A polio vaccinator administers the oral polio vaccine to a child in Pakistan. The country remains one of three in the world where polio is yet to be eradicated. Credit: Zofeen T. Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Pakistan, Mar 11 2020 (IPS)

Dr. Rana Muhammad Safdar, the coordinator for Pakistan’s National Emergency Operations Centre for Polio Eradication, has sleepless nights thinking about what needs to be done for his country to eradicate polio.

“Not only me but the entire team is having sleepless nights thinking how best and how quickly we can reach the finish line,” he told IPS. “It’s always painful to hear a child getting paralysed for life from a vaccine-preventable disease.”

Last month, over 39 million children under the age of five were vaccinated across Pakistan. And a little more than 180,000 children were missed because their parents refused to have them vaccinated. While the number of missed children is marginal in comparison to those who were vaccinated, it has caused concern.

“The proportion of children missed in the last two campaigns due to refusals is very small (0.5 percent) but where clustered these can still provide the virus with the opportunity to survive longer and re-infect areas that we clean through so much hard work,” Safdar lamented.

The Pakistan Polio Eradication Programme began 26 years ago with the “largest surveillance network” in the world — an army of 260,000 polio vaccinators going door to door to administer oral polio vaccine (OPV) to children under five. Yet the country is only one of three in the world, along with Afghanistan and Nigeria (Nigeria has not reported any wild polio virus cases for a year, however there have been cases of vaccine-derived poliovirus in the West African nation), that has not eradicated the virus.

Last year, for the first time, Pakistan reported 25 positive Wild Poliovirus 1 (WPV1) cases across the country. Since the start of the year 23 new cases have been reported, with more expected to be recorded later this year.

The issue is so sensitive that every small gain by anti-vaccine groups takes the vaccination campaign two giant steps back. A video shared on Twitter last year, claiming that polio drops had some toxic ingredient making children sick, went viral and led to a round of refusals for months afterwards.

The reason for refusals include the same misconceptions that vaccination teams have been facing the past several years and include unfounded beliefs that; the programme is a western-funded campaign with some hidden agenda, polio drops are given to Muslim children to cause infertility and to stem the population of the Muslim community, it has some ingredients that are forbidden for Muslims, and that it causes paralysis.

Abrar Khan, a 29-year-old teacher, contracted polio when was just three. He’s no public health specialist, but Khan has an encyclopedia of knowledge about the virus. Five years ago he was a polio ambassador with the government’s Polio Eradication Initiative.

And he still makes it a point to visit homes in his locality of Baldia Town, in Karachi’s District West, that are marked by polio workers with an “R” because the family refused to have their children vaccinated. “I tell them it is their right to refuse; I try and convince them but even if they say yes to me, I have no way of knowing if they got their child vaccinated,” he told IPS in a phone interview.

He said people were more concerned about the other more common diseases their children where battling with, as well as the failing healthcare system. “One way to win these people over would be to provide better quality healthcare,” said Khan.

Swaleha Ahmed*, who asked for her real name not to printed because she holds a senior position within the polio programme, told IPS that if the government were to provide for the needs of young children, including paying for their healthcare, education and basic needs, “all those parents who hide their kids when polio workers visit their homes will come forward and get their kids registered to avail this childcare fund”. 

Ahmed, who has been with the programme for some 17 years, pointed out that because the campaign was so old, complacency has set in. And as parents continue to refuse to all their children to vaccinated, it was discovered that some vaccinators in Khyber Pakhtunkhwa (KP), where the virus originated and is circulating, were wrongly marking refusals as having been vaccinated.

“It happened in KP in the very remote areas where these workers have to walk miles in knee deep snow only to be told by families that they do not want their kids to be administered drops,” she said.

But the programme is trying to overcome this.

“We are telling polio workers that if they get refusals, it will not make a dent on their daily wages nor will they have to go again as someone else will be sent in their place if they face resistance,” said Ahmed. “They are also warned that if they are found to fake the process and mark the kids without first giving them drops, they can lose their jobs.”

But there is growing fatigue for this campaign from the side of parents as well. Nasik Abbas,who works as a supervisor in Tarnol, some 20 km from the federal capital, Islamabad, has been involved in the polio campaign for over 13 years. “Parents are now annoyed by the regular knocking at their door,” he told IPS.

Hifza Tahir, who works in Islamabad’s Bahria Town has been facing another dilemma. “They turn me away saying they will get their kids vaccinated from the hospital.”   

Ahmed said the working hours and ways of working for polio vaccinators, some 62 percent of whom are women, needed to be reevaluated.

“We should not bind these workers by time and attendance. We are dealing with kids and their parents. So we should give the workers flexi times in which they must cover the required number of homes,” said Ahmed. In some cases, she said, it would make more sense to visit the house later in the day when the decision maker, usually a father, was home from work, or early morning before the kids went to school. 

Ahmed, however, admitted that despite the challenges the polio programme has come a long way. “Today, the polio workers are better trained to deal with parents, have an ID card to prove their identity, are provided security and everything is documented,” she said.

The campaigns will continue with another round of special vaccination in high risk districts this month followed by a nationwide campaign in mid-April, said Safdar.

“Our efforts from December 2019 till April 2020 will push the virus back to 2017-18 levels and from thereon we will further push it towards zero polio by focusing on routine immunisation, improving basic health services, malnutrition as well as ensuring safe water and sanitation,” he said.

Polio cases around have declined globally by more than 99 percent since 1988, but the type 1 poliovirus remains endemic in Pakistan and Afghanistan, where it has made a comeback this year and infected 102 people. Credit: Ashfaq Yusufzai/IPS

By James Reinl
UNITED NATIONS, Nov 20 2019 (IPS)

Efforts to wipe polio off the face of the planet took a step forward this week, with a multibillion-dollar fundraiser in the Middle East helping eradication schemes tackle a virus that disproportionately kills and cripples children in poor countries.

Donor governments and philanthropists pledged $2.6 billion on Tuesday in Abu Dhabi to immunise 450 million children against polio each year — further beating back a bug that is only endemic nowadays in Pakistan and Afghanistan.

Some global health experts say mankind is walking its “final mile” towards a polio-free world, but others warn that so-called polioviruses could re-emerge and spread swiftly, as was witnessed to deadly effect in the Philippines earlier this year.

In Abu Dhabi, Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation (WHO), said “one of the world’s largest health workforces” had been assembled so that medics reach “every last child with vaccines”.

#polio end game strategy 2019 – 2023 strongly supported by partners and global leaders pledging U$2.6 billion at Reaching the Last Mile Forum #RLMForum in Adu Dhabi today. read more https://t.co/mQJa8yjqGr

— WHO Afghanistan (@WHOAfghanistan) November 19, 2019

Reem Al Hashimy, Minister of State for International Cooperation for the United Arab Emirates, which hosted the event, said the Gulf nation was working hard injecting Pakistan children so that “together we can consign polio to the pages of history”.

The fundraiser came on the back of last month’s WHO announcement that the second of three types of poliovirus had been successfully eradicated around the world. The other strain was certified as wiped out in 2015.

Polio cases around have declined globally by more than 99 percent since 1988, but the type 1 poliovirus remains endemic in Pakistan and Afghanistan, where it has made a comeback this year and infected 102 people. 

Health workers in South Asia say that conflict prevents them from vaccinating children in Afghanistan’s polio hotspots, while in Pakistan, inaccurate video reports about vaccinations causing sickness have deterred parents from sending their children for jabs.

#DYK last month UNICEF and @WHO mounted a national immunization campaign against #polio aiming to protect all children under 15, across Iraq; including over 4,500 #Syrian children in Bardarash camp, outside Dohuk City in Iraq. pic.twitter.com/2xuiE4QR33

— UNICEF Canada (@UNICEFCanada) November 19, 2019

Polio invades the nervous system and can cause irreversible paralysis within hours. There is no known cure, but the bug can be prevented by vaccination. Immunisation campaigns have reduced worldwide cases in recent decades.

The disease mostly affects children aged under five years. In every 200 cases, one infection will lead to irreversible paralysis. Among those paralysed, between 5-10 percent of victims perish when their breathing muscles stop working.

Nigeria, the last African country to have cases of wild polio, has not seen any such outbreaks since 2016. WHO aims to certify Africa as polio-free next year, under the Global Polio Eradication Initiative’s “endgame strategy”, which culminates in 2023.

Still, polio-eradication efforts have repeatedly faced setbacks. In unvaccinated populations, or in areas where immunity is low and sanitation is poor, the resilient bug can quickly re-emerge and tear through vulnerable populations.

In September, the Philippines said it was planning an emergency vaccination campaign after polio re-surfaced and caused the first two recorded polio cases for 20 years, affecting different parts of the tropical archipelago.

? Incredible news! Thank you to our visionary donors at the #RLMForum who have pledged $2.6 billion to #EndPolio.

Standing together we will protect 450M children each year against polio and make the ? polio-free.#AcceleratingThePacehttps://t.co/GuSLc7R0uh pic.twitter.com/jsRZ504VQO

— Michel Zaffran (@michelzaffran) November 19, 2019

As such, health officials warned that donations in Abu Dhabi alone were not enough. Michel Zaffran, WHO’s point man on polio, told the Wall Street Journal daily that without immunisation schemes polio would “rapidly spread in the Middle East and Asia and go back to Africa.”

The biggest donation of $1.08 billion came from the Bill & Melinda Gates Foundation. Other pledges included Abu Dhabi’s crown prince Mohamed bin Zayed ($160 million) and the United States government ($216 million). 

A Pakistani child receives a dose of the oral polio vaccine (OPV). According to the WHO, Pakistan is responsible for 80 percent of polio cases worldwide. Credit: Ashfaq Yusufzai/IPS

By IPS Correspondents
KATHMANDU/PESHAWAR, Pakistan, Oct 24 2014 (IPS)

The goal is an ambitious one – to deliver a polio-free world by 2018. Towards this end, the multi-sector Global Polio Eradication Initiative (GPEI) is bringing out the big guns, sparing no expense to ensure that “every last child” is immunised against the crippling disease.

Home to 1.8 billion people, roughly a quarter of the world’s population, Southeast Asia was declared polio-free earlier this year, its 11 countries – Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste – joining the ranks of those nations that live without the polio burden.

United in the goal of eradicating polio, an infectious viral disease that invades the nervous system and can result in paralysis within hours, governments across the region worked hand in hand with community workers, NGOs and advocates to make the dream a reality.

“Pakistan has the highest [number of polio cases] among the three endemic countries worldwide." -- Elias Durry, emergency coordinator for polio eradication with the WHO in Pakistan
According to GPEI, immunisation drives reached some 7.5 billion children over the course of 17 years, not just in city centres but also in remote rural outposts. During that time, the region witnessed some 189 nationwide campaigns that delivered over 13 billion doses of the oral polio vaccine (OPV).

High-performing countries like Sri Lanka, the Maldives and Bhutan eradicated polio a decade-and-a-half ago while India, once considered a stubborn hotbed for the disease, clocked its last case in January 2011, thus bringing about the much-awaited regional ‘polio-free’ tag.

But further north, dark clouds in the shapes of Afghanistan and Pakistan blight Asia’s happy tale. Together with Nigeria, these two nations are blocking global efforts to mark 2018 as polio’s last year on this planet.

Celebrating success from Nepal to the Philippines

For countries like Nepal, home to 27 million people, the prevalence of polio in other nations in the Asian region threatens its hard-won gains in stamping out the disease.

“There’s always fear that polio may see a resurgence as the disease hasn’t been eradicated everywhere,” said Shyam Raj Upreti, chief of the immunisation section of Nepal’s child health division (CDH).

Anxious to hold on to the coveted polio-free status, Nepal recently introduced the inactivated injectable polio vaccine (IPV) into its routine immunisation programme, the first country in South Asia to do so.

“While the oral polio vaccine has been the primary tool in polio eradication efforts, new evidence shows that adding one dose of IPV – given to children of 14 weeks by intramuscular injection – to the OPV [schedule], will maximise immunity to poliovirus,” Upreti explained.

He credits his country’s success to a high degree of social acceptance of the importance of child health in overall national development. “Female health volunteers play a key role in making the community understand why immunisation is important,” he said, adding that these volunteers provide services to some of the poorest segments of the population.

Between 1984 and 2011, Nepal’s immunisation coverage more than doubled from 44 to 90 percent. Ashish KC, child health specialist at UNICEF-Nepal, said that immunisation programmes didn’t stop even during the ‘people’s war’, a brutal conflict between the Maoists and the Nepali state that lasted a decade and killed 13,000 people.

“We understood that [we] needed a multi-sector approach, so service delivery was decentralised, and access was made easier,” KC told IPS. “Immunisation went beyond health, it became a part of [our] development plans.”

Such a mindset is also apparent in the Philippines, where the government recently decided to include the IPV into its national health plan, making it the largest developing country to do so.

According to a press release by Sanofi Pasteur, the multinational pharmaceutical company working closely with the Philippine government on its eradication initiatives, many Filipinos feel deeply about polio, having had a prime minister who was a survivor of the disease and lived with lifelong disabilities as a result.

“What’s striking about the Philippines is how strong a partnership there is around vaccinations,” said Mike Watson, vice president of vaccinations and advocacy at Sanofi Pasteur, referring to the unprecedented support shown by government officials and civil society at an event in Manila earlier this month that ended with several children receiving the IPV, the first of some two million children who will now be vaccinated every year.

“Getting the vaccine out to distribution centres on the smaller islands obviously poses a logistical challenge, but the Philippines has proven it’s really good at that,” Watson told IPS.

He added that strong networks of community health workers have enabled the Philippines to move into the “endgame”, the last stage in global eradication efforts that will require the 120 countries that aren’t currently using the IPV to introduce it by the end of 2016, representing one of the biggest and fastest vaccine introductions in history.

Over 5,700 km away from the Philippines, however, lives the lingering threat of polio, with thousands of children still at risk, and hundreds suffering from the debilitating results of the disease.

Pakistan’s polio troubles

This past June, the World Health Organisation (WHO) recommended a travel ban on all those leaving Pakistan without proof of immunisation, in a bid to prevent the spread of polio outside the country’s troubled borders.

But absent swift political action, travel bans alone will not staunch the epidemic.

A 2012 Taliban-imposed ban on the OPV has effectively prevented over 800,000 children from being immunised in two years, health officials told IPS.

In 2014 alone, Pakistan has recorded 206 cases of paralysis due to wild poliovirus, the most savage strain of the disease. Last week, 19 new cases of this strain were brought to the attention of the authorities.

“Pakistan has the highest [number of cases] among the three endemic countries worldwide,” Elias Durry, emergency coordinator for polio eradication with the WHO in Pakistan, told IPS.

The situation is most severe in the northern tribal areas, where the Taliban has used both violence and terror to spread the message that OPV is a ploy by Western governments to sterilise the Muslim population.

“The militancy-racked Federally Administered Tribal Areas (FATA) accounts for 138 cases, while the adjacent Khyber Pakhtunkhwa (KP) province has 43 cases,” Pervez Kamal, director of health in FATA, told IPS.

North Waziristan Agency has registered 69 cases, while the Khyber Agency and South Waziristan Agency are struggling with 49 and 17 cases respectively.

In a tragic development, an 18-month-old baby girl named Shakira Bibi has become the latest in a long line of polio victims. Her father, Shoiab Shah, told IPS that “Taliban militants” were responsible for depriving his daughter of the OPV.

In an unexpected twist, a military offensive aimed at breaking the Taliban’s hold over northern Pakistan has given health officials rare access to hundreds of thousands of residents in the tribal areas.

With close to a million people from North Waziristan Agency fleeing airstrikes and taking refuge in the neighbouring KP province, community health workers have been delivering the vaccine to residents of displacement camps in cities like Bannu and Lakki Marwat.

Still, this is only a tiny step towards overcoming the crisis.

Altaf Bosan, head of Pakistan’s national vaccination programme, said 34 million children under the age of five are in need of the vaccine but in 2014 alone “about 500,000 children missed their doses due to refusals by parents to [defy] the Taliban’s ban.”

The government has now elicited support from religious leaders to convince parents to submit to the OPV programme.

“Islamic scholars from Pakistan, Saudi Arabia, Egypt [and] Afghanistan have issued a fatwa [edict], reminding parents that it is their Islamic duty to protect their children against disease,” Maulana Israr ul Haq, one of the signatories, told IPS.

According to the WHO, Pakistan is responsible for nearly 80 percent of polio cases reported globally, posing a massive threat to worldwide eradication efforts.

Excerpt:

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)