Polio virus was confirmed in environmental samples from six more districts of Pakistan. According to the spokesperson of the Ministry of Health, polio virus was confirmed (10 November 2023) in four samples from Karachi and two samples from Chaman. Polio virus was found in one sample each from Peshawar, Kohat and Nowshera. While this health crisis confronts Pakistan, the nation stands out for instances of anti-polio steps taken by the State being targeted. Many instances have occurred, most recently in August this year, when police and security forces guarding polio vaccination campaigns are targeted and killed. Unfortunately, Pakistan is a global threat to efforts at making children polio free. In conservative Pakistani rural areas, hardline religious groups have long opposed and viewed polio inoculation campaigns as a ploy to make Muslim children infertile. Anti-state militants operating in Baluchistan and elsewhere view polio vaccinators as government spies. Pakistan and neighbouring Afghanistan are the only two countries in the world where polio continues to threaten the health and well-being of children.
Pakistan’s caretaker Health Minister Dr. Nadeem Jan has stated that the latest polio virus strand discovered belongs to the YB3A virus cluster in Afghanistan. He said every child is at risk from the presence of the virus adding that that this virus can cripple children under five years of age for life. He requested parents to welcome polio workers to their homes and get their children vaccinated against lifelong disabilities (Roznama Intekhab, 03 October 2023.) The regional reference laboratory for polio eradication at the National Institute of Health (NIH), Islamabad, has confirmed the detection of Type-1 Wild Poliovirus (WPV1) in nine environmental samples collected in October,” The News International reported. This news comes even as Pakistan launched its second nationwide anti-polio campaign in 2023 (2 October) in an effort to inoculate 44 million children under the age of 5 amid signs the country was close to eradicating the disease.
Vaccine providers and the police assigned to protect them have been attacked during past anti-polio campaigns, which militants falsely claimed were a Western conspiracy to sterilize children. A policeman assigned to protect the polio team in Sarozai, a suburb of Hangu, was killed by unknown persons. The official policeman was a constable in Orakzai police. According to the police, Constable Sadiqullah was on duty with the polio team was shot dead by unknown persons near Sarozai Pul, a suburb of Hangu district (Roznama Intekhab, 9 November 2023). Earlier, in August this year, unknown gunmen killed two police officers in southwestern Pakistan in an attack on polio vaccinators. The shooting occurred during a national immunization campaign in Quetta, the capital of Baluchistan province.
The incident occurred when health workers were administering polio doses to children in the Nawa Killi area when two men riding a motorcycle opened fire on them and fled the scene. The shooting left two police guards dead, but the polio vaccinators escaped unhurt. The local polce officer Marwat said that the polio campaign in the area was suspended. There was no immediate claim of responsibility for the deadly shooting, but militant attacks against polio teams are not uncommon in Pakistan. The violence has killed scores of health workers and security forces escorting them. More than 200 polio team workers have lost their lives while working on polio campaigns, including female workers, male workers, police, and security personnel and a large number of casualties have also been reported.
A research article in the National Library of Medicine (March 2023) notes that local sources have confirmed 70 deaths of polio workers in Khyber Pakhtunkhwa (KPK) province alone since 2012. Just to provide context, it may be mentioned that in January 2016, 16 polio workers died in a suicide attack in Quetta (BBC, 13 January 2016) while six female polio workers were shot and died in the same city. One source reported 68 deaths all across Pakistan from December 2012 to January 2014. In addition to this, multiple cases of verbal and physical abuse have also been reported in Karachi and KPK province and 11 teachers involved in polio campaigns were also abducted from Khyber agency. Thus, the scale of the problem is quite daunting.
Pakistan launched its latest polio vaccination drive in August 2023 to eradicate the highly contagious virus in the country. The weeklong campaign aimed at immunizing eight million children under five across 61 districts, including those in Baluchistan. The provincial government had deployed around 65,000 “front-line workers” to administer polio drops to the targeted population. Pakistan has had three cases of polio paralysis in a child so far in 2023 compared to 20 victims last year (Relief Web, 5 October 2023). The highly contagious virus used to paralyze thousands of children annually in Pakistan until the 1990s when the government launched internationally supported vaccination campaigns. However, the latest discovery of a new strain raises concern over Pakistan’s ability to completely eradicate the virus.
The fact of the matter is that propaganda against the vaccine and the deadly militant attacks have set back Pakistan’s efforts to eradicate the crippling disease. One of the primary factors impeding anti-polio vaccination is the hesitation of a substantial proportion of the population to vaccinate their children. Two reasons stand out, according to an article in Lancet (14 September 2018). Children in Pakistan are given more doses than the number recommended by WHO. This raises speculations amongst the public because of the lack of awareness of the need for booster doses in the tropics. Additionally, conspiracy rumours exist about the mishandling of the vaccines during storage and transportation as well as about side-effects of the vaccine. For example, in a single incident in 2019, hundreds of children were rushed to hospital with complaints of abdominal pain, vomiting, and fainting following polio vaccination, and angry protesters burnt down a health-care facility in the Khyber Pakhtunkhwa province.
The Pakistan government managed the situation by arresting the key conspirator involved in rumour spreading. However, the incident resulted in mistrust among many parents who otherwise were opposed to the fear-based propaganda against polio vaccination. This hostile attitude toward polio vaccinators and misconceptions about religion and polio vaccine continues to be a major public health challenge. While the rest of the world has been declared polio free, Pakistan could well become a source of its transmission to other parts of the world. Although Pakistan has outlined effective strategies under the National Emergency Action Plan to address current challenges, unfortunately, this plan does not include any policy and strategic priority for the safety of polio workers. Pakistan could well be the next super-spreader of polio.