A tale of two drops
With bowed heads, we stand in line with Nigeria and Afghanistan in the shameful category of countries in which the highly infectious crippling disease of polio remains endemic. In October, the three-day nationwide polio drive backed by the government and WHO set out to target 32 million children, yet according to Pakistan Polio Eradication Initiative and Unicef, over 0.5 million of children were missed in which 45,000 refusals are included.
One hoped that in the latest round, kicked off on December 17, the stats will be more heartening and every child will be administered those precious two drops. Unfortunately, during this roud a number of them were killed while on duty; they had been reportedly being receiving threats to stop their work. The drive had to be stopped in Karachi.
Pakistan has been battling polio since the first immunisation round in 1994 when on April 27 of that year, the then Prime
Minister Benazir Bhutto initiated the campaign by administering oral polio vaccine to her own daughter.
Azmat Abbas, Media Specialist – Polio, Unicef, recounts this long and uphill journey. “A dramatic decrease was seen in the cases from the estimated 20,000 to 25,000 cases per year in early 1990s to a few hundreds within a few years. Efforts were intensified in 2000 with increased technical support and number of vaccination rounds up to seven or eight per year. Another evidence of the success of polio eradication activities is the eradication of poliovirus type 2, which has not been found in Pakistan since March 1997. Furthermore, there is clear evidence of decreasing poliovirus diversity and intensity of transmission. Endemic transmission of polio has also become restricted geographically to three distinct, well defined transmission zones”.
Yet Mr Abbas admits that a progressive upsurge has occurred in the number of polio cases since 2008. The country reported 117 polio cases in 2008, 89 in 2009, 144 in 2010 and 198 in 2011.
The heartening aspect is that in 2012 only 56 polio cases have been seen so far. The refusals have also fallen by about 60 per cent as compared to 2011. Eight rounds of anti-polio campaign are held every year with four nation-wide campaigns targeting approximately 33.4 million children below the age of five and four sub-national campaigns for ‘high risk’ districts covering 20 million children.
The Unicef identifies that the continuing challenges for the upsurge have been the inability to reach children in areas along Pak-Afghan border from where the spread of wild polio virus circulation has been frequent. Adding to the hurdles is the inadequate campaign preparation and implementation in some townships of Karachi and sub-optimal preparation of the campaigns which results in low vaccination coverage in three districts: Quetta, Qila Abdullah and Pishin, in Balochistan.
Things are going from bad to worse as the Independent Monitoring Board in its recent report recommended travel restrictions on the three polio endemic countries in the coming months if they fail to stop polio virus circulation. Pakistanis travelling for Hajj or Umrah are already required to have polio vaccination while India has also made polio vaccination compulsory for Pakistani children travelling to India and Indian children visiting Pakistan.
Unicef Pakistan says that its primary role in the Polio Eradication Initiative is to reach out to the communities and bring about a behavioural change towards polio vaccination in particular. “We carry out communication activities in 33 High Risk districts across Pakistan through Communication Network which has more than 1,100 staff on ground to reach out to the people to address their concerns,” says Abbas.
Unicef works closely with the Pakistan Paediatrics Association, a representative body of paediatrics in Pakistan, for awareness and advocacy activities with doctors.
Sona Bari, spokesperson Global Polio Eradication Initiative, WHO Headquarters, Geneva, says that myths regarding the vaccine exist in many countries. People may think vaccines cause sterility or are a conspiracy by the government, but all these myths can be dealt with through communication, by involvement of the community, and by the engagement of trusted figures in the community. It is thanks to such measures that many vaccine-preventable diseases are now largely gone or diminished, such as whooping cough.
The media has played its part in bringing about this slow but steady revolution in thinking. Television ads advocating polio vaccination and awareness created through radio and print media in eight different languages help reach out to people. A recently conducted research shows that nearly 50 per cent of the respondents had heard about the polio campaign from TV, while in FATA radio was the source of information for nearly 50 per cent of the respondents. Unicef also works hand in hand with parliamentarians, transporters, teachers, religious scholars, police, journalists, etc. Certainly, every child reached in any way, is a victory achieved.
Abbas outlines a solution, “The goal of a polio-free Pakistan can only be achieved with all organs of the state working together to eradicate polio. The goal can be achieved with consistent government involvement, ownership and accountability for the polio programme performance at each administrative level in Pakistan. We need to ensure highest quality polio vaccination in the high risk populations through improved quality and innovative approaches and guarantee consistent access to children in security-compromised areas especially in FATA and Khyber Pakhtunkhwa.”
According to Dr Asad Shubair, a child specialist, the reason why people refuse polio vaccination is simply the lack of health education. Shubair clarifies, “Polio is contagious like any other virus through the faecal-oral route. Administration does ‘not’ guarantee that the polio virus will not get inside the body; however it does provide immunity which will not allow the virus to multiply”.
Shubair lauds the dedication and efforts of certain health care providers who administer the vaccine, going door-to-door, yet he laments that they do not get the much-deserved pat on their backs.
It is a matter of two drops every year. Two drops which can brighten a child’s life. Two drops which can ensure him a normal, fulfilling existence. Every child deserves that.
• Eight rounds of the anti-polio campaign are held every year with four nation-wide and four sub-national campaigns for high risk districts.
• Approximately 33.4 million children below five years of age are immunised throughout the country in the national round whereas over 20 million children are covered during the sub-national campaigns in high risk areas.
• A total of 76,587 trained house-to-house vaccination teams conduct the vaccination activity during the national campaigns. Each team comprises two members with one of the members preferably a female to allow easier access to households.
• A total of 5,184 trained transit teams work to cover children at busy markets, bus terminals, district borders, etc.
• A total of 9,723 fixed points trained vaccination teams work at designated centres to vaccinate children brought in by parents during the campaign.
• A total of 20,104 team supervisors oversee the work of the teams.
• A total of 1,830 medical officers supervise the entire operation.
• Permanent & active cross-border teams are placed at the border with Afghanistan.
• In FATA 22 teams work at eight crossing points-In Balochistan six teams work at three crossing points
— Courtesy: Unicef Pakistan