Health workers began a campaign this week to vaccinate 9.5 million children against polio in 41 districts of Pakistan. The latest round of the nationwide vaccination campaign includes Islamabad, with a special focus on areas where polio-positive sewage samples have been found.
According to local media, the polio eradication drive will be launched in 16 districts of Balochistan, 11 districts of Khyber Pakhtunkhwa, eight districts of Sindh and five districts of Punjab.
Despite significant efforts to eradicate the disease in Pakistan – six cases of the highly contagious virus have already been reported this year – efforts are further hampered by harassment and physical attacks on vaccination teams and health workers in some parts of the country.
But after meeting with American billionaire philanthropist Bill Gates in Islamabad last week, Pakistan’s Prime Minister Nawaz Sharif said the government remained “unwavering” in its goal of eradicating polio.
How serious is the polio problem in Pakistan?
According to the World Health Organization (WHO), Pakistan is one of only two countries in the world where polio is still endemic – the other being neighbouring Afghanistan.
This highly contagious viral disease primarily affects children under the age of 5. Children infected with the polio virus become paralyzed and in some cases, die.
The South Asian country began its vaccination program as part of a polio eradication initiative in 1994. Officials say the country once reported more than 20,000 cases a year.
Despite administering more than 300 million doses of oral vaccines each year and spending billions of dollars, the disease remains widespread across Pakistan.
Four vaccination campaigns have already been carried out this year, targeting more than 43 million children, and officials claim they are in the “final stages” of eradicating polio in the country of 235 million people.
How many cases have been reported in Pakistan?
Pakistan has reported 357 cases of polio since 2015, including six so far this year. One victim, a two-year-old boy, died in May.
Officials said all of this year’s cases are part of the YB3A cluster and originated in Afghanistan, where four cases have been reported this year.
In addition to human infections, wild poliovirus type 1 (WPV1) is frequently detected in environmental samples collected across the country and has been found in 45 of Pakistan’s 166 districts this year.
How is Pakistan conducting its polio vaccination campaign?
The nationwide vaccination campaign, involving more than 350,000 health workers, is being carried out in stages, with vaccination desks set up in health centres and health workers going door-to-door, and is being organised by the government-run National Emergency Operation Centre (NEOC), which is tasked with running Pakistan’s polio eradication programme.
Field workers will go door-to-door over a designated number of days to vaccinate children under the age of five.
Vaccinations are also being carried out at land and air borders, including for adults, and on highways connecting major cities across the country.
What are the challenges facing the polio eradication campaign?
Resistance to the polio vaccination drive grew in Pakistan after the US intelligence agency, the CIA, organised a fake hepatitis vaccination drive to track down Osama bin Laden, the al-Qaida leader killed in Pakistan by US special forces in 2011.
Misinformation linked to religious beliefs has also been spread, claiming the vaccine contains traces of pork or alcohol, which are forbidden in Islam.
Disinformation, policy-driven campaigns, myths, community boycotts and distrust of the government are also factors in the refusal, but officials said government campaigns are helping to change negative perceptions.
Pakistani health officials have named seven districts where polio is “endemic,” all in the northwestern province of Khyber Pakhtunkhwa, where officials say the security situation is the biggest obstacle to getting vaccines to eligible residents.
Health officials say the security situation, along with target populations moving from one place to another who may be carrying the YB3A variant, poses challenges.
Why were health workers and security officials targeted?
Health workers and the security officials accompanying them have been subject to harassment, ridicule, abuse, threats and even physical attacks.
At least 102 polio eradication workers, officials and security personnel have been killed, including at least six in campaigns conducted this year.
In recent years, the Pakistani Taliban have killed dozens of health workers and security forces working to eradicate polio, but authorities believe the violence is not solely due to the effort.
“In recent years, it has not been the polio programme that has been the target, but unfortunately the security personnel who are guarding the teams, because given the security situation in some parts of the country, they are vulnerable targets when they are out in the communities,” Dr Hamid Jafari, WHO’s polio eradication chief, told Al Jazeera.
What other issues are affecting healthcare workers?
Low wages, delayed salary payments, lack of support and compassion, and difficult working conditions are some of the problems faced by workers in the field.
Some health workers told Al Jazeera they are paid just 1,360 rupees (around $5) a day for at least eight hours of work, with no pay for make-up days when they travel to the field after vaccination campaigns have ended to vaccinate children who were not reached.
In addition, some of the polio survivors currently working on this initiative are unable to access assistance for transportation or medical benefits, despite their condition, and continue to walk through adverse weather conditions and difficult terrain.
Some officials lamented the inequality in pay, saying people working for international organisations involved in the campaign are paid much more.
What are the prospects for the polio eradication campaign?
Dr Shahzad Baig, who headed NEOC until May, told Al Jazeera the goal is to make Pakistan polio-free by 2026.
“That’s our goal at the moment,” he said before the substitution.
However, Pakistan’s Dawn newspaper reported that concerns were growing over a “deteriorating disease situation” in the country following a WHO-organised technical advisory group meeting in Qatar in May.
“All the gains Pakistan made in 2021 have been lost and we are faced with an embarrassing situation as the virus has re-emerged in three regions,” a Pakistani official quoted in the report said at the meeting.
But health officials remain hopeful as the number of positive cases has dropped significantly over the past five years, from 147 in 2019 to just six so far this year.
“The Pakistan-Afghanistan programs are very mature and we have learned a lot,” Jafari said.
“These programs have evolved, adapted and adjusted despite changes in government and security situations, which is why we have achieved a level of herd immunity where we no longer see cases of paralytic polio.”
“This is not a problem that is spread across Pakistan. It is not a problem that is spread geographically. The challenge now is to reach those last-ditch people who are hard to reach. Once you start reaching these people, progress will happen very quickly.”