My eldest son Babar had polio and was bedridden since childhood,” recalls Nasreen Sajid, a mother of four from Kotha Pind, in Lahore, capital of Punjab and Pakistan’s second-largest city, after Karachi.
“When he was 18 years old one day a fire erupted at home and as he could not come out, he was burned to death,” she continues. She had not known about polio vaccination then. It cost her first son his life—and taught her a painful lesson.
The scars remain until today. Every time she sees health workers going around administering polio drops, she is reminded of her eldest, and is filled with guilt. But she’s learned to channel that energy more productively. She makes sure that her four remaining kids are vaccinated and healthy, and she’s involved in keeping her neighborhood immunized, too.
“No child or parent should have to go through what I’ve gone through,” she says. But the reality is that Nasreen’s experience is hardly unique. Many parents across Pakistan have lost children to a life-threatening, but largely preventable illness.
Fraught Campaign
Poliomyelitis, also known as Polio, is not a new disease. It has been around for centuries, dating back to around 1400 BC. But in the 1980s, the virus exploded globally, causing nearly 350,000 cases across 125 countries. Following this, in 1988, Global Polio Eradication Initiative was created with the goal of eliminating the disease by the year 2000.
Its name comes from the causative agent, the poliovirus. The virus is very contagious and is transmitted primarily through the feco-oral route. This means that it passes from the excrement of an infected person and into the mouth of a susceptible person. This is especially problematic in places where sanitation is weak, as food and water become easily contaminated.
While most people who get sick with polio will not develop obvious symptoms, some show flu-like manifestations, including fevers, tiredness, and headaches. In the more extreme cases, the virus invades the spinal cord and leads to meningitis and paralysis, sometimes eventually causing disability and death.
Thankfully, polio can be immunized against. Vaccines can be delivered through shots, usually in several doses, and through oral drops. This is especially potent in children, where just three doses of injected vaccines can provide at least 99 percent immunity to polio.
The program has been largely successful. Most countries have already eliminated polio, save for three, where the condition remains prevalent: Nigeria, Afghanistan, and Pakistan.
Among the many reasons for the incomplete eradication of polio in Pakistan is the nomadic population that constantly moves between Pakistan and Afghanistan, which has a higher disease prevalence. As a result, the virus is consistently being reintroduced in Pakistan.
But just as importantly, if not more so, is an unhealthy population. Unbalanced diets, lack of awareness about exclusive breast feeding, unhygienic living conditions and lifestyles, and irregular waste disposal are common problems in Pakistan. Coupled with low routine vaccination coverage, these lead to poor immunity among children.
To make things worse, the Covid-19 pandemic has added another layer of complication on top of an already-fraught immunization campaign.
In Pakistan, polio immunization drives are often carried out by Lady Health Workers, who go door-to-door and administer the oral vaccines directly into the mouths of the children. But quarantine and physical distancing measures due to the Covid-19 pandemic have forced authorities to change the way immunization programs are implemented.
Program restart
The last polio immunization drive was held in February 2020, and as Pakistan went into lockdown due to the novel coronavirus in March, the next drive, initially scheduled in April, was postponed. This year alone and as of writing, 64 polio cases have already been reported in the country.
When the Covid-19 numbers started to drop in July, Special Assistant to the Prime Minister on Health, Dr Zafar Mirza, announced that the anti-polio drops drive would resume on July 20 in parts of the country that were considered high-risk. It kicked off on 13 August in Khyber Pakhtun Khawa and other provinces.
Aside from delaying the rollout of the immunization program, the Covid-19 pandemic also forced officials to recalibrate their campaign, and revise their standard operating procedures.
Typically, Lady Health Workers (LHWs), who bring essential healthcare services, carry out the immunization drive because they are well-known in the community and people are comfortable in engaging with them. Before the pandemic, LHWs would go from door to door, sometimes even enter the house, and hold the mouths of the children to be immunized in their hands to put the drops.
But because of the coronavirus, LHWs now need to follow strict health protocols. These include daily temperature checks, mandatory masks, use of sanitizers, and keeping physically distant from the community families, among others. In addition, only LHWs younger than 50 years of age were allowed to do rounds.
Despite these adjustments, the campaign remained reasonably successful. Its goal was to immunize some 800,000 kids under the age of 5 years. Between July 20 and 28, 722,500 children were given the oral vaccine in select districts across the country, according to the Pakistan Polio Eradication Program.
In Sindh the drive was conducted in 23 Union Councils, with a target of immunizing 260,742 children. Over 80 percent of the target was achieved, with 18,000 refusals. In Baluchistan, 10 Union Councils were targeted; 103,495 children were covered with 3,625 refusals.
“Our aim was to vaccinate children in Union Councils having super high-risk areas where nomads, Afghans, and Pashtoon people live, and the surrounding areas where inter-province bus terminals exist,” explains Dr Nadia Ata, herself a polio survivor, and the Deputy District Health Officer in Lahore.
Challenges remain
As the vaccination campaign is finding ways to adjust to the Covid-19 pandemic, so are some of its most insidious roadblocks.
There has always been some resistance to vaccines in Pakistan, including among Pashtoon people. After the arrest of Dr Shakil Afridi in a fake polio vaccination program in Abbottabad in the area where Osama Bin Laden was killed, Taliban started a propaganda that the vaccination is a Western conspiracy to sterilize children or collect intelligence. Prior to that, some religious leaders spread the rumor that vaccinations may lead to infertility.
Under the pandemic, the conspiracies have taken on a new life, with fake messages circulating on different social media platforms saying a new coronavirus is being injected in people.
Many parents, in response, have grown hesitant of having their children vaccinated, which sometimes even sparks hostility. LHWs are now provided with security as some of them have been targeted in the past.
Dr Iqbal Memon, President of the Pakistan Pediatric Association, says that “Amongst other problems, administrative issues are faced by field workers. They have been exhausted over time doing the same exercise with no positive result forthcoming. They are underpaid; they are threatened and some have been killed, which affects the campaign. There are areas where polio workers cannot go due to tribal rivalry.”
In this regard, the media have been a great help. Just before the polio drive started on July 20, electronic and print media were used to educate the masses regarding this issue. Messages were relayed through celebrities and religious leaders to get children vaccinated.
Tahir Mehmood Ashrafi, Chief of the All Pakistan Ulema Council (PUC) said, “For years PUC and I have been under threat for spreading awareness but we can’t cripple our future generations.”
“It is a must that every child is given polio drops,” he said. “People need to understand that if these drops were causing infertility, why is the population growing?”
Pakistanis, even in the 21st century, are suffering from diseases that have been eradicated in other countries. The government has to come up with robust and aggressive methodology to regulate cross-border movement, ensure hygienic living conditions for the people, and provide proper and timely waste disposal and access to clean water. These must continue alongside intensified efforts to quell the Covid-19 pandemic.
Only then can the efforts to eradicate polio and many other diseases bear fruit, ensuring that the next generation is born and bred disease-free and healthy. ●
R Umaima Ahmed is Associate Web Editor at The News on Sunday in Pakistan and has over ten years experience in content, print, and local and foreign online media. Her areas of interest are digital security, minorities, and animal and transgender rights. She tweets @UmaimaBlogger
