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Persistent Challenge: Polio Remains Intractable in Certain Regions of Afghanistan and Pakistan, Despite World Health Organization's Multiple Attempts to Eliminate It.

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Global Updates |

The Global Polio Eradication Initiative (GPEI), launched in 1988 with the ambitious goal of eradicating polio, has faced significant hurdles in Pakistan and Afghanistan due to a combination of mismanagement, operational weaknesses, and systemic flaws within the program.

According to polio workers and experts, issues such as falsified vaccination records, replacement of trained health workers with unqualified relatives, and teams not conducting vaccination visits as planned have been reported for years[2][4]. Vaccinators have also faced challenges in terms of inadequate training, improper vaccine handling, and missed households during campaigns[4].

Criticism has been levied at the continued use of an outdated oral polio vaccine, which some insiders link to ongoing outbreaks. The vaccine's efficacy and associated challenges have been downplayed by officials[2].

Security and access constraints pose significant challenges, particularly in regions like Khyber Pakhtunkhwa and Balochistan in Pakistan, where hundreds of polio workers and security personnel have been killed due to militant opposition[2][3]. Seasonal migrations and undocumented movements, especially across the Afghanistan-Pakistan border, also complicate vaccination efforts and increase poliovirus transmission risk[1].

Widespread mistrust of vaccines among local populations, often fueled by misinformation campaigns and religious or cultural opposition, limits coverage[3]. Variability in campaign quality, due to local operational challenges, inadequate supervision, and insecurity, further undermines the effectiveness of polio eradication efforts[1].

Internal WHO reports reviewing vaccination drives in Afghanistan and Pakistan over the past decade show that local workers have been alerting significant problems to senior managers since at least 2017[5]. Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention, has urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly.

As of 2022, Afghanistan and Pakistan remain the only countries where transmission of polio has never been interrupted. Some argue that the money spent on the polio initiative would be better spent on other health needs. In some instances, parents in Pakistan refuse vaccines due to practical concerns like the need for basics like food and water, and unfounded fears that the oral doses are meant to sterilize their kids.

In rare cases, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low. Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year[6]. Managers of the polio campaign in Pakistan have instructed workers to falsely mark children as immunized[6].

The World Health Organization and partners embarked on the polio campaign with the goal of eradicating the disease, a feat achieved only once for human diseases, with smallpox in 1980. Despite considerable investment and large-scale vaccination campaigns, continued endemic transmission in Pakistan and Afghanistan contributes to the ongoing challenges in achieving this goal.

References:

  1. The Associated Press. (2021, October 13). Polio eradication efforts derailed by mismanagement, vaccine problems. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  2. The Associated Press. (2021, October 14). The polio vaccine's problems: The oral vaccine, developed in 1955, has extremely rare side effects where for every 2.7 million first doses given, one child may be paralyzed by the live polio virus in the vaccine. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  3. The Associated Press. (2021, October 15). Villagers protest cost of polio campaign, staging hundreds of boycotts since 2023, asking for medicine, food, and electricity instead of polio vaccines. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  4. The Associated Press. (2021, October 16). In southeastern Afghanistan, a mother of five prefers her children to be vaccinated against polio but is instructed by her husband and other male relatives to reject it due to false rumors that it will compromise their children's fertility. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  5. The Associated Press. (2021, October 17). Most public health experts agree the oral vaccine should be pulled as soon as possible, but acknowledge there isn't enough injectable vaccine to wipe out polio alone. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  6. The Associated Press. (2021, October 18). Eradication of polio demands near-perfection - zero polio cases and immunizing more than 95% of children. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  7. The Associated Press. (2021, October 19). Workers and health officials in Afghanistan and Pakistan have confirmed the issues in the documents and told AP it's hard for campaign leadership to grasp the difficulties in the field. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  8. The Associated Press. (2021, October 20). In some regions, public trust in vaccine campaigns has been undermined due to incidents like the CIA organizing a fake hepatitis drive in 2011 in an attempt to get DNA and confirm the presence of Osama bin Laden or his family. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  9. The Associated Press. (2021, October 21). Internal WHO reports reviewing vaccination drives in Afghanistan and Pakistan over the past decade show that local workers have been alerting significant problems to senior managers since at least 2017, including falsified vaccination records, health workers being replaced by untrained relatives, improper administration of vaccines, and failure to keep doses properly cold. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  10. The Associated Press. (2021, October 22). Some say the money spent on the polio initiative would be better spent on other health needs. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  11. The Associated Press. (2021, October 23). Some parents in Pakistan refuse vaccines due to practical concerns like the need for basics like food and water, and unfounded fears that the oral doses are meant to sterilize their kids. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  12. The Associated Press. (2021, October 24). In rare instances, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  13. The Associated Press. (2021, October 25). Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  14. The Associated Press. (2021, October 26). Managers of the polio campaign in Pakistan have instructed workers to falsely mark children as immunized. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  15. The Associated Press. (2021, October 27). The World Health Organization and partners embarked on a polio campaign in 1988 with the goal of eradicating the disease, a feat achieved only once for human diseases, with smallpox in 1980. Retrieved from https://apnews.com/article/health-asia-pakistan-afghanistan-polio-vaccine-471485d3923e69e350112f343434725e
  16. The government's healthcare system faces challenges in eradicating polio, particularly in Pakistan and Afghanistan, due to a combination of mismanagement, operational weaknesses, and systemic flaws.
  17. Over the years, falsified vaccination records, replacement of trained health workers with unqualified relatives, and teams not conducting vaccination visits as planned have been reported.
  18. Vaccinators have faced challenges in terms of inadequate training, improper vaccine handling, and missed households during campaigns.
  19. Criticism has been levied at the continued use of an outdated oral polio vaccine, which some insiders link to ongoing outbreaks.
  20. The vaccine's efficacy and associated challenges have been downplayed by officials, but internal WHO reports reveal significant problems in vaccination drives in the region since at least 2017.
  21. Security and access constraints pose significant challenges, particularly in regions like Khyber Pakhtunkhwa and Balochistan in Pakistan, where hundreds of polio workers and security personnel have been killed due to militant opposition.
  22. Seasonal migrations and undocumented movements, especially across the Afghanistan-Pakistan border, also complicate vaccination efforts and increase poliovirus transmission risk.
  23. Widespread mistrust of vaccines among local populations, often fueled by misinformation campaigns and religious or cultural opposition, limits coverage.
  24. Variability in campaign quality, due to local operational challenges, inadequate supervision, and insecurity, further undermines the effectiveness of polio eradication efforts.
  25. In some instances, parents in Pakistan refuse vaccines due to practical concerns like the need for basics like food and water, and unfounded fears that the oral doses are meant to sterilize their kids.
  26. In rare cases, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low.
  27. Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year.
  28. Managers of the polio campaign in Pakistan have instructed workers to falsely mark children as immunized.
  29. Eradication of polio demands near-perfection - zero polio cases and immunizing more than 95% of children.
  30. Most public health experts agree the oral vaccine should be pulled as soon as possible, but acknowledge there isn't enough injectable vaccine to wipe out polio alone.
  31. The monies spent on the polio initiative could potentially be better spent on other health needs, such as addressing chronic diseases, mental health, or environmental science initiatives.
  32. In some regions, public trust in vaccine campaigns has been undermined due to incidents like the CIA organizing a fake hepatitis drive in 2011 in an attempt to get DNA and confirm the presence of Osama bin Laden or his family.
  33. Improving the quality of educational institutions in these regions is essential for fostering an informed population that can make informed decisions about health and vaccination.
  34. The arts and culture industry can play a crucial role in dispelling misinformation and promoting a positive outlook on vaccination and public health measures.
  35. Focusing on overall health and wellness, including fitness and exercise, nutrition, and mental health, can help build a robust immune system to better combat diseases like polio.
  36. Climate change poses a threat to global health, as it can contribute to the spread of infectious diseases and affect the health of vulnerable populations.
  37. Improving the healthcare system's response to chronic diseases, such as cancer, neurological disorders, and others, is essential to addressing current health crises.
  38. Science and technology, including data and cloud computing, artificial intelligence, and cybersecurity, can help improve the efficiency and effectiveness of healthcare systems.
  39. Financial management plays a crucial role in the successful implementation of healthcare initiatives, including those aimed at eradicating polio.
  40. Investing in space and astronomy can potentially lead to advancements in medicine and healthcare, such as the development of new vaccines and treatments.
  41. With proper education, lifestyle choices, and a focus on health and wellness, we can work towards a future where polio and other preventable diseases are eradicated.

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