Is Pakistan on the brink of eliminating polio?

Dr Shahzad Baig, a key health official supervising the polio programme. Image Credit: Supplied

Islamabad: Pakistan’s polio programme has made substantial gains in 2021 with only one wild poliovirus case and eight type 2 cases reported this year as of October. In comparison, wild poliovirus affected 84 while 135 children were infected by type 2 virus in Pakistan last year.

Is Pakistan on the brink of finally eliminating polio? While there is a significant decrease in cases but the country “cannot celebrate any success yet and rather consider this a golden opportunity for Pakistan to intensify our concerted efforts to achieve polio eradication,” said Dr Shahzad Baig, a key health official supervising the polio programme.

The 99 per cent decline in wild poliovirus type 1 cases indicates that “Pakistan is on the right track to achieve polio eradication however the current gains are fragile as the country has been at this point twice before but was unable to curtail the virus” shared Dr Shahzad Baig, coordinator at the national emergency operations centre, Polio Eradication Initiative (PEI), in an interview with Gulf News. Pakistan needs to “redouble efforts to ensure zero new cases by reaching every child with the polio vaccine.”

To be certified as a polio-free country, Pakistan is required to report that there were no children affected by the wild poliovirus over a period of three years.

Intensified campaigns

Over 40 million children under five years of age were vaccinated with the polio vaccine during the third nationwide immunisation campaign in September 2021 as health workers went door to door to protect Pakistani children from the crippling disease. The first two countrywide vaccination campaigns this year in January and April reached more than 80 million children.

What is polio?

Polio is a highly infectious and incurable disease caused by poliovirus mainly affecting children under the age of five. It attacks the nervous system and can cause paralysis or even death. Vaccination is the most effective way to protect children as the virus has no cure. The virus transmits through contact with infected faeces. Contact with objects like toys that have come near infected faeces can also transmit the virus, hence access to clean water and toilets is also crucial to stop the infection.

Types of viruses

There are three distinct wild poliovirus strains. Wild poliovirus type 3 has been globally eradicated. Pakistan is affected by wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 circulating vaccine-derived poliovirus type 2 (cVDPV2). All three strains are symptomatically identical as they cause irreversible paralysis or even death, according to experts.

The cVDPVs occur when immunisation coverage is low or vaccination activities are poorly conducted and fail to reach enough children. “If all children are vaccinated, there would be no outbreaks of any strain of polio. With no children left to infect, the virus would simply die away” Dr Baig said.

Pakistan’s polio eradication strategy

The fact that Pakistan and neighbouring Afghanistan are the only two countries in the world where polio cases are being reported warrants extraordinary efforts.

Prime Minister Imran Khan says that his government is committed to make Pakistan polio-free. To address the health risk, Pakistan recently approved the use of the novel oral polio vaccine type 2 (nOPV2) for the first time. It is also administered via two oral drops and is considered to be safe and effective in providing immunity against polio.

“The new vaccine is being introduced to better address poliovirus type 2 and respond to cVDPV2 outbreaks. Clinical trials have shown comparable protection against poliovirus while being more genetically stable” reducing the risk of circulation of virus.

Detailing some of the specific strategies to eradicate polio, Dr Baig said that the health officials are “working hard to consolidate gains and reach the last child with vaccines.”

Global Polio Eradication Strategy:

1. Commitment and support from top leadership: PM Imran Khan is monitoring the programme and providing guidance through the national task force for polio eradication and meetings with the authorities of high-risk districts for polio.
2. Empowered polio emergency operations centres: National, provincial and district level health officials are offered full authority and resources to design polio operations required to achieve eradication while the partner agencies together with the government are providing critical technical and operational support.
3. Focus on field operations: Immunisation campaigns have been intensified to reach the missing children and the last mile of polio eradication. In 2021, Pakistan conducted three successful national-level campaigns, each reaching more than 40 million children with life-saving vaccines despite the COVID-19 pandemic.

Pakistan Polio Eradication Initiative has adopted three key strategies to prevent all types of poliovirus transmission by the end of 2023 in line with the UAE determined to help Pakistan eradicate polio

The UAE is one of the long-time supporters of Pakistan’s polio eradication programme and has provided $200 million since 2014. The UAE’s $23 million support for this year is helping Pakistan’s efforts to protect 16 million children under five years from polio in the country’s 84 highest-risk districts.