Editorial: The continuing polio challenge

Polio has bounced back with a vengeance in Pakistan. Compared with 53 cases reported during the period January to September last year and 54 in 2012, there have been 174 cases during the corresponding period this year. As on November 5, all of 235 cases have been recorded, the highest-ever in the past 15 years; there were 558 cases in 1999. With a sharp spike in the numbers, Pakistan has turned into a bigger polio reservoir, accounting for 80 per cent of the world’s cases. The Taliban militants’ role in preventing nearly a quarter of a million children in North Waziristan from being vaccinated against polio over the last two years has marked a severe setback to the country. The repercussions of a fake Hepatitis B immunisation programme carried out by the Central Intelligence Agency in Abbottabad in 2011 are also there for everyone to see. If lack of trust in polio immunisation efforts already existed in the community, the militants exploited the fake programme to exacerbate distrust. The exodus of virus-carriers from the region to the rest of the country in June this year has greatly increased the risk of transmission. But the good news is that none of the regions remains inaccessible to health workers. Yet, there is a monumental task ahead for the polio programme in Pakistan as no province is free of the disease; even cities such as Karachi and Lahore have recorded a few cases this year. “The polio programme [in Pakistan] is a disaster. It continues to flounder hopelessly, as its virus flourishes,” notes a recent report of the Independent Monitoring Board.

Prime Minister Nawaz Sharif has just set an ambitious goal of ridding the country of polio in six months. Aside from collective action by all actors, there has to be an immediate, transformative change in the polio programme for Pakistan to get anywhere near disease-elimination. As November to May is a low-transmission season — the virus is the least active and the vaccine most effective during this time — a great opportunity exists now to tame the virus. As the Type 1 virus spreads quickly, is tenacious and is the most difficult to get rid of epidemiologically, vaccination coverage should be 100 per cent; herd immunity is the least in India and Pakistan. It should also explore the option of giving at least two polio shots to children in addition to the oral polio drops. The double-vaccination strategy can greatly boost immunity and reduce the number of oral drops campaigns needed. With the Pakistan virus paralysing children in Afghanistan, Syria and Iraq, the possibility of it emerging in India is real. India, which has been polio-free for over three years, cannot lower its guard till such time as polio is eliminated from Pakistan, Afghanistan and Nigeria, the three polio-endemic countries.

Published in The Hindu on November 12, 2014

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