Drop by Drop: Achieving Polio Eradication in Pakistan

Abstract

Since the start of the global campaign to eradicate poliomyelitis in 1988, case numbers have been reduced by more than 99%, such that only 406 cases were reported in 2013. While the Global Polio Eradication Initiative (GPEI) hopes to be rid of the disease by 2018, the spread of the virus strain in Pakistan to countries that have been polio-free for decades is a cause for concern. Among the three countries where polio remains endemic today, the eventual success of the drive for eradication in Pakistan remains questionable: from 2012 to 2013, the number of polio cases actually increased by 57%, and April marked the 50th case in the country in 2014. Given the ability of polio transmission in one country to jeopardize the success that has already been achieved around the world, this study stresses the need to examine barriers to eradication that remain in Pakistan. Recognizing the absence of a study seeking to assist the GPEI in Pakistan by comparison with past projects elsewhere, this work uses a consideration of select case studies to draw recommendations for the initiative In Pakistan. The ongoing polio eradication efforts in Nigeria, and the successful elimination of the disease by India in 2011 are used to examine three specific problems within the Pakistani case: resistance to vaccines, resistance by militants, and resistance within the government. The study reaffirms the value of current efforts to overcome vaccine resistance through positive engagement with religious and community leaders. However, it notes the relative neglect of communication that provides information about the oral polio vaccine helpful in mitigating suspicion about immunization, specifically as relates to the need for multiple doses of vaccination. Moreover, greater emphasis needs to be laid on transforming the drive to eradicate polio in Pakistan from a foreign project to a local one, invested in national pride and support. In this regard, there is a need for a coordinated project aimed at grassroots community mobilization and engagement, modelled on the success of the Community Participation for Action in the Social Sector (COMPASS) Project in Nigeria and the Social Network Mobilization initiative in India. Emphasis must be laid on a strategy that incorporates communication campaigns at local levels with national advertisements featuring, for instance, vaccination endorsement by polio victims and admired cricketers. In the short run, security threats to vaccination staff must be countered by immediate ground protection, and the packaging of polio vaccination efforts as part of broader health services provision. For inaccessibility concerns, innovative approaches being employed in Nigeria, such as hit and run, checkpoint vaccination and the creation of permanent health teams by training elderly women as vaccinators should be incorporated. In the long run, creating pervasive national demand for a polio-free Pakistan is crucial to mitigating security challenges, since this would enable attacks on health workers to adversely impact militant group perception among their support base. Efforts to create national demand and commitment to vaccination on the government must similarly rely on the creation of a culture of pride and investment in the successful eradication of the disease. National humiliation associated with unsuccessful polio eradication, as in the case of the outbreak following the 2003 boycott in Nigeria, should be utilized to encourage commitment and overcome polio fatigue, where necessary. In the Pakistani case, comparisons with India have proven successful in the past.