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Pakistan: The latest push for polio eradication comes amid murders, mistrust and misconceptions | DAWN.

[February 11, 2020] Zofeen Ebrahim writes:

Still a little shaken by the cold-blooded murder last month of the two lady health workers who also worked as polio workers, Faheem Bibi remains determined saying she will continue to administer polio drops in her village in Khyber Pakhtunkhwa's Swabi district.

The 45-year old unlettered mother of four does not have the luxury to be scared. She has little choice but to continue going door to door cajoling parents to get their children protected from the crippling virus.

With a husband who's unwell, Bibi is the sole bread winner of the family and desperately needs the extra Rs 4,050 she earns for the four days that she works as a vaccinator.

The incident comes as a five-day nationwide polio vaccination campaign is set to begin on Feb 17.

Aiming to inoculate approximately 40 million children, the campaign will involve approximately 265,000 polio workers going door-to-door to inoculate children under the age of five.

This will be the first of two nationwide polio campaigns aimed at plugging the immunity gap that emerged in Pakistan during 2019.

Misconceptions abound.

Bibi says the LHWs in Swabi were killed because extremist elements in her area "staunchly believe that polio drops are being given to Muslim children to make them sterile and to slash their population".

"They disapprove anyone carrying out this work, but they particularly target women because when women are killed the fear factor increases and acts as a deterrent for recruiting women," says Dr Yasmeen Jaseem, a gynecologist hailing from Swabi who has also been an MPA.

According to Dr Rana Muhammad Safdar, National Coordinator for Polio Eradication, the vaccine is administered in as many as 120 countries around the world, irrespective of religion. He adds that the idea that the vaccine was only being given to Muslim children was utterly preposterous and untrue.

Also read | Polio: What's behind the refusals?

The same mistrust travels all the way to Tarnol, some 20 kilometres from Islamabad.

Zonal supervisor Nasik Abbas has been involved in the anti-polio campaign for over 13 years. "There is a lot of mistrust and certain elements take advantage of this and stoke it further," he says.

We are often asked why "instead of providing their children food, shelter and education, does the government insist on administering the anti-polio vaccine".

Abbas adds that because foreign agencies support the cause of polio eradication, some parents and guardians get suspicious.

"They believe that some nefarious designs are underway against Pakistani children and that the aim of foreign assistance in this regard is to sterilise Muslim children."

While the number of people holding this view has decreased compared to a decade ago, the campaigners, Abbas says, have failed to address or quell this misconception completely.

In order to help parents and guardians understand that the vaccine is only for the children's and the community's benefit, "at times we have to take some notables or the area police chief along" on vaccination visits.

Abbas says lack of education is the biggest culprit behind prevalence of this mindset, which he says is the reason why polio still haunts Pakistani children.

To this, Dr Safdar adds that the vaccine is procured using "taxpayers' money, as well as with loans from the Islamic Development Bank".

"Meanwhile, international assistance is limited to the communications part of the programme."

More on this: Time to declare a polio emergency

"Then some parents say they have heard the vaccine is made of haram ingredients," says Abbas, adding that this misconception is also one reason why parents express reluctance to administering the drops.

When approached to respond to the above, Dr Safdar emphatically says that "that is out of question".

He explains that there are only three ingredients in the vaccine — a weakened virus, a mixture of water and salts that ensures that the virus does not change its characteristics, and a very small quantity of antibiotic to ensure that no bacteria grows in the vaccine.

Another view, though not so widely held but which does come up every now and then is that children get the disease when they have been given these drops.

"One in six million children may get parlaysed if the child is malnourished and with a compromised immunity," says Dr Safdar. He, however, points out that "the benefits of immunising the generation of Pakistani children are huge and far outweigh this rarity".

The power of digital media.

Another bigger challenge is that social mobilisers have been unable to put an end to the propaganda on digital media.

"When anything comes on social media, it spreads faster than the outbreak of a disease. Our social mobilisers are few and unable to do damage control through conventional means," he says, giving the example of how a video shared on Twitter claiming polio drops were toxic led to a rise in refusals in Tarnol.

"These elements are very organised and the timing of their dissemination against the polio campaign or against the vaccine itself is usually just before we are about to begin our door-to-door drives, thereby jeopardising them," laments Dr Safdar.

To counter the digital propaganda against the vaccine, Dr Safdar says the polio programme has since last year "activated" a social media cell to monitor various platforms.

In addition, he says, "two months back we went into a partnership with Facebook after showing them evidence that certain elements were using social media to harm the global campaign".

Read further | Polio: no quick-fix solutions

In fact, a Facebook delegation had also visited Pakistan and committed to helping the campaign to combat the virus.

According to the Pakistan Polio Eradication Programme website, 144 cases of wild polio virus (WPV) were reported in Pakistan in 2019. In comparison, only 12 and eight cases had emerged in 2018 and 2017, respectively. Meanwhile, 12 cases of WPV have been reported across the country so far in 2020.

Communities growing weary of repeated visits.

Polio worker Hifza Tahir, who works in Islamabad's Bahria Town, recalls that last December she ended up going to each home three times and that led to people becoming really irritable.

"They ask me why I visit again and again. They even say that they will take their children to the hospital to administer the drops," she says.

Tahir goes on to explain the reason for frequent visits. She says: "Because of so many new cases erupting, as well as refusals, we are sometimes required to carry out two to three drives in a month — one week campaigns after every 15 days. This is unusual but so is the situation with the rise in cases."

She says the campaign faced a large number of refusals even eight months after the bogus video episode and hopes that when the campaign begins this month, that problem will have mitigated to some extent by social mobilisers.

"Repeated knocks at times are annoying for communities," agrees Dr Safdar. "We are trying to minimise them without compromising on the quality of our campaigns."

Under a polio-linked travel restriction imposed by the WHO, Pakistan is one of the two countries in the world that have been unable to eradicate polio.

The restriction imposed since 2014 requires every person travelling abroad to carry a certificate to prove that they have been vaccinated against polio.

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Executive Board Endorse Intensified Polio Eradication Effort | Global Polio Eradication Initiative.


In face of challenging epidemiology, global health experts endorse new cVDPV2 response strategy.

Global health leaders at an Executive Board Meeting. © WHOGlobal health leaders at an Executive Board Meeting. © WHO

7 February 2020 – Meeting in Geneva, Switzerland, Member States of the Executive Board expressed overwhelming support to the global effort to eradicate polio, in the face of an alarming polio epidemiology which emerged in 2019.

Last year saw an upsurge of wild poliovirus cases in Pakistan and Afghanistan, and an unexpectedly large number of circulating vaccine-derived poliovirus outbreaks. To address the situation requires new energy, and Member States strongly asserted their support to urgently achieve a world free of all strains of poliovirus.

Addressing the delegations, WHO Director of the Global Polio Eradication Initiative Michel Zaffran noted the strong response of Member States to 2019 setbacks: “Witnessing the efforts of colleagues, and the commitment of national governments, I feel personally confident and optimistic that we have begun to turn things around to ensure success. I see new commitments at country level. In Pakistan, a re-launch of the effort began midway through 2019. The programme undertook an in-depth analysis of the major area-specific challenges and their root causes, which they have now started to address.”

Eradicating polio in the remaining global wild poliovirus transmission block in Afghanistan and Pakistan is critical, as failure could result in global resurgence of the disease. Modelling indicates that within ten years, 200,000 cases would be reported worldwide, every single year. The risk of global spread of communicable disease has this year been underlined by the novel coronavirus (2019-nCoV) situation.

Member States also almost unanimously offered their support and commitment to closing outbreaks of vaccine-derived viruses (cVDPVs), endorsing new and concerted efforts. With Africa on the verge of being certified free of wild poliovirus, WHO Regional Director for Africa Dr Matshidiso Rebecca Moeti emphasised that the continent will continue to fully commit to eradication efforts until the cVDPV2 emergency is overcome. “New approaches and rapid response teams across the continent are intensifying their efforts in ensuring every child is reached during outbreak response, and that new outbreaks are rapidly detected and responded to.”

To this effect, the Executive Board endorsed in a Decision a new cVDPV2 outbreak response strategy, including accelerated roll-out of novel oral polio vaccine type 2 (nOPV2) to more effectively address the cVDPV2 health emergency currently affecting parts of Africa, the Middle East and the Southeast Asia region.  Novel OPV2 – a brand new tool to address outbreaks – could be available to address this health emergency as early as mid-2020 under WHO’s Emergency Use Listing procedure.

The new vaccine, however, is only half the battle, cautioned Zaffran, stressing that resources and operational improvements are needed to ensure the vaccine reaches every last child. “We also need to implement stronger outbreak response and ensure more comprehensive surveillance, both things that cost money. With thanks to the generosity of the international development community, we have mobilized pledges of US$2.6 billion made at the Last Mile Forum in Abu Dhabi just two months ago. But this will not be enough to eradicate polio and tackle these increasing number of outbreaks. We are therefore calling on member states to mobilize domestic resources to respond to outbreaks, where possible.”

Zaffran continued: “On the horizon I witness a new epidemiological situation slowly beginning to emerge. I see a new, re-launched programme which has the building blocks in place to lead us to success.  Let us not be under illusions however. This will not happen overnight and this will not be easy. The nature of the virus is that every operational improvement will take several months or longer to be reflected in epidemiology. This is the way polio eradication works: there is always a time-lag. So for now, we need to measure our progress in programmatic and operational success. We must continue our new commitments, action our new strategies, introduce new tools, monitor results and maintain our drive. Significant impact on epidemiology will subsequently follow.”

“We have a lot to do,” Zaffran concluded. “But the programme is starting 2020 on a very strong footing.  I am convinced 2020 will go down in history as the year which turned the programme around, and back onto the path towards lasting success.”

Concluding the polio deliberations and speaking on behalf of 1.2 million Rotarians worldwide, Judith Diment, Chair of the Rotary Polio Advocacy Task Force, stated: “Rotary remains fully committed to the pursuit of a polio free world, as evidenced by our extended commitment to raise 50 million dollars annually through 2023. We urge all countries to devote the national financial and human resources needed to sustain high levels of population immunity through routine immunization, mitigate the risk of polio outbreaks and avoid significant unnecessary human and financial cost. The window of opportunity to achieve a polio-free world will not remain open forever. The time for urgent action is now.”

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USA: Maine Voices: Polio survivor urges ‘no’ vote on Question 1 | Portland Press Herald.

[10th February 2020]

No new medical advance has prevented more suffering than the increased use of vaccines.

Tony Owens, M.D. writes:

CAPE ELIZABETH — I remember awakening slowly and with a headache that late summer morning in 1954. I remember as well the many white coats and the spinal tap that afternoon. I was only 5 and don’t remember anyone telling me I had polio, and not sure at that age it would have meant much to me anyway. As a parent and grandparent now myself, I can only imagine the terror that must have stricken my mom and dad.

I spent weeks in a children’s hospital, all the wards full of children with polio. I remember my daily wheelchair excursions through the halls seeing other, less fortunate kids, some even in “iron lungs.”

I was lucky. Unlike so many thousands of other victims each summer, I made a full recovery. By the next summer of 1955, Dr. Jonas Salk and his team had released a killed virus vaccine and in short order polio in most of the world was eliminated. Polio occurs now only among the unvaccinated in Afghanistan, Pakistan and Nigeria due to a religious fatwa suggesting that vaccination is a Western plot to sterilize their children.

That intense and prolonged exposure to health providers during my recovery probably planted the seeds that became my ambition from an early age to enter the practice of medicine.

By the time I entered medical school in 1972, measles and mumps, both of which I’d had, including a febrile seizure with the measles, were practically eliminated in the United States. Pertussis – whooping cough – had been eliminated decades before among vaccinated children. The most feared of all for me was Hemophilus influenza infection in children. This dread bacteria could take a healthy, vigorous child from normalcy to death in such a short time, by way of meningitis, blood infection or swelling shut of the airway, called epiglottitis.

The release of the Hib vaccine in 1985 all but eliminated this horrible disease, and fortunately the residents and medical students I teach will likely never see a case of it.

Other important vaccines have followed suit, reducing or eliminating diseases that cause suffering or death. Even today the world looks to prompt development of a vaccine to help contain the coronavirus pandemic, and vaccines will likely play a role in containment of future outbreaks.

I can honestly say in my nearly 50 years in the practice of medicine, which included the development of CT scans and MRIs, all incredible technology, as well as countless procedures and pharmaceuticals that save lives, reduce suffering and improve the quality of life, nothing approaches the effectiveness, both measured by cost and outcomes, of vaccines.

As both a parent and grandparent I have great respect for the challenges, tough decisions and responsibilities of those who choose to parent. When I testified last spring in Augusta, I listened with an open heart to those many parents who feel that their parental rights are being infringed. I respect their right to disagree; however, as a physician and a scientist, I must reassure them the science is clear and the consensus is strong that vaccines are safe and effective. As a community, we must rely on one another and contribute to each other’s welfare. I ask those who would vote “yes” on Question 1, what risk they are willing to take to expose their children and those around them to preventable diseases.

As a parent, a polio survivor and a physician, I encourage you to vote “no” on Question 1.

Tony Owens, M.D., is a resident of Cape Elizabeth.

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Pakistan: Polio vaccination campaign in Karachi to begin from Feb 10 | DAWN.

[February 10, 2020]

A polio vaccination drive will be carried out in Karachi starting February 10 and will go on till the 16th of the month, an official at the National Emergency Operations Centre for Polio told

The drive will be conducted in all six districts of Karachi and will target children less than five years of age.

Meanwhile, elsewhere in the country, a five-day polio vaccination campaign, aiming to inoculate approximately 40 million children will begin on Feb 17 and will go on till Feb 21.

Dates for the campaign in Karachi were moved up in light of the Pakistan Super League matches scheduled to take place in the metropolis, the official told

The official added that approximately 265,000 polio workers will participate in the nationwide campaign, going door-to-door to inoculate children under the age of five.

This will be the first of two nationwide polio campaigns aimed at plugging the immunity gap that emerged in Pakistan during 2019.

According to the Pakistan Polio Eradication Programme website, 144 cases of wild polio virus (WPV) were reported in Pakistan in 2019. In comparison, only 12 and eight cases had emerged in 2018 and 2017, respectively.

Meanwhile, seven cases of WPV have been reported across the country so far in 2020.

Pakistan and Afghanistan are the last remaining countries that have been unable to eradicate polio. According to the World Health Organisation (WHO), a lack of infrastructure, remote locations, population movement, conflict and insecurity, and resistance to vaccination are some of the reasons why polio is still endemic in the two countries .

Pakistan is also under a polio-linked travel restriction imposed by the WHO due to which, since 2014, every person travelling abroad has to carry a vaccination certificate.

Polio is a disease that affects the nervous system, causing paralysis and even death. Children under the age of five are most vulnerable to the disease. While there is no cure for the disease, regular vaccinations have proven to be effective in keeping children polio free.

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Pakistan: Rising Polio Cases | Editorial | The Nation.

[10th February 2020]

The polio epidemic in the country is on the rise once again with 12 cases of polio reported in just 39 days of the first year. This means that the crippling disease finds a new victim almost every third day. The government of Pakistan Tehreek-i-Insaaf (PTI) was extensively involved in the criticism against the Pakistan Muslim League Nawaz (PML-N) government’s polio eradication programme. This was despite the fact that the last polio eradication programme was highly effective in bringing down the numbers of people who contracted the virus. While PTI was quick at pointing out that the programme lacked the vision to eradicate the virus altogether, they were not able to sustain what the previous government was already doing - a criticism that is usually associated with the party.

The last policy, except for the eradication of the presence of the virus in the country, was quite wholesome. It included awareness campaigns, along with strict monitoring of parents so that no one skipped vaccinating their children based on misconceptions. The work this year seems to be absent especially with regards to the strict enforcement of the vaccination. This not just impacts the domestic scenario of Pakistan but also puts us in trouble internationally. Due to the primitive virus still being present in the country, our travellers need to get health certificates. With congo and coronaviruses making their way to Pakistan, a health emergency would need to be declared. With provinces like Sindh facing a severe health crisis due to a lack of availability of medicines and vaccinations, the problem can get worse for the country.

The lives of polio workers are also at risk despite a grave understanding of how misconceptions threaten their lives. The government should investigate the matter and penalise those responsible for not taking charge of the situation. Health concerns in the country cannot go unnoticed. The government needs to assemble special units to deal with pressing health issues in the country. Only last year a lot of lives were lost due to the dengue fever as well, and the government responded by dismissing District Commissioner Saleha Saeed from service as a result. Such ad-hoc measures leave the country plagued with problems, leaving less understanding of how it manifested, and how the current set up can be used to improve the outputs being performed.

The issue right now is concentred in the provinces of Khyber Pakhtunkhwa (KP) and Sindh. Both provincial governments need to mobilise to coordinate with the federal government in order to tackle the situation. Such tasks can only be performed due to a collaborative effort between the centre and the provinces. The government should see this as an opportunity to work alongside the opposition to streamline issues along with bridging the gap between the two sides.

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