The Polio Curse

polioBy Sabena Saiddiqui

Pakistan has succeeded considerably in eradicating poliomyelitis (polio) , in the early 1990s, there were more than 20000 cases a year. In 1994, the national polio eradication programme made major advances in reaching children with immunization all over the country, number of cases came down to 28 cases in 2005. Managerial problems came about in key high-risk areas and children could not receive adequate doses of oral poliovaccine.
As a result the number of cases of polio increased in 2011 reached 198.

According to the international website of polio eradication (www.polioeradication.org), Pakistan reported six polio cases last year , this year the number of cases touched 50 with 6 month old Zainab living in Ahmedkhel village in located in Town-III of Peshawar district. This child received four doses of the oral polio vaccine under the ‘Sehat Ka Insaf’ programme . There have been similar cases even in the West where multiple polio shots have resulted in polio. 78% of Pakistani children with polio were given polio vaccines , so what went wrong ?

The type of polio vaccine used is very important , there are two main types ; Inactivated Polio Vaccine IPV and Oral Polio Vaccine OPV. The first type uses dead cells of poliomyelitis , it quelled the polio epidemic in America in the 1950s when 22000 children were affected yearly. In Pakistan , OPV is used in which the virus is run through a number of animals to weaken the strain , not kill it .This weakened strain is injected into children whose immune systems defeat it. It is possible that treatment backfires when the strain is not weak enough for the human immune system to handle. Why is OPV the choice of the Polio Global Eradication Initiative when it has such inherent defects ? This Initiative is financed through UNICEF and the US .

At times Pakistani parents refuse polio vaccinations maybe because of such faulty vaccines . This year there were more polio cases . FATA areas had 39 polio cases ,other Taliban-controlled areas like North Waziristan had 34, South Waziristan had three cases, Khyber Agency one and Frontier Region Bannu one.

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Progress has been hampered at times by instability and war on borders with Afghanistan, limiting safe access to children.
The government has not been able to send polio teams to South and North Waziristan tribal areas because of the ban imposed by the local Taliban two years ago as a protest against US drone attacks.

There have been concerns in Pakistan that UN agencies might have been used in fake polio vaccination campaigns – this is connected to the search for Osama bin Laden in Abbottabad by American CIA through a fake vaccination campaign. “We have been pointing out to the WHO the difficulties we face which include the security situation in certain pockets, the threat of terrorism, attacks on polio workers, also excessive focus on one type of vaccination i.e. polio while children require a cluster of nine vaccines. This created some doubts about the agenda of vaccination among people. On top of that, a fake campaign of vaccination was conducted in Pakistan in which the UN agencies were also used. I am referring to Dr Shakeel Afridi’s case,” Foreign Office spokesperson Tasnim Aslam Khan said on Thursday. She said, “This further reinforced the negative perception about the agenda behind the polio eradication campaign. We have been trying to overcome that. The religious scholars have been involved to educate and enlighten the population. We have been discussing these issues with WHO.” This just seems to be one more price Pakistan has had to pay for the American War on Terror in Afghanistan , Pakistan had to face numerous problems even at the time of the Soviet invasion .

High-risk areas are Federally Administered Tribal Areas; Khyber Pakhtunkhwa province; Quetta block in Baluchistan; and also Karachi towns of Gadap, Baldia and Gulshan E Iqbal. 75% cases are reported from these districts , wild viruses reported from cases in other areas are all genetically linked to these high-risk areas.

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Not only every erratic polio case in Pakistan is genetically linked to these hotbeds of virus , polio has no borders .
The WHO confirmed that recent cases of polio in China and Syria have been traced to Pakistan, even environment samples of the poliovirus found in Israel are thought to have origins here. If these polio risk areas are not completely eliminated Pakistan is on the way to becoming a global polio threat .

There has been talk of travel bans on Pakistanis , immunisation certificates would be required for all age groups notwithstanding the fact that most had their polio shots in infancy .

It can be surmised that people of a certain tribal mindset are wholly responsible for the prevalance of the disease in Pakistan . At most times , polio workers meet resistance from such households, at times they have even been shot dead .
These tribal folk felt they were being spied upon and refused to let polio drops be administered to their children . Fake vaccination campaigns by people like Dr.Shakil Afridi created risks for genuine polio workers.

Another factor that comes in mind is that polio vaccine must be stored at temperatures between +2 to +8 degrees C.
The polio teams carry vaccines in water coolers made for storing drinking water rather than vaccines. How effective are these coolers in maintaining temperature? If the vaccine is not handled properly and requisite temperature is not maintained it is rendered ineffectual. Long hours of load shedding cause refrigerators to lose their efficacy in maintaining adequate temperature range. The standard schedule for immunization is called EPI, in which the vaccine is to be administered in total of four doses, i.e. at birth, 6th week, 10th week and 14th week after birth.

It has been noted that polio teams are visiting schools at very frequent time intervals almost every month and are administrating polio vaccines to children of age greater than 3 years , in fact school going children. It is compulsory to take a child’s medical history before administering the vaccine, as certain diseases can lead to increased chances of contracting polio through vaccination. The teams visiting homes or schools do not inquire about any medical history because they are not trained to do so. Storing the vaccines for longer periods requires -20 C. There is definitely some type of negligence at play.

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Does our Health Dept provide cold storages at the level of every district? Special care is needed in the storage and administration of the vaccine , the vaccine should be checked and verified by our Health Department to remove any suspicions of it being spoilt , fake or tainted. This is something that Pakistan has to to take into its own hands completely and decide to excel in this polio eradication programme . At the end of the day , Pakistani children get crippled and this issue is damaging the image of our nation. If provincial governments lack the resolve the army could oversee this immunization drive. It is important that the vaccines are verified and checked for the peace of mind of our people .

Pakistan is a nuclear advanced nation , many scientific breakthroughs have taken place here. There is no dearth of the best doctors. It is not that backward a nation to still have this polio malaise threatening society.

It almost seems like certain groups refuse to let polio vaccination programmes succeed with malicious intent. The WHO feels that its recommendations on ensuring polio vaccination for Pakistani travellers raises awareness about the seriousness of the situation and will significantly help to combat the menace of polio in Pakistan. For Pakistanis there is a certain humiliation factor involved and they would like such a travel ban to be waived.

In any case , every Pakistani would like to see a polio free Pakistan

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