Pakistan has been responding to an intense resurgence of wild poliovirus Type-1 (WPV-1) with 71 cases reported in 2024. Of these, 27 are from Balochistan, 21 from Khyber Pakhtunkhwa, 21 are from Sindh, and one each from Punjab and Islamabad. Polio is a paralysing illness that is incurable, once contracted. Multiple doses of the oral polio vaccine and completion of the routine vaccination plan for all children under five years of age are important to provide children with high resistance against this disease.
Unfortunately, Pakistan and Afghanistan are the only remaining countries in the world where polio is still prevalent. According to the Global Polio Eradication Initiative,
“Polio remains endemic in two countries Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunisation services and travel or trade links to endemic countries.”
According to a survey conducted by the National Emergency Operations Centre, the polio virus is present in sewage samples collected from Bannu, Lahore, Hyderabad, Sukkur, Kambar, Rawalpindi, Peshawar, and Mardan. Pakistan is infected with WPV-1.
As reported on December 3, 2024, there has been an upward trend of WPV-1 detection in Pakistan since mid-2023, initially in the environmental samples and later also in paralytic polio cases, mostly from the provinces of Khyber Pakhtunkhwa (KP), Sindh and Balochistan. This represents a 550% increase in cases in 2024, in Pakistan compared to all of 2023. The most intense WPV-1 transmission is in the southern cross-border epidemiological corridor comprising of Quetta Block of Pakistan and the South Region of Afghanistan. Besides, WPV-1 transmission is apparently re-establishing in the historical core reservoirs of Karachi and Peshawar. In Pakistan, the campaign quality in the endemic zone of South KP and historic WPV-1 reservoirs continues to face challenges relating to effective execution and growing insecurity, in terms of attacks on health works, predominantly in the KP and Balochistan.
Established in 1994, Pakistan’s polio program demonstrated few early accomplishments. From the year 2000, the eradication program was extended, counting an increase in personnel and the number of rounds, as well as the initiation of door-to-door immunisation. The polio eradication effort reached out to children all over the country. However, despite over 120 supplementary immunisation activities in the last decade, polio eradication efforts have not achieved much success.
Polio vaccination campaigns have been hampered, particularly in the border regions of Balochistan and KP, as militant groups attack staff administering polio drops as well as police officers escorting the vaccinating teams
The reasons for not attaining much success are numerous. First, absence of awareness regarding the dangers of polio, rather prevalent in the northern areas of Pakistan, particularly in places near the Pakistan-Afghan border. Most of the population in that zone is also not familiar with the consequences and transmission dynamics of the polio virus. Secondly, certain areas in Pakistan also lack effective water and sanitation, therefore becoming breeding grounds for viruses. Additionally, myths and conspiracy theories about the vaccine are widespread in a few regions, leading people to believe that the polio vaccine is a Western intrusion to sterilise the population or that taking the vaccine is prohibited in the religion under Islamic law. Inconstant governance and erratic leadership and accountability have also deferred the success of the polio program and the quality of the campaigns. Most importantly, uncertainty and terrorism have interrupted polio activities.
The year 2012, marked the beginning of a series of violent attacks against polio workers across Pakistan. Polio eradication efforts suffered a serious blow at the end of 2012 when Pakistani vaccination workers were targeted directly for the first time. In an unprecedented spark of violence, four women and three men were shot dead in two apparently coordinated attacks. Since then the victims of these dastardly attacks include inoculators, frontline health workers, program officers, and even security forces personnel. Nearly 150 people associated with the polio drive have been killed across Pakistan since 2012.
Lately, the situation has become so grievous, that in September 2024, Bajaur District Police in KP announced a boycott of duties for Anti-Polio Campaigns because of Police being consistently targeted and killed while protecting polio eradicating teams. The 50-second clip shows several Policemen gathered at the police line in Khar, announcing their decision to boycott the vaccination drive in protest.
Apart from killing, several ways of violence meted out against polio vaccination teams are targeted attacks, explosions, abductions, shootings, threats, etc. Shooting is the most prominent method of attack, along with kidnapping and abuse (including torture and rape of female vaccinators), attack with an axe, bombing of a polio vaccination center, roadside bomb explosion, and stone pelting.
Polio vaccination campaigns have been hampered, particularly in the border regions of Balochistan and KP, as militant groups attack staff administering polio drops as well as police officers escorting the vaccinating teams. These groups perceive the campaigns as part of a larger anti-Muslim and Western conspiracy, and many vaccinators, particularly women, have received death threats.
The major reason for the mistrust of the local population in tribal areas is due to the false polio immunisation campaign of the CIA launched to trace Osama bin Laden
According to published reports, most of the attacks on polio workers were committed by Pakistan Taliban/Tehreek-e-Taliban- TTP. TTP has sustained a violent campaign against polio vaccinators and security forces guarding polio team workers in Pakistan for nearly 15 years. There is no doubt that overall, militant-sponsored violence has increased in Pakistan since the Taliban took over Afghanistan in 2021. According to the Emergency Operations Center in KP, militants have carried out 23 attacks against polio teams and security escorts in Pakistan in 2024. The Safeguarding Health in Conflict Coalition identified 16 incidents of violence against or obstruction of health care in Pakistan in 2022, an increase from seven in 2021. Nearly 90 percent of these incidents involved threats and violence against polio vaccination workers, undermining healthcare providers' capability to meet vaccination targets.
Pakistani Taliban have long been the biggest opponents of the polio vaccination drive in the country. The reasons for their opposition are bizarre. Some say it aims to sterilise Muslims. The Taliban have repeatedly threatened health workers involved in the campaign. Some say they received calls telling them to stop working with “infidels” just before the attacks.
Also, the major reason for the mistrust of the local population in tribal areas is due to the false polio immunisation campaign of the CIA launched to trace Osama bin Laden. The CIA with the help of Pakistani Physician, Dr. Shakeel Afridi, carried out a fake Polio vaccination campaign as a cover to facilitate the search for Osama. The campaign confirmed the presence of bin Laden in Abbottabad city of Pakistan by obtaining DNA samples of his family members and subsequently killed by US special forces in Pakistan in 2011.
To be considered officially ‘polio-free’, a country must show an absence of wild poliovirus transmission for at least three successive years, according to the Global Polio Eradication Initiative. Unfortunately, the number of polio cases is rising in Pakistan, and the government has initiated efforts to control the spread of the disease and scheduled a vaccination campaign between February 3 and 9. But comprehensive eradication will need a steadier security environment, especially one that has curtailed terror activities in the country. An all-encompassing strategy must also be developed, along with cooperation from community-based religious clerics and local leaders to garner popular support and participation in the polio vaccination program to mitigate this disease.