In the early hours of Wednesday, on December 19, unknown attackers shot at two police officers on their way to a polio vaccination drive in the Lower Dir District area near the capital of Pakistan, Islamabad. The officers died on the spot. According to the local police, these officers were “on duty with the polio vaccination team.” The number of attackers is still not clear.
This event comes in the wake of another disturbing news that came out this month. According to an estimate, “104 cases of polio were recorded in Pakistan this year, which is a sharp increase from 12 recorded in 2018 and eight, the year before.”
On Monday, December 16, Pakistan inaugurated the National Immunization Day, aiming at immunizing around 39 million children under the age of five all across the country. Carrying these mass immunizations takes the services of approximately 260,000 staff members who are sent on a door to door campaign across the country.
In the hours after the attack, the government announced that the polio campaign would continue regardless, except in the Bishigram sub-district, where the attack took place. According to a statement, a comprehensive search for the suspects is going on all over the country.
Earlier this year in April, a polio vaccination campaign was suspended in Pakistan’s province of Khyber Pakhtunkhwa (KP) due to rumors about “side-effects of the vaccine”. This led to a mob attack on a local health unit in KP’s capital Peshawar.
Attacks on Polio eradication teams are not new in Pakistan. The country has faced multiple challenges regarding polio vaccination due to several reasons. According to a report, nearly 98 officers, including polio team members have been killed in attacks on polio vaccination teams in Pakistan to date.
A virus transmitted by feces causes polio. The virus spreads in areas where hygiene is ineffective, through flies contaminating food, and drinking water contaminated with fecal remnants. In most polio cases, the carriers of the infection have no symptoms of the disease, or they have mild flu-like symptoms that clear on their own. However, in less than one percent of cases, this virus has a much more severe impact, often resulting in sudden permanent paralysis. If this paralysis strikes the lungs, polio can be fatal.
Polio has no cure; however, it is preventable with the help of a vaccine. In 1988, when the Global Polio Eradication Initiative began, the number of global paralysis cases came down from an estimated 350,000 cases in the 1980s to almost 120 cases a year today. Polio persists in Pakistan, Afghanistan, and Nigeria. But it is often the last remaining cases that are the most difficult to eradicate. It shows that this virus persisted in these communities despite repeated vaccination campaigns for over 30 years, presenting a problem.
The Pakistani government has carried out door-to-door polio campaigns supported by the Global Polio Eradication Initiative nearly every month for the last 10 years. Polio vaccination teams visit houses to find and immunize every child under 5.
Since the polio vaccine has low efficiency in places where many children might be infected, multiple doses of the vaccine are necessary. Most children in these areas have received oral vaccines up to 30 or 40 times now. However, polio is still rampant mainly because some children have repeatedly been overlooked by the campaign teams or, in some instances, where their parents have refused the vaccine.
The current situation in Pakistan regarding Polio is nothing new. It is the result of various issues that the country has tackled over the decades.
Pakistan has traditionally neglected its sectors like education and health care, pouring most of its resources into sectors like national defense. But this has come at a cost. The country’s public health care system is now not capable of providing even the most basic services like vaccines, which becomes a problem, especially for the poor majority in the country who cannot afford to look at the private sector for medical care.
Another conspiracy is surrounding the local campaign to eradicate polio springs from suspicions. It is a widespread belief in some areas that the vaccination drive is part of a Western agenda to sterilize Muslims. This has further been supported by the fact that in 2011, Osama bin Laden was tracked down with the help of a vaccination team. There have been frequent attacks on health workers, which are then accused of being spies. It is not that security has not been provided against the anti-polio teams, but from what was seen this Wednesday, more efforts are needed. According to officials, factors like malnutrition, contaminated water, and poor sanitation have played their part in allowing the virus to survive and paralyze children. Anti-vaccine propaganda on social media has added to the problem.
Several governments in Pakistan have tried to tackle this problem by introducing awareness campaigns in every era. Some have even taken the help of religious scholars to dispel rumors surrounding vaccination, tackle propaganda to encourage vaccination effectively. Despite all these measures, attacks on polio vaccination teams are still rampant.
In April this year, rumors were circulating in some areas of Peshawar, regarding expired Polio vaccination drops being given to children in Peshawar. This issue began with children complaining of nausea and vomiting after getting the polio drops. Within hours, an angry mob had set fire to a public health facility.
As the public health facility got destroyed, the general public completely panicked, leading to the local government declaring emergency in hospitals. It later came to the government’s knowledge that there was nothing wrong with the vaccine and that it was not expired.
However, all this did not stop the mass protests and hysteria in public. It also did nothing to protect that police officer who was on duty with the polio team and was murdered just a day after the burning of the facility.
The situation got worse as another police officer was killed the next day in the same province. In the aftermath of the incident, many families refused polio vaccines vehemently. According to some estimates, at least 700,000 families refused to get their children vaccinated due to rumors and mass panic.
The situation isn’t this bad only in the smaller provinces. According to some experts, polio vaccination teams in cities like Islamabad have also been subjected to crimes against polio vaccination teams. They have faced refusal by parents to get their children vaccinated.
This aggravates the problem as, according to experts, the gravity of the situation persists even if one percent of the children don’t get vaccinated against polio. They say that this would eventually mean that polio will stay alive in the environment, hence more effort will be required for the vaccination program next year.
There has been a tremendous effort by the government to tackle these problems and to address widespread rumors appropriately. According to officials, building enough trust in public for them to comply with the polio vaccination schedules is a difficult job to do, which is being sought on an ongoing basis.
Pakistan is facing several challenges, which makes it challenging to eradicate the polio problem. The original target for the complete eradication of polio was the year 2000. This target was then extended to 2005, then to 2008, 2010, up to the current goal of 2021.
Countries like India have controlled their polio problem by providing better facilities to the public and improving the overall hygiene situation. There should be special efforts to prevent fecal matter from entering populated areas so that people do not come in direct contact with it.
However, there is the problem of funding, and not many international donors seem too keen on funding a project that is taking so long to come to fruition. In Karachi recently, polio vaccination teams have started using mobile clinics to meet severe health care problems. They are also trying to generate more public interest in immunizations against diseases.
There have been efforts to install water filtration plants in areas of Karachi, where there is a severe water problem. According to the public free medicine and clean water can make a lot of difference as this leads them to begin trusting the health care system again.
However, to fully eradicate polio from Pakistan, better and more concrete steps will have to be taken. It is time for governments and international donor agencies to start looking at basic health care, sanitation, and infrastructure with the same interest as disease eradication programs. These programs will not be successful unless and until the basic health facilities are improved.
It is not easy to build these facilities, and building them in a third world country will undoubtedly involve a lot of complexities. Still, if we are serious about eradicating polio from Pakistan, we will have to start at the beginning.
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