Health workers have launched a campaign this week to vaccinate 9.5 million children against polio in 41 districts across Pakistan. This latest round of a nationwide vaccination drive will include Islamabad and will focus especially on areas where sewage samples have been found to be polio-positive.
The polio campaign will be launched in 16 districts of Balochistan, 11 districts of Khyber Pakhtunkhwa, eight districts of Sindh and five districts of Punjab, according to local media.
Despite extensive efforts to eradicate the disease in Pakistan, there have already been six cases of the highly contagious virus this year. To further complicate the campaign, vaccination teams and medical professionals have faced harassment and even physical attacks in some parts of Pakistan.
Pakistan's Prime Minister Shehbaz Sharif, however, said the government was “steadfast” in its goal of eradicating polio after a meeting with US billionaire philanthropist Bill Gates in Islamabad last week.
How serious is the polio problem in Pakistan?
Pakistan is one of only two countries in the world where polio is still endemic, the other being neighbouring Afghanistan, according to the World Health Organisation (WHO).
This highly contagious viral disease primarily affects children under the age of five. Children infected with poliovirus can suffer paralysis and, in some cases, death.
The South Asian nation launched a vaccination programme as part of its Polio Eradication Programme in 1994. Officials say the country used to report more than 20,000 cases a year.
Despite administering more than 300 million doses of the oral vaccine annually and spending billions of dollars, the disease is still widespread in Pakistan.
Four vaccination campaigns targeting more than 43 million children have already been carried out this year and authorities say they are in the “last mile” of their fight against polio in the country of 235 million people.
How many cases have been reported in Pakistan?
Since 2015, Pakistan has reported 357 cases of polio, including six this year. One of the victims, a two-year-old child, died in May.
Officials said all of this year's cases belong to the YB3A cluster, which they said originated in Afghanistan, where four cases have been reported this year.
In addition to human cases, wild poliovirus type 1 (WPV1) has been frequently detected in environmental samples taken across the country. This year, WPV1 has been found in 45 of Pakistan's 166 districts.
How does Pakistan carry out its polio vaccination campaigns?
The nationwide immunization campaigns, involving more than 350,000 health workers, are being carried out in phases, with vaccination booths set up at health facilities and health workers going door-to-door. The campaigns are organized by the government-run National Emergency Operations Centre (NEOC), which is responsible for managing Pakistan’s Polio Eradication Programme.
Field workers go door to door for a set number of days, vaccinating children under the age of five.
Vaccines are also administered at land and air borders, including to adults, and on highways connecting the country's major cities.
What are the issues facing the polio campaign?
Resistance to the polio immunization campaign grew in Pakistan after the CIA, a US spy agency, organized a fake hepatitis vaccination campaign to track down al-Qaeda leader Osama bin Laden, who was killed in 2011 in Pakistan by US special forces.
Misinformation linked to religious beliefs has also been spread, claiming that the vaccine contains traces of pork and alcohol, which are prohibited in Islam.
Misinformation, agenda-driven campaigns, myths, community boycotts and distrust of the government have also been factors contributing to the rejections. But officials say government campaigns are helping to change misperceptions.
Pakistani health authorities have listed seven districts where polio is “endemic”. All seven are in the northwest, in Khyber-Pakhtunkhwa province. Officials said the security situation has been the biggest obstacle to reaching the target population in the province bordering Afghanistan.
In addition to the security situation, health officials say a mobile target population that may be carrying the YB3A variant has proven to be a challenge.
Why have health workers and security officials been targeted?
Health workers and the security officials accompanying them have been harassed, ridiculed, mocked, threatened and even physically attacked.
At least 102 field workers, officials and security personnel fighting polio have been killed, including at least six in campaigns carried out this year.
In recent years, the Pakistani Taliban have killed dozens of health workers and security forces involved in polio campaigns. But authorities believe the reason for the violence is not only the polio programme.
“In recent years, it is not the polio programme that is being targeted, but unfortunately the security personnel who protect the teams because given the security situation in some parts of the country, they become easy targets when they are out in the community,” Dr Hamid Jafari, WHO’s director of polio eradication, told Al Jazeera.
What other issues affect health workers?
Low wages, late payment of wages, lack of assistance and compassion, and harsh working conditions are other problems faced by farm workers.
Some health workers told Al Jazeera that they are paid as little as 1,360 rupees a day (about $5) for at least eight hours of work. On recovery days, when they go out into the fields after finishing the campaign to vaccinate children they were unable to vaccinate, they are not paid, they said.
In addition, some polio survivors now working in the campaign do not receive assistance with transportation or health benefits despite their conditions, forcing them to walk in harsh weather conditions and difficult terrain to carry out their work.
Some staff members lamented the lack of pay parity, saying that people working with international organisations involved in the campaign receive much higher salaries.
What are the prospects for the polio eradication campaign?
Dr Shahzad Baig, who was head of the NEOC until May, told Al Jazeera the aim was to make Pakistan polio-free by 2026.
“That’s our goal right now,” he said before being replaced.
However, following a WHO-organized Technical Advisory Group meeting in Qatar in May, there are growing concerns about the “deteriorating disease situation” in the country, according to a report in Pakistan’s Dawn newspaper.
A Pakistani official quoted in the report said that at the meeting, “we are faced with an embarrassing situation as all the gains made by Pakistan in 2021 have been lost and the virus has re-emerged in three blocks.”
However, health officials remain hopeful, given that the number of positive cases has dropped significantly over the past five years – from 147 in 2019 to six so far this year.
“The programs in Pakistan and Afghanistan are very mature and have learned a lot,” Jafari said.
“Despite changes in government and security situations, these programs have evolved, adapted and adjusted. And that is why they have a level of population immunity that is not leading to outbreaks of paralytic polio cases.
“This is not a problem that is widespread across Pakistan, or even a geographical problem. Now it is about reaching those last populations, which are difficult to reach. Once you start reaching those populations, progress happens very quickly.”
