We made history in Pakistan last year with one recorded polio case - the lowest it has ever been. Is this good news? Yes and no.

It is a major achievement and the result of decades of hard work and commitment towards eradication. One case was reported in Pakistan as compared to 84 in 2020, but it’s far more important to remember that it is still one case too many.

The journey from one to zero is a long and arduous one.

In 1988, the World Health Assembly made a commitment in Geneva to eradicate polio. If it hadn’t been for that global commitment, today nearly 18 million people in the world would be paralyzed by the poliovirus. But while the rest of the world has fulfilled its promise, Pakistan and Afghanistan – the only two countries in the world with polio - still lag behind.

The good news is that while the end of the tunnel is far, it is finally visible.

Leading the Polio Eradication Initiative in Pakistan at this critical juncture, I am reminded so often about my experience in Africa. I had initially been posted to Nigeria in the mid 2000s when the country had over 340 cases, by the time I left, it was zero. What was meant to be a three-month deputation, ended up being 13 years.

I had various roles during this period, ranging from polio consultant to member of the national strategy group and deputy incident manager at the Emergency and Operations Center (EOC) in Kano. There were many things on my plate, navigating the challenges of a country where vaccine boycotts, anti-immunization propaganda and ongoing conflict plagued eradication efforts.

Heading the Pakistan Polio Programme today, I’m getting the feeling one has when walking a path one has walked before, knowing exactly where the bends and crevices appear, knowing what to expect on the next turn and mentally preparing for all the bumps along the way. The challenges on this route are the same, only the names are different. Kano, Borno and Abuja might as well be high-risk areas of Pakistan.

So far, I have yet to come across a challenge that is entirely new.

In the years before Nigeria was certified as polio-free, I remember starting every morning with a heightened degree of anxiousness around the ‘what if’. What if we weren’t where we needed to be, what if another case had come again, what if we needed to start over. In the years spent there, everyday would begin and end with checking on the health surveillance review. When the country became polio-free, it was a landmark achievement not only because Nigeria was the last country in Africa to eliminate the virus, but more so because until 2008, Nigeria had nearly half of all polio cases in the world.

I remember being told that Kano will be the last place on earth to eradicate polio, I said give me 12 months. Kano became zero polio in 13 months. If the whole world can eliminate a disease by using vaccines, why can’t Pakistan?

To many readers it may seem that one case of polio is a sign of the end. But Pakistan has had two previous opportunities to eradicate the poliovirus and we failed to seize those chances.

Sometimes when a country has gone years without a case, a new one comes up, throwing the country back by several years. This is what happened to us in Borno where after 2.5 years of no cases, a polio case emerged pushing us back by years.

That’s why I’m not interested in presenting a rosy picture of Pakistan. I am interested in self accountability and giving 100% of my time and efforts to understanding the problems at hand and not gloating about our successes. What we need to aim for and be satisfied with are not a reduction in cases but elimination and zero cases year after year.

I believe we have come this far not because of one programme - it is the collective effort of the government, law enforcement agencies, our global partners, the media, corporations and all parents who value their children’s health above all else. I’m indebted to the SAPM on Health, Dr Faisal Sultan, who has made polio eradication a priority and personally travels to high-risk areas for the virus to address issues on ground, and to our over 300,000 frontline workers who traverse the length and breadth of this country to ensure that no child ever again is paralysed by polio.

While our polio teams are experts in building trust and addressing vaccine hesitancy, I still believe that they can never have the impact that a trusted neighbour, a friend or a relative does in addressing vaccine concerns. We must all play our part in increasing awareness and educating ourselves and others. Polio eradication needs each one of us.

I’m often asked what makes polio so important. It takes just one image of someone living in an iron lung to remind us what the virus really means. I also wonder what reason could ever be good enough for risking a child to life-long paralysis?

I believe there are various things I haven’t done right in my life that I can be held accountable for, but I have always felt that if I’m able to help eliminate polio, I will die with my conscience at ease. I will die knowing that I played my own small role in finishing one of the two diseases in the history of the world to be eliminated.

I hope each one of us can play our own small role.

Dr Shahzad Baig
National Coordinator
Pakistan Polio Eradication Programme
Islamabad

Published in Dawn, January 17th, 2022