Polio Cases Surge in Pakistan and Afghanistan

By Anonymous
Health|Polio Cases Surge in Pakistan and Afghanistan

Global health

False rumors that children are fainting or dying have led parents to turn away vaccinators, threatening the campaign to eradicate the disease.

ImagePolio Cases Surge in Pakistan and Afghanistan
A health worker gave polio vaccine to a child in Kandahar Province in Afghanistan in March. Polio immunization is compulsory in the country, but distrust of vaccines is widespread and the programs are difficult to enforce, particularly in rural regions.CreditCreditJaved Tanveer/Agence France-Presse — Getty Images

The global drive to eliminate polio, which has gone on for 31 years and consumed over $16 billion, has been set back again by a surge of new cases in Pakistan and Afghanistan.

As of July 10, there were a total of 42 polio paralysis cases in the two countries. They comprise a single large outbreak, because most cases are in the tribal areas along the border, where local people easily cross back and forth.

Pakistan had 32 of the cases, compared to only three by the same date last year, and the situation is expected to get worse because hot summer weather favors the virus. There were only 12 cases in the country in 2018 and eight in 2017.

For each paralyzed victim — usually a child below age 5 — there are about 200 others who are infected and shedding the virus in their stool, the World Health Organization estimates.

About 20,000 children are born each day in Pakistan. In cities with open sewers, and where other pathogens may attach to the same intestinal receptors that the vaccine does, it can take many doses to fully immunize a child.

Last year’s hotly contested national elections temporarily threw the program off track as local officials were replaced, said Aziz Memon, head of Rotary International’s polio campaign in Pakistan. Cases have typically spiked during elections and moments of political turmoil, according to an article in The Diplomat, a current affairs magazine focused on Asia.

Earlier this year, Pakistan announced that it would streamline its national vaccination drive in June in order to make the campaigns faster and less intrusive. Teams would try a friendlier approach and gather less data on the families they visited, the prime minister’s office said.

But false rumors spread on social media saying the vaccine had triggered fainting spells — or even that it had killed dozens of children — and many families locked their doors to vaccinators or hid their children.

ImagePolio Cases Surge in Pakistan and Afghanistan
In March, a health worker administered polio vaccine drops to a child during a campaign in Lahore, Pakistan.CreditArif Ali/Agence France-Presse — Getty Images

The issue has split families; The Times of London recently described a Pakistani man returning from work and divorcing his wife on the spot after finding their children’s fingers marked with the indelible ink used by polio vaccinators. Islamic law allows a man to end a marriage by merely saying “I divorce you” three times; he threw his wife and children out of the house.

As in other countries, like Italy, vaccines have become politicized, with opposition parties spreading anti-vaccine rumors.

Babar bin Atta, the prime minister’s special assistant for polio eradication, said in a letter to the Dawn newspaper that population movements and increasing numbers of refusals were hurting the effort.

The country, he said, would try to fix continuing problems with routine immunization, safe water and sanitation, and the high incidence of malnutrition.

Eradicating polio from Pakistan “may take longer than we hoped for," he said.

The virus is threatening to spread to other countries. In May, a sewage sample in a bordering province in Iran tested positive for the strain of virus circulating in Pakistan; Iran had its last case of polio paralysis in 2001.

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Image
Children at a refugee camp in Nigeria lined up to receive polio vaccine in 2016.CreditSunday Alamba/Associated Press

A further threat to the eradication campaign is that a few countries — mostly in Africa — have been unable to eliminate some mutated strains of the polio viruses used in live vaccines. Those strains have reverted back into forms capable of causing paralysis.

In the last two years, there have been outbreaks of “vaccine-derived polio” in Angola, the Democratic Republic of Congo, Ethiopia, Indonesia, Mozambique, Niger, Nigeria, Papua New Guinea and Somalia.

Image
Hilda Simon and her baby, Matilda, waited to receive polio vaccine at the Malahang Health Clinic in Lae, Papua New Guinea, in July 2018.  CreditGavi/EPA, via Shutterstock

Last week, a sewage sample in western China tested positive for a vaccine-derived polio strain, meaning the virus must be circulating there although no cases of paralysis caused by it have yet been detected.

Xinjiang, the province where it was found, borders on both Pakistan and Afghanistan.

Historically, such outbreaks have always been eliminated by the use of injectable killed vaccines, which cannot mutate, and live vaccines that protect against the mutated strains. But the outbreaks in some countries have gone on for many months.

Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the world’s poor. He joined The Times in 1976, and has reported from 60 countries. 

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Polio Cases Surge in Pakistan and Afghanistan

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