Exalting efforts for Polio Eradication in Balochistan
By Ahmed Khan
Polio is an infectious disease caused by a virus, which lives in the throat and intestinal tract is spread through contaminated food or water cause life-long paralysis or even death can strike at any age, but effects mainly children under five has no cure but is preventable by vaccination.
Pakistan is responsible for over 60 percent of polio cases in the world. It beat its own ten-year record with 198 children paralyzed in 2011, and exports polio virus to other countries in the region.
Polio cases in Balochistan:
During 2011, Balochistan remained the worst affected province of the country with 73 children paralyzed by polio. The districts where polio was active increased to 13. Most polio cases in Balochistan are attributed to low coverage due to nomadic population groups, inaccessibility, religious and social refusals. In 2012, uptill now, 4 polio cases reported from Quetta while the total case count of the country is 53. A large number of social mobilization staff including District Health Communication Support Officers (DHCSOs) and Union Council Communication Officers (UCOs) has been deployed in the province to work on communications, awareness raising and addressing refusals.
Global Polio Eradication – Walking the Last Mile
Launched in 1988 when global polio cases were reported at a rate of 1,000 per day, the Global Polio Eradication Initiative spearheaded by World Health Organization (WHO), United Nations
Children’s Fund (UNICEF), Rotary International and other partners, donors and governments around the world made a commitment to wipe polio off the face of the planet with massive vaccination programme. Over the past 23 years governments of 200 countries engaged around 20 million volunteers to immunize over 2.5 billion children.
Today the wild polio virus is freely circulating only in 4 countries of the world including India, Nigeria, Afghanistan and Pakistan. With the exception of India that had only one case last year, none of the other countries are making progress at the rate needed to eradicate Polio by 2012. In Pakistan polio cases are back on the rise — the highest in the world. Roughly every other day another Pakistani child becomes paralyzed for life from a disease that can be easily prevented by vaccination.
Polio Eradication in Pakistan: Can We Succeed?
The annual incidence of polio in Pakistan which was estimated to be more than 20,000 cases a year in early 1990’s had decreased to around thirty cases in 2005. It is hard to believe today but just few years ago Pakistan was on the verge of polio eradication. It seemed that we had almost made it due to insufficient commitment, accountability and ownership of the program at provincial, district and union council levels, polio eradication activities have remained inconsistent in recent year. The number of cases increased to a fifteen-year record high of 198 in 2011.For the current year a total of 53 Polio Cases are reported up till now.
The particular strain of the Polio virus, which is specific to Pakistan, has traveled to other countries and caused outbreaks in China in 2011, and in Afghanistan (ongoing). This causes concern for the public image of Pakistan overseas. In part, because of this increase, Pakistan is going to Hajj or Umrah are required to have a polio vaccination. Recently India has also made polio vaccination compulsory for Pakistani children traveling to Pakistan and for Indian children traveling to Pakistan. If the situation does not improve, travel restrictions upon citizens of Pakistan endorsed by other states may be considered. As a nation is Pakistan able to stop polio transmission and turn this dramatic trend around? The answer is yes!
Key Challenges to Polio Eradication in Pakistan
– access problems due to insecurity particularly in KP and FATA
– failure to identify and focus on underserved population and mobile groups
– operational and planning challenges to deliver vaccination door-to-door to more than 38 million children several times a year and achieving high coverage at UC level
– overall campaign fatigue in public domain, rumors and negative perception of oral polio vaccine in some communities
Polio vaccination coverage has remained consistently low over the years in some areas of Pakistan, especially the towns of Karachi (Gadap, Gulshan-e-Iqbal, Baldia), Balochistan (Quetta, Pishin, and Killah Abdullah) and FATA. These have turned into reservoirs where the polio virus breeds freely and spreads all over the country. Such areas have been infamously labeled as “high-risk”. Seventy percent of all polio cases in Pakistan are attributed to them. Defeating polio there means ending Polio almost all over the country in Pakistan!
Essential Polio Information
We use eradication of a disease to speak of getting rid of it completely. That is, that the disease does not exist anywhere within a country, and then finally any place within the world. No routine polio vaccination will be needed once the disease is eradicated. To stop the transmission of polio virus we need to immunize all the children.
Prevent transmission of polio:
The only prevention against polio is the regular administration of the polio vaccine to each and every child up to 5 years of age. In a country like Pakistan, where the polio virus breeds freely, every child below 5-years of age should receive two drops of the oral polio vaccine in each and every immunization round. Improving sanitation, hand washing and better nutrition are also vital for eradicating polio.
Possibility of polio eradication:
Polio virus infects only human beings. It will not survive in the environment if all people are immunized and there is no place for virus to breed. Similarly in 1979 Smallpox that once claimed the lives of 2 million people a year has been eradicated from the face of the Earth. Therefore, no vaccination against Smallpox is needed anymore.
If polio vaccination is done:
Oral polio vaccine is given orally in the form of two drops. It can be given by volunteers and does not require trained health workers or sterile injections. OPV is safe, effective, and induces long-lasting immunity to all types of poliovirus.
Needed for polio vaccination:
OPV should be given to all children up to five (5) years of age. This includes newborns and sick children; oral polio vaccine has no side effects and does not interfere with any other on-going medication.
Required doses of OPV for immunity:
Oral polio vaccine needs to be administered multiple times to be fully effective. To be fully protected a child should get at least seven to ten doses of oral polio vaccine. Until a child is fully immunized THEY ARE STILL AT RISK FROM POLIO. Every missed child is a place for the polio virus to hide and breed. Every extra dose means a child gets extra protection against polio.
Some children get infected by polio even having doses of polio drops:
Building immunity against virus is a very complex biological process. We are all different; same are organisms’ reactions to medications and vaccines. Few children may acquire strong immunity after just five or six doses of the polio vaccine, while most need more than ten. Immune system of underweight, malnourished and children suffering from diarrhea responds to the polio vaccine in a different way than of healthy children. Therefore, to remain protected all children under five years of age should receive polio vaccine every immunization round.
Need of many vaccination campaigns:
To stop polio transmission no less than 95% of all children of Pakistan should be immunized during each campaign. To achieve this high coverage is very challenging logistically. In other words, the remaining 5% that make almost 2 million unimmunized children should be reached during consecutive campaigns in a short interval to ensure all children are covered. Furthermore, once the polio virus is detected in a certain area, an additional campaign will be carried out for that district to prevent potential outbreak of polio amongst children in the community. That is why multiple polio campaigns are done every year. No child should miss a single dose of polio vaccine! Each additional dose is an additional protection against polio!
Oral polio vaccine safe:
Oral polio vaccine (OPV) is one of the safest vaccines ever developed. It is so safe it can be given to sick children and newborns. It has been used all over the world to protect children, saving at least 5 million children from permanent paralysis by polio. The vaccine has gone through a rigorous process of testing by the World Health Organization and the Government.
Oral polio vaccine doesn’t cause infertility:
Since it has been tried and tested worldwide for many decades there is no known link between OPV and infertility or impotence. It is internationally and nationally endorsed by doctors and governments worldwide including Saudi Arabia, and other Muslim countries.
Oral polio vaccine is halal:
Various muftis and religious Islamic institutions in Pakistan and across the world have endorsed OPV and vaccination against polio. Some of the prominent international institutions endorsing OPV include Dar al UloomDeo-Band, India; the Organization of the Islamic Conference; the International Union for Muslim Scholars (Mufti Dr. Yousuf al-Qaradawi); Imam of Masjid Al Aqsa (Bait ulMuqades) and other prominent scholars and muftis from all sects in all provinces of Pakistan. All hajjis traveling for Haj are now required to be vaccinated against polio.
Protection from other diseases:
Along with this special effort to eradicate polio it is important that routine immunization against polio and other diseases is well established. Every year more than 5 million children are born in Pakistan. If we miss their routine vaccination against polio, measles and rubella, tetanus, pertussis and other life-threatening diseases we shall have a large cohort of children at risk that will need to be “caught up” during special campaigns that require enormous efforts. Every parent must ensure that their child’s vaccination is up to date! Take your child to the nearest health site for vaccination routine vaccination!
Legal measures requisition in Balochistan:
The Polio virus is threat for all children, hence it isn’t a personal, family or community domestic question but catering this virus means spread of virus to others’ children. Consequently, it is responsibility of state that like other citizens granted rights protection; provide protection from Polio virus, too. Religious leaders like Fazal-ur-Rehan head of Jamat-e- Ullema Islam him gave drops to children and provincial leader of this party, like Shamus-ul-Haque, minister for health also gave drops to children by his own. After such modal initiatives, no logic remains to deny for giving drops for polio to children on base of religion. Internal and external religious scholars themselves gave to remove doubts whether it is probated by Islam.
Provincial Government for immunization to Balochistan should know refused houses for polio drops by vaccinating teams or security personal accompanied with team for those who disapprove polio drops for their children, hence they are to be dealt by law. The amendments in law to be made prior to taking any action. This way province can be freed from polio virus.
On this stage, deputed officials about polio campaign have shown outstanding performance and no area in Balochistan missed in parted campaigns. Some houses or families in remote areas missed but they never missed by teams but they denied to give drops their children and resultantly such children causing spread of virus and transaction to other community children. These elements are required to be dealt by law.