Introduction
Poliomyelitis is an acute disease, and it is mainly caused by a single-stranded positive-sense RNA virus, which is found in three serotypes (types 1, 2, and 3) that cause paralysis and acute muscle weakness. It mainly affects children under the age of 5. The basic transmission is through the fecal-oral route and significantly through contaminated water. It affects children all around the globe, and the first known clinical description of polio was done by British Doctor Michael Underwood in 1789, it was formally recognized as a disease by German Physician Jakob Heine in 1840.
Polio Eradication Campaign in Pakistan
Although almost every country has emerged victorious while fighting this incurable disease, two countries are still facing its spread, one of which is Pakistan and the other is Afghanistan. The government is taking several measures to eradicate this disease. The only cure for polio is immunization, so to make Pakistan a polio-free country, a campaign started in 1994 known as the “Polio Eradication Programme.”
Upon the initiation of this program, the number of cases in Pakistan was 20,000, and since then, many cases have successfully been eradicated, and now only 1% of the remaining cases are left. Almost 285,000 frontline workers are providing door-to-door services of polio vaccination and this makes it one of the biggest vaccination projects in the whole world.
Since 1994, cases dropped to almost just a few, until 2019 when the confirmed cases peaked, and 147 Polio cases were reported. After this, in 2020, major vaccination efforts contributed to a decline in polio cases and the recent years proved to be a huge success. Almost 6 cases were reported in 2021, and two wild poliovirus (WPV) cases were reported in 2023. However, in 2024, the cases have increased with the total nationwide count reaching 39.
Objectives and Major Plan
The major action plan of this campaign includes four major objectives: poliovirus detection and interruption, Immunization system strengthening, containment, and legacy planning. WPV detection includes the basic set of data and the ongoing transmission of the disease. It includes every single piece of news regarding any outbreak and enhanced surveillance response. It also includes a tailored emergency action plan and risk management measures to further cope with present scenarios.
The second important factor is the Immunization system strengthening, which allows poliovirus transmission and the building of a proper network for a stronger delivery of life-saving vaccines and raising awareness about the spread of disease. Along with the interference of the World Health Organization (WHO) and different other sectors, polio vaccination stocks and their containment are reviewed and a proper plan is devised for such a purpose. This ensures the proper availability of vaccinations to different centers.
The last objective is to look for prospects to make Pakistan a polio-free zone by considering the present circumstances and keeping in mind the future dividends and help necessary for upcoming projects. It also makes a huge impact on the self-image of the state in front of other global health organizations. This makes this campaign a successful plan against the eradication of polio from every single part of the country, keeping in mind all the ins and outs of the circumstances.
Solutions
For the past 25 years, the Polio Eradication Programme has been actively vaccinating children from different parts of the country. In 2022, an estimated 12.6 million children were vaccinated. In this regard, a National Emergency Action Plan for the Polio Eradication Programme was devised, which is a document that contains objectives, rules, and solutions to implement a zero-polio goal and further highlights the need for future changes.
It was first proposed in 2011 and then revised each year to better implement the objectives according to the situation. Small-scale subnational immunization campaigns are also carried out in selected districts so that every single risk-affected area will be covered. The introduction of the inactivated polio vaccine (IPV) is also one of the main reasons for success in this regard.
An inactive polio virus is generated in the body, and consequently, the antibodies are developed that will remain in the system for a long time. If the body comes into contact with the actual virus, then the already present antibodies will fight against it, and this will prevent the virus from occupying the body. This method is very effective and in 2015, the first IPV was used in Pakistan, and since then millions of children have been vaccinated by this.
There are some myths and stereotypical viewpoints regarding vaccinating children that were highlighted by a few tribal groups. The groups asserted that they wouldn’t vaccinate their children because it would make them sterile and cause serious problems for their future. To fight these myths, door-to-door vaccination facilities are provided by front-line workers who are not only experienced but also quite educated.
They cross-check every single detail and highlight the positive influence of vaccination among the masses to make their worries seem like dust. Along with that, a strong awareness of the benefits of vaccination is promoted through social media and print media platforms, further making it a successful campaign. That’s why a good mobilization and communication scheme is necessary for a wide-scale campaign, and this program is benefiting from this.
Challenges
A major risk of this whole campaign is the security of front-line workers, as there are several reported cases in which the people simply say no to vaccinating their kids and in this conversation, they physically abuse the worker, creating problems for the organization, and the individual. Along with that, the misconceptions regarding vaccination make people question the authority and hesitate to vaccinate their children.
The geographical barrier and limited infrastructure for the availability of vaccines make it a challenge to provide vaccination to every single child from far-off places, and due to this very reason, polio cases emerge. In this regard, one important factor is the cooperation between Pakistan and Afghanistan’s polio vaccination campaigns. As both states are still fighting for a common cause and the majority of immigrants are from Afghanistan, some proper systems should be devised that will improve vaccination availability.
One major factor in the persistence of polio in Pakistan is that children are marked by a single stroke in their smallest right finger after vaccination. There have been reports of people marking their children’s fingers and presenting them in front of health workers to avoid getting them vaccinated. From this, we can assume that the workers have to tackle many situations and events that cause huge pain and severe disruption in marking the records and data.
Conclusion
Polio eradication enables children to have a normal upbringing and brings Pakistan one step closer to being a polio-free state. This program has been through many ups and downs, but still, the management and action plan make it a program worthy of appreciation. From 20,000 cases in 1994 to 02 cases of WPV-1 in 2023, this program has eradicated almost 99% of the disease.
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