To Calm Nervous Families, Pakistan Changes Polio Vaccination Tactics
Dated: May 24, 2019
Paralysis cases spiked after a vaccination drive was derailed by false rumors that dozens of children had collapsed and died.
After serious setbacks in April led to a cluster of new polio cases, Pakistan is revamping its vaccination strategy in a renewed effort to wipe out the virus.
The country is one of just three — along with Afghanistan and perhaps Nigeria — in which polio is still endemic. Eradication of the virus in Pakistan is crucial to the drive to rid the world of polio, once and for all.
Now, vaccination teams will take a friendlier approach, ask fewer questions, make fewer follow-up visits, and stop recording extensive details about the families they visit, Pakistan’s polio eradication program announced.
Families were intimidated by the questions, and vaccinators spent too much time filling out the registration forms introduced in 2016, said Babar Atta, the polio coordinator in the prime minister’s office, according to local media.
A new vaccination drive is scheduled for the second week of June; thousands of teams will spread out around the country trying to reach almost 40 million children under age 10.
Many vaccinators will go house to house, while others will look for families with young children in refugee camps, train and bus stations, and at highway checkpoints.
Pakistan has had 17 cases of polio paralysis this year; it had only three by this date last year, and only 12 in all of 2018.
In mid-April, widespread panic among parents in Peshawar and the surrounding northern tribal areas forced the suspension of a national immunization drive.
A scaremongering video spread on Twitter, purporting to show students collapsing after getting an expired batch of vaccine.
The video seemed obviously fake. The boys in it flop prone across a hospital bed on cue after the speaker waves his hand; one even makes a funny face on camera. Also, expired vaccine — if it was expired — is harmless.
Nonetheless, “our TV channels found it profitable to cover this nonsense,” Aziz Memon, a textile executive who leads Rotary International’s involvement in Pakistan’s anti-polio campaign, said in an interview in New York. “It became a national event.”
Rumors spread that 50 children had died; mosques used their loudspeakers to tell parents to rush their children to medical care. Hospitals were swamped as more than 25,000 children arrived.
“No one had died,” Mr. Memon said. “But we had to call everything off.”
Local politics were behind the scare, he said. District elections were underway and the conservative Jamaat-e-Islami party was trying to discredit the polio campaign, which is supported by Prime Minister Imran Khan’s Tehreek-e-Insaf party.
The man speaking in the video was arrested.
To restore confidence, Mr. Memon added, the district health and communications ministers appeared on television giving vaccine drops to their own children.
Because suspicion of the campaign remains high in some areas — vaccinators have been accused of marking targets for American drones — interactions with families will now be briefer and less intrusive.
Residents will be asked only how many children are in the household and whether they have been vaccinated.
In Pakistan, extended families often live in large compounds; previously, they were asked about all couples inside, whether they were married, how many children each couple had, and who was pregnant.
Sometimes, the police arrested families who refused vaccinations.
“That was not helpful,” Mr. Memon said. “If you drag people to the police station, they feel insulted. Now, we will have a friendly chat. You don’t have to challenge the refusers, you give them a pep talk and encourage the religious leaders to persuade them.”
In early April, a campaign worker trying to persuade a family to vaccinate was shot dead, apparently by an 18-year-old family member who then fled to nearby Afghanistan.
As compensation, Rotary International gave the family of the campaign worker, Wajid Ali, 32, about $3,300, and the local government promised his brother a job.
In an encouraging sign, Mr. Memon said, the polio virus is no longer found in sewage samples in Karachi, Pakistan’s biggest city, so transmission there may have been halted.
Polio transmission has never been interrupted in Pakistan and Afghanistan; most of the cases are in the mountainous districts along the border, where government control is weak.
Nigeria has not had a confirmed polio paralysis case since 2016, but it takes at least three years without confirmed cases despite vigorous surveillance before a country is declared polio free.
Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the world’s poor. He joined The Times in 1976, and has reported from 60 countries.
‘Polio surge in Pakistan’
Dated: May 25, 2019
APROPOS the letter ‘Polio surge in Pakistan’ (May 23). Indeed, this year the number of cases of polio in Pakistan has increased and the virus transmission has intensified. Pakistan’s case count now stands at 19.
Of the total 19 cases, 13 have been detected from Khyber Pakhtunkhwa, while three were detected from Punjab and Sindh each.
Polio eradication is very simple: if you vaccinate enough children in a given area, then poliovirus has nowhere to hide and disappears from that area.
The fact that Pakistan continues to report polio cases means that we are still missing children during house-to-house vaccination campaigns.
It is important to note here that the children who contracted polio this year had not been vaccinated with OPV.
This challenge is due to many reasons, including massive population movements across the borders with Afghanistan and within the country, as well as an increase in the number of missed children due to refusals which can be attributed to the anti-vaccination propaganda circulating on social media.
In addition, the routine immunisation services are not strong. There is also a lack of safe water and sanitation, and high prevalence of malnutrition — all conditions allowing the virus to survive and paralyse vulnerable children with low immunity levels.
Right now, we are focusing on addressing any gaps in order to stop virus transmission detected in different parts of the country as soon as possible.
This includes trust-building work to help parents better understand the safety and benefits of polio vaccination and to build their resilience to misinformation.
We also continue to provide integrated packages of services for communities in core reservoir areas that include basic health services, improved access to healthcare, enhanced routine immunisation, and interventions that address sanitation issues and waste management.
We also continue to work closely with Afghanistan, with a special focus on high-risk and mobile populations moving between the two countries.
Despite the remaining challenges, we know we can get back on track to eradicate polio from Pakistan.
It may take longer than we hoped for, but with sufficient resources, commitment and support from influencers including the Pakistan Paediatric Association and broader medical community in general, we can get there.
We knew that the last few steps in polio eradication would be the hardest, but we are committed to continuing vaccination campaigns until this disease is eradicated for good.
Babar bin Atta
PM’s Focal Person for Polio Eradication
Islamabad
Published in Dawn, May 25th, 2019
An update from the fight to eradicate polio
By Bill Gates | May 17, 2019
I was born just a few months after the first polio vaccine became available. When I was a kid, I had no idea how lucky I was. Just three years earlier, in 1952, the U.S. experienced one of the worst polio epidemics in its history. More than 57,000 kids got sick with the disease. Thousands died.
But thanks to the invention and distribution of the vaccine, I didn’t know anyone who got polio when I was growing up. That’s how quickly it changed the world. My friends and I got vaccinated early, and so we never had to worry about the devastating paralysis the disease can cause.
Today, there are only three countries left that are still polio-endemic: Pakistan, Afghanistan, and Nigeria. The world has pushed the virus to the brink of eradication. If we continue to invest in stopping the disease, a future without polio is within reach.
One of the organizations responsible for this progress is Rotary International. Tomorrow I’m going to speak at one of their district conferences in Spokane, Washington. Here is the full text of my prepared remarks:
Remarks as prepared
Rotary Joint District Conference
May 18, 2019
Spokane, Washington
Thanks, everyone, for welcoming me. And thank you for the very kind introduction.
Today, I want to begin by showing you some maps. They’re maps of the polio virus. Not all that long ago, polio was everywhere. In the year 1988, scientists estimated that there were more than 350,000 new cases of the disease across 125 countries. Most of those cases were children under the age of 5, and the virus paralyzed many of them for life.
But within six years, polio was wiped out in both North and South America. Then, six years after that, in 2000, Australia and its neighboring countries were certified as polio-free. Then, in 2002, Europe was, too.
By 2014, Southeast Asia was declared polio-free – and the virus was gone from most of Africa, as well. Thirty years ago, there were more than 40 new polio cases an hour. Today, there are fewer than 40 polio cases a year. And instead of being in 125 countries, today all but three are certified polio-free: Pakistan, Afghanistan, and Nigeria. (And we hope that Nigeria will be coming off the map soon).
Here’s another way of looking at it: There are more than 18 million people walking the Earth today who would’ve otherwise been paralyzed by polio. And none of it would’ve happened without you.
The world has known how to fight polio for more than half a century. Jonas Salk developed his vaccine before I was born, and the oral polio vaccine – which protects a child from the disease with just two drops – has been around since 1961. But for a long time, the world didn’t have the resources – or the will – to get the vaccine to every single child who needed it.
That only changed in the mid-80s, when Rotary International began to fight polio – and especially in 1988, when this organization – along with others like the WHO, UNICEF, and the CDC – helped found the Global Polio Eradication Initiative.
In the years since, Rotarians have proven themselves heroes in public health. Not only has this organization raised more than $1.8 billion dollars to fight the disease – you have fought it yourselves, sometimes on the front lines.
I’m thinking about Rotarians like Ezra Teshome from Seattle. Every year for the last 22 years, he has brought Rotarians – by the dozens – to his native Ethiopia to vaccinate children. Then there’s Sara Archer of Walla Walla. A few years ago on New Year’s Eve, she took her end-of-year bonus – and traded it for a plane ticket to Pakistan to participate in a vaccination campaign.
And then there’s Joan Toon of Victoria. Some of you may have met Joan. When she was seven years old, polio paralyzed her brother from the neck down. Then, a few weeks later, Joan woke up and couldn’t move her left side. She spent 3 months in a hospital under quarantine – and remembers seeing children in the iron lung.
Joan has devoted much of her adult life fighting the disease that visited her as a child – and convincing other Rotarians to join that fight, too… to raise money and speak to their elected officials.
When you talk to Joan, she’ll also tell you about the time her husband, Terry, came home from a Rotary meeting in the early 1980s. He busted through the door. Rotary, he’d just learned, was going to wipe polio off the face of the Earth. Joan’s response was “Yeah, right.” Back then, she said, “I never imagined that it would happen.”
Today, things are different. We’ve come so close to eradication that now it’s easy to imagine it happening. Instead, people wonder: When can we stop imagining? When will polio eradication be real?
It’s a fair question. When this initiative started, the head of the World Health Organization declared that we could eradicate polio from – quote – “spaceship Earth by the year 2000.” But by the turn of the millennium, about 33 percent of the world’s population was still living in countries where the virus was still endemic. That’s when our foundation got involved. And although we’ve come so close to zero in the years since, that magic number has eluded us. Last year, the total number of polio cases worldwide was 33.
I think all of us are frustrated by this. But Rotarians most of all. Each year, many of you travel around the world, saving children from a terrible disease two drops at a time – and everyone hopes it will be the last year you have to do it; that we’ll have no need for polio vaccination campaigns anymore because polio won’t exist.
But I also think most of us understand the challenge: Fighting polio today is much harder – and different – than fighting it the 80’s and 90’s. The last 40 cases are far more difficult than the first 400,000. And preventing them takes more experience; it takes more grit – and more learning and innovation.
Look at India. The country was once considered the toughest place on earth to eradicate polio – and it was: high population density, low vaccination rates, poor sanitation systems, lots of people moving around the country, many in remote areas.
In 2010, for example, I visited a town in the marshlands of the Bihar province. Each year, the national immunization drive missed thousands of children in the area in part because the nearby Kosi River tended to flood, rendering the town inaccessible.
In response to situations like this, the Indian government – working with organizations like Rotary – launched an all-out effort to reach every child. They commissioned better maps to ensure every part of the country was navigable – and deployed more than 2 million vaccinators to reach every speck of land, including the town I visited. (One of the most inspiring photographs of that time was an image of polio workers wading waist deep in water to reach remote villages with the polio vaccine.)
This year is India’s 5th anniversary of being certified polio-free, and we’re applying many of the same lessons we learned during that effort to the places where polio is still endemic.
For example, just a few years ago, vaccinators in Nigeria were also missing thousands of children – in part because the maps they were using were inaccurate and incomplete. Whole villages weren’t included.
Since then, our understanding of polio’s geography has grown. The maps health workers are using today are detailed and full. In fact, today we not only know where the at-risk populations are – increasingly, we can predict the disease will be. Even before it infects people.
It used to be that we could only identify a polio outbreak once children started showing up paralyzed. Today, though, we have health workers monitoring the sewage – where the polio virus can survive – at 125 separate sites in the corners of Pakistan, Afghanistan, and Nigeria. Monthly – sometimes weekly – they take samples and send them to labs in 70 different countries. If the labs find traces of the disease, the vaccinators know where to go next – and they can immunize people before the virus infects them.
Even in the world’s most dangerous places, we’ve shown that we can stop polio in its tracks. In 2013, for example, polio paralyzed nearly three dozen children who were living in the midst of the Syrian civil war. Vaccinators not only had to enter the war zone – waiting for lulls in the fighting to make sure children were protected – they also had to account for the 2 million refugees fleeing to surrounding Jordan, Lebanon, and Turkey.
Within weeks, the WHO announced a plan to immunize 2.4 million Syrian children, and the outbreak was over by the following year.
So back to the question: When will we eradicate this disease? I think the answer is: sooner than recent history indicates.
We’ve not only cornered the last few cases of polio – we’ve also spent the last few years sharpening the tools and the strategies to finish the job.
The only question is whether we have the will to do it. Whether people and governments still believe eradicating polio is worth it. And that’s more of an open question than I would like.
Over the next 5 years, the Global Polio Eradication Initiative will need a total of $3.27 billion to continue its work.
I suppose it’s natural to wonder whether the time and money wouldn’t be better spent on something else, rather than a handful of cases of a specific disease. But I also know that fighting disease is like fighting fire. It’s not enough to put out most of it. Unless you extinguish it completely, the disease comes roaring back.
Our projections show what would happen if stopped trying to eradicate polio today: By the year 2029, as many as 200,000 children would be infected annually. Within 10 years, we’d backslide to where we were 40 years before.
Back around 2013, when Ethiopia looked to be free of the wild polio virus, a few cases cropped up. For those who’d spent years fighting the disease there – people like Ezra Teshome – it was frustrating. But Ezra and the many other Rotarians who traveled to Ethiopia stuck by a motto. “Never, never, never give up.”
So long as Rotarians continue to believe that – so long as we never give up – then polio does not stand a chance.
Thank you, again, for all your remarkable work.
Published , May 17, 2019
