Karachi, Aug 5 (AP) — For a decade, Sughra Ayaz has been advocating door to door in southeastern Pakistan, urging parents to vaccinate their children against polio. Her mission is to help eradicate this paralytic disease. Yet, in her journey, Ayaz encounters a range of responses, from practical concerns such as families prioritizing basic needs like food and water over vaccines, to fear fueled by misinformation.
These challenges come in addition to immense pressure on campaign workers to show success. Ayaz reveals that, in some cases, workers have been instructed to falsely record immunizations. Furthermore, the vaccines, which need to be stored cold, are not always kept under proper conditions.
The World Health Organization (WHO) and its partners launched a global campaign to eradicate polio in 1988. The campaign aimed to achieve complete eradication—a feat accomplished only once before with smallpox in 1980. Success seemed near in 2021, with just five cases of the virus reported in Pakistan and Afghanistan. However, these numbers surged afterward, reaching 99 cases last year, and numerous self-imposed deadlines have been missed.
Afghanistan and Pakistan remain the only nations with ongoing polio transmission. The Global Polio Eradication Initiative (GPEI) has been hindered by what insiders describe as mismanagement and a rigid adherence to outdated strategies. According to workers, polio experts, and internal documents acquired by the Associated Press, these issues include falsified vaccination records, improperly selected and untrained workers, and incomplete mass vaccination campaigns.
Documents reveal other significant challenges faced by polio vaccination teams, such as falsified records, use of untrained relatives in place of certified workers, and mistakes in vaccine administration. Vaccinators reportedly lacked knowledge of vaccine management, leading to mishandling and temperature control lapses. Reports cite unaccounted-for vaccine vials and a hurried approach to vaccine delivery, indicating potential inefficiencies.
In Afghanistan's Kandahar, interference in the selection of vaccinators led to the recruitment of underage and illiterate individuals. In 2017, a team in Nawzad missed 250 households, and village elders reported years without visits from vaccination teams.
Health officials and vaccine workers in both Afghanistan and Pakistan validate these documented issues, attributing them to cultural obstacles, misinformation, and regional poverty. WHO's polio director, Dr. Jamal Ahmed, acknowledges the operational challenges but emphasizes the program's robust monitoring and evaluation processes.
However, issues like "fake finger marking," where children are marked as vaccinated using ink but not given the vaccine, persist. Critics have called attention to the continued reliance on the oral polio vaccine.
Polio, a once-dreaded disease, spreads via contaminated water, predominantly in places with inadequate sanitation, risking children worldwide. Eradication demands exceptional effort—zero cases globally and immunization of over 95% of children.
The oral vaccine has effectively protected over 3 billion children but carries rare risks. Scientists estimate one child may be paralyzed for every 2.7 million first doses administered. In rare cases, the virus may mutate, causing new outbreaks in areas with low vaccination coverage.
Public health experts emphasize the importance of transitioning from the oral vaccine due to these risks, despite its past successes. There isn't enough injectable vaccine, which avoids the live virus risk, to rely on it alone. This injectable form is also more costly and requires more training.
Dr. Tom Frieden, a former CDC director and current member of an independent polio eradication review board, argues the necessity of the oral vaccine but urges adaptations like quicker case identification methods. Reports have documented ongoing program failures since 2011.
Former WHO scientist Dr. T. Jacob John has appealed to WHO Director-General Tedros Adhanom Ghebreyesus to reassess the campaign, yet has received no response.
Dr. Ahmed asserts that the oral vaccine remains crucial, highlighting its role in the polio eradication in countries like India, once deemed an impossible task.
Today, most polio cases stem from vaccine-derived viruses, predominantly in Africa and the Middle East, except in Afghanistan and Pakistan. Columbia University Professor Scott Barrett suggests an inquiry into missteps, particularly a failed 2016 effort to remove a strain from the oral vaccine, resulting in significant setbacks and outbreaks in numerous countries.
The polio eradication initiative faces ongoing distrust. With an annual budget of about USD 1 billion, it is one of the costliest public health efforts. Recent political developments, such as the US exiting the WHO and funding cuts under President Trump, add financial strain. Some argue reallocation of funds to other health needs might be more beneficial.
Efforts in countries like Pakistan have seen significant resources spent without progress. Locals protest the expense, demanding essential services like medicine, food, and power instead of vaccines. Communities experience broader issues like water safety and addiction. Security concerns persist, with over 200 associated deaths of workers and police since the 1990s.
The initiative also confronts a widespread misinformation wave, suggesting, for example, that the vaccine alters fertility. In suburban Pakistan, citizens express unfounded fears, complicating vaccination drives.
Svea Closser, a Johns Hopkins University health professor, notes increased resistance in immunization efforts across Pakistan and Afghanistan, partly due to perceived neglect of other diseases and consequent conspiracy theories.
In Afghanistan's rural areas, social dynamics and misinformation pose significant hurdles. A mother of five expresses a desire for polio vaccination, yet yields to male relatives who reject it due to myths about fertility.[0m
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