The emergence of as many as six polio cases since April in North Waziristan district, after a hiatus of 15 months, has poured cold water over hopes of Pakistan being, in the words of Unicef officials, “closest to the finish line”. While the cases in themselves are cause for alarm, they also reflect the damaging impact Covid-19 has had on routine and targeted vaccination campaigns against a number of infectious diseases, including polio. Moreover, the strong resurgence of the virus in a high-risk area also indicates that several systemic issues have persisted, despite efforts to correct them. It appears that Pakistan’s robust handling of the pandemic came at a high cost to anti-polio efforts. Some experts say that significantly fewer vaccination campaigns, and the use of the polio infrastructure for Covid-19 reporting, led to reduced vigilance in high-risk polio areas, including North Waziristan.

The gaps in vigilance are evident in the fact that all six children who have contracted polio in North Waziristan were unvaccinated, despite official efforts to improve immunisation coverage. Then there are also reports that the polio workers were deceived by the ink markings applied on the children’s fingers, presumably by their parents who were pretending the vaccine had already been administered to their offspring. This should give sleepless nights to the national polio managers for two reasons. Resistance to anti-polio efforts in the form of refusals or violence is already a long-standing issue, even in pockets of large cities such as Rawalpindi and Karachi. And efforts to mislead vaccinators could also be prevalent in other parts of the country. It is in this context that Pakistan’s polio managers were, earlier in the year, warned by the WHO to not become complacent in immunisation efforts since the absence of active cases could not be read as eradication of the polio virus from the country. Hence, the resurgence in cases should be viewed with a true understanding of the realities and tackled firmly, in accordance with the advice of international health bodies.

Published in Dawn, May 31st, 2022