. There was unanimous outrage in Pakistan over these killings and authorities have been asked to beef up security measure for nationwide immunization drives. The Taleban militants in Pakistan’s volatile north have linked stoppage of attacks on health workers to a halt in the drone attacks. Commenting on the resolve of these militants, Hasan Askari, a political analyst, says that “the desire to establish their control and create their domain of authority by whatever means is the objective. They represent an authority alternate to Pakistani authority.”
It is crucial that Pakistan maintains its strong momentum in the months ahead and does not lose focus because of the upcoming elections. The current low-transmission season offers Pakistan its best chance of completely eradicating the disease and proving to the world that it is serious about guaranteeing a healthy future for its future generations. There should be strong governance at all levels to ensure implementation and management of the eradication program for the final push.