Social attitudes need to change for Pakistan to be polio-free

Pakistan has recorded at least 134 cases of polio in 2019, a sharp increase from 12 in 2018 and eight the year before. Rumours about adverse effects of polio vaccine and attacks targeting vaccination teams have hampered the country’s efforts to eradicate the debilitating disease, which targets children and can cause paralysis or loss of limb function.

Mass misinformation campaigns urging parents to refuse to give the drops to their children for fear of health concerns have gone from oral to digital now. Anti-vaxxer videos from Europe are dubbed in Urdu, and then promoted online. Last year, Pakistan successfully removed at least 174 pieces of content promoting misinformation by social media websites.

Since 2012, at least 98 people — seven out of them last year — have been killed in attacks targeting vaccination teams. Suspension of the anti-polio drive last year after attacks on polio teams made around 250,000 children miss their vaccination. Population mobility internally and across Pakistan and Afghanistan too has made it hard to reach all children for vaccination.

And so, despite more than 260,000 staff, guarded by 100,000 security personnel, taking part in each drive to reach more than 35 million children across the country of 207 million people, the disease remains endemic in Pakistan, alongside Afghanistan and Nigeria. Nigeria has had no case since 2016.

The challenge is getting complex. The Global Polio Eradication Initiative reports Pakistan is the only country with consistent barriers preventing vaccination and the eradication of the disease.

Experts say first four doses in routine immunisation are vital and these cannot be covered through multiple doses at a later stage. Also, malnutrition and co-morbidities such as diarrhoea, dysentery, and fever make children vulnerable to get polio even after receiving multiple doses of vaccine. With weak immunity, they fail to produce antibodies from the vaccine. Vaccine is useless if administered to a child with bad stomach or if they vomit after getting the dose.

Hesitation of a large proportion of the general population to vaccinate their children is still a major hurdle. Data from the KhyberPakhtunkhwa Health Department show that in 2019, over a million parents refused to allow health workers to administer the polio vaccine to their children. The highest number of refusals — 694,984 — occurred in April, likely attributed to an outbreak of hysteria over the vaccine after rumours spread of children being poisoned by the vaccine, resulting in vomiting, and loss of consciousness. The since-debunked rumours led to thousands rushing to hospitals to get their vaccinated children examined, while those who were yet to receive vaccinations rejected them en masse.

Such behaviours need to change, as a part of a holistic strategy addressing misperception, insecurity, ill-planning, and malnutrition, before the country kills the virus that continues crippling its kids, its future.