Last month, India recorded a milestone in its effort to eradicate polio when it marked one year without any new infections. During the same year, Pakistan recorded 180 new polio cases, the most of any country. Pakistani authorities say national pride is now at stake for polio eradication and they are hoping to overcome years of setbacks from natural disasters, misinformation and war.
A polio vaccination team in Islamabad is visiting every house in a poor neighborhood of Afghan refugees to immunize every child against polio. They are part of a nationwide effort to administer the polio vaccine to more than 23 million children in a three-day period.
Children are given the vaccine orally, just a couple drops of sour tasting medicine. Those that have been vaccinated already during the three-day campaign receive a small ink stain on the finger. Pakistan holds polio eradication campaigns either at the national or regional level eight times a year. Their goal is to administer six vaccine dosages at sustained intervals to every child under five years old to ensure lifelong immunity.
Shahnaz Wazir Ali, the prime minister's administrator for polio eradication efforts, says it is important to make sure that children, especially in poor areas of Pakistan, receive several doses of the vaccine.
“Here of course because of factors such as malnutrition, poor health of children, diarrhea diseases, because as you know the virus is in the intestine, it's in the gut and you have to kill the virus with the vaccine, so you have to give repeated doses,” she said.
After the vaccination team visits a family, they mark the outside of the house with chalk, noting the number of children vaccinated. Lists of families in the neighborhood are checked and re-checked.
Dr. Hassan Urooj, the director of health services in Islamabad, says even under stable conditions a polio vaccination campaign can be a challenging logistical operation. He says the influx of refugees from areas like the Swat valley and the federally administered tribal areas or FATA, where there is ongoing fighting between Taliban insurgents and the Pakistan military, makes it almost impossible to make sure every child is vaccinated.
“If there is a security situation, insurgency in Swat or FATA, millions of internally displaced people leave their home town and their first place to stay is in Islamabad," he said. "So they are not in the demographic statistics. They are not on the data. But we have to cover them.”
There is no cure for polio and it can cause irreversible paralysis within hours of infection.
Effects of floods
The virus thrives in unsanitary conditions and Pakistan has suffered a number major natural disasters that has facilitated the spread of the disease. There was a sharp rise polio cases in Pakistan after the 2011 monsoon floods forced more than five million people into overpopulated, temporary shelters with inadequate clean water and sanitation facilities.
Ongoing fighting along the Afghanistan border and in Baluchistan has also made it unsafe for vaccination teams to carry out immunizations campaigns.
In some Muslim majority countries, officials also have to work to overcome mistrust from segments of the population that see Western countries as anti-Islamic, and are skeptical about the intentions behind the international vaccination effort.
Ali says this year they face increased resistance in Pakistan after reports last year that the American military in Abbottabad used a local doctor posing as a polio worker to try to confirm Osama Bin Laden's identity.
“We think it is indeed a highly unfortunate and inadvisable situation that occurred when the United States government, through apparently its CIA operation, wanted to collect intelligence and they used health and the immunization campaign as a cover,” said Ali.
Still, she says Pakistan is determined to overcome these obstacles and is putting added resources into the polio eradication effort, particularly after hearing of rival India's claim it is now polio free.
“It is a matter of national pride that we ensure that the maximum effort is made because failure is not an option,” continued Ali.
She says the spirit of competition with India has played a role in uniting Pakistan's political opponents and every level of government to focus on polio eradication as a national emergency.