Why Polio Remains Endemic in Pakistan

By Hoor Tariq

Home to almost all of the world’s polio cases, Pakistan remains an impediment to a polio-free world. Although the country has made tremendous steps in its efforts to contain the spread of polio, with the number of cases declining from 306 in 2014 to 12 in 2018—according to the

World Health Organization (WHO), a resurgence of polio has culminated in cases rising to a five-year high. Thus far in 2020, there have been 17 cases. Today, Pakistan continues to be one of two countries (the other being Afghanistan) where polio remains endemic—so, why has the end remained elusive?

A complicated journey

Pakistan’s road to polio eradication has been shrouded in complexities. Misinformation about the vaccine, attacks on workers, political transitions have been major setbacks to the country’s Polio Eradication Initiative since its launch in 1994. Conspiracy theories about vaccines have a long history, aggravated by the CIA’s orchestration of a failed vaccination campaign in 2011 to obtain Osama bin Laden’s family DNA. The use of health workers in intelligence operations sparked local suspicions about a ‘Western plot.’ Many Pakistanis began conflating efforts to fight polio with dangerous Western influence in the country’s affairs. As a result, anti-polio vaccination groups, including religious fanatics and so-called scholars intensified their disruption of immunization campaigns, ultimately undermining decades of efforts to eradicate polio.

Unfortunately, mistrust of the vaccination continues to dampen progress. The number of vaccine refusals increased to 120,000 in 2019 from 40,000 in previous years. In March 2019, Prime Minister Imran Khan urged social media giants, including Facebook and Twitter, to remove propaganda videos against polio vaccination from their websites. Such propagatory content, Khan emphasized, catalyzed the spread of more misinformation which remains a “major obstacle in achieving complete eradication.” Although the offensive videos were removed, the growing movement against vaccinations, fueled by social media, presents a new challenge for the country.

Experts also cite mismanagement in the program due to political transitions that prompt bureaucratic changes as a reason for its flagging effectiveness. “Pakistan, its political transition, and polio cases go in the same direction, an upward direction. Due to the transition, a chaotic environment develops,” says Dr. Rana Safdar, former National Emergency Operations Coordinator of the Polio Eradication Program in Pakistan. “The entire [polio] program goes upside down.”

On October 18, 2019, Babar Atta, the Prime Minister’s focal person for polio eradication resigned, citing “personal reasons” for his departure in a tweet. Long before his ‘resignation’ the National Health Services ministry had warned against Atta’s reckless attitude towards polio eradication efforts. At the time, the Prime Minister’s Office had ignored such warnings, but finally took action in the wake of the country’s global embarrassment following a surge in polio cases. Nonetheless, bureaucratic shuffling means the program continues to suffer.

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