Endgame for polio in Pakistan

There has been no polio case reported in Pakistan for the last one year, but the poliovirus is still present in the environment.
Published February 3, 2022

“It was like a heavy burden had been lifted, and I could breathe easier,” said Irum Khan, a polio worker, recalling the cloudy, gloomy, winter morning of January 28, 2022, when her supervisor announced Pakistan had not reported a single case of a child afflicted with polio in the last one year.

In fact, the last polio case was reported on January 27, 2021, from the province of Balochistan.

“There were 16 of us, and we all burst in applause. It was the best news we had heard in years,” said the 20-year-old Khan, working with the polio eradication programme since 2018, in Dera Ismail Khan (DI Khan), in the province of Khyber Pakhtunkhwa, once a hotbed of polio.

The day passed like a breeze as she went about her work, administering polio drops to children under five. On a daily basis, she visits between 30-50 households, and each home may have between three to five families living together.

“I was on some sort of a high; even those who refused and sent me away failed to dampen my mood,” she added.

“Without the unwavering support of the 380,000 polio workers, we would never have been able to reach this milestone,” said Dr Shahzad Baig, national coordinator for the Pakistan Polio Eradication Programme, speaking to IPS over the phone from Islamabad.

The director-general for health at the ministry of national health services, Dr Rana Safdar, Baig’s predecessor, agreed. He gave all the credit to “hundreds of thousands of our frontline workers who demonstrated an unprecedented commitment to battle polio”.

A child being given polio drops in Peshawar, Khyber Pakhtunkhwa. Pakistan recently reported that it had been a year since the last case of polio was detected. — Photo courtesy: EOC KP
A child being given polio drops in Peshawar, Khyber Pakhtunkhwa. Pakistan recently reported that it had been a year since the last case of polio was detected. — Photo courtesy: EOC KP

In 2015, there were 54 cases, 20 in 2016 and only 8 in 2017. Pakistan thought it would be possible to eradicate polio, having reached single-digit cases, but then the country saw a surge with 12 cases in 2018. And in 2019, 147 cases were detected.

Safdar, who had left the polio programme in 2019 after working there for six years, returned when the surge began and was tasked with reorganising it so that work on polio eradication could be carried out in tandem with the routine childhood immunisation.

The Covid challenge

In 2020, like in the rest of the world, Pakistan was in the grip of Covid-19. Both the anti-polio campaigns and routine immunisation had to be suspended to ensure the safety of the workers and communities, explained Safdar. That year, up to 84 cases were reported.

“We enhanced our outreach to vaccinate eligible children against all vaccine-preventable diseases in an organised manner and were able to reach them in the remotest pockets where communities were finding it difficult to access our healthcare facilities, taking full Covid-19 precautions,” said the director-general.

But it is not the time for the government to sit on its laurels. Although the “finish line is visible”, for him “the job is far from over”, and Pakistan cannot let its guard down, Baig said.

The reason for caution, explained Irum Khan, was because the virus is still lurking around in the environment and her district. “The virus was found in some environmental samples,” she said, and therefore the “danger is not over yet”.

Baig said that in the last three months of the environmental samples collected from 64 sites, two were found to have the poliovirus in the towns of Lakki Marwat and Tank, in DI Khan district.

Polio spreads quickly, and chances of an outbreak could become imminent. “We need to kill the virus on its turf before it reaches other bigger cities of, say Quetta, Karachi or Islamabad,” he said.

His apprehension is palpable. DI Khan is the hub from where large swathes of the population move, both from bordering Afghanistan — the only other country where polio is endemic after Pakistan — and the tribal belt of the province and then inward to other provinces.

A frontline health worker walking in snow in Quetta, Balochistan province. — Photo courtesy: EOC Balochistan
A frontline health worker walking in snow in Quetta, Balochistan province. — Photo courtesy: EOC Balochistan

“Instead of fighting the polio battle across the country, if we can focus the fight in these districts of Khyber Pakhtunkhwa (KP), we can become polio-free in the next three years,” says the polio programme head.

Although the virus does not respect borders, be it Pakistan or Afghanistan, a much stricter border control since the takeover of Kabul by the Taliban on August 15, 2021, has meant the free and frequent movement of Afghan nationals has been contained to some extent.

Refusal cases

In addition, the persistent refusals by anti-vaxxers could also lead to the spread of the virus. “I am worried the virus may reach the children who are kept hidden from polio workers,” said Baig.

“They tell us the child is not home, or he or she is sleeping and to come later, or that they are busy and to come later; some will hide their children,” said Bushra Khan, a polio worker from KP’s capital city, Peshawar. She said they have to make as many as “four visits” just to administer two drops because the time is not convenient for the parents, or they don’t want to get their children vaccinated.

This attitude of nonchalance, according to Irum Khan, is because the vaccine is free, and people do not value it because they are not paying for it.

“Put a price tag on this vaccine, and you will see parents bringing their kids to the health centres,” she said.

According to Baig, the two drops cost the government Rs130 per child, and over 40 million under-five children were administered these drops in the last nationwide campaign.

Security concerns

Providing security to the polio workers is another task. As many as 70 polio workers have been killed by militants since 2012, a majority in KP. But those providing them with the security are also on the radar of miscreants. In December 2021, two policemen accompanying polio vaccination teams were killed and two injured in separate incidents in Tank and Lakki Marwat. And last month, in January, one more police officer was killed in KP’s Kohat.

“This saps the morale of the team. The families get scared and are reluctant to send the workers out in the field. This means we have to organise the two-member team all over again, train the ones who are new, some of whom may be new to the community they are serving,” said Baig. “And it’s not even that we are paying handsomely for it to be worth their life,” he added, referring to the Rs1,000/day wage.

Still, according to Dr Safdar, the biggest challenge is the burnout of polio workers and “keeping teams motivated on both sides of the borders (between Pakistan and Afghanistan) till we reach the finish line”.

Header image: A health worker marks a finger with indelible ink to indicate that a child has been vaccinated. The campaign to eradicate polio reached a critical milestone with no cases reported for a year. — Photo: Zofeen T. Ebrahim/IPS

This article was originally published on the Inter Press Service and has been reproduced with permission.