Authorities in North Waziristan district in Pakistan, vaccinate children against polio. With one case reported, intensified efforts to eradicate the disease are underway. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, May 12 2022 (IPS)

Pakistan’s North Waziristan district authorities have launched an aggressive vaccination drive after a polio case surfaced after 15 polio-free months in the country.

The disease was detected in a 15-month-old toddler about 15 kilometers away from the Afghanistan border. This area was considered a Taliban militant’s hub until 2014.

The Taliban were against polio vaccinations, but immunization drives restarted after the militants were evicted in 2014.

The boy’s family says he had been vaccinated.

“The boy has been vaccinated in every door-to-door polio vaccination campaign, but even then, he developed the crippling disease. We aren’t opposed to polio drops,” says Naheedullah, the toddler’s uncle. “We are religious people but never defied vaccination.”

However, the authorities dispute the family’s version and say the newly infected child hadn’t received oral polio vaccines (OPV) because his family was among those they call “silent refusals”.

“Silent refusals are those whose families argue that their children below five years have been inoculated, but they remain unvaccinated,” Dr Shamsur Rehman, a health official in the region, told IPS. In Khyber Pakhtunkhwa, 18,349 children remain unvaccinated due to refusal by their families during the March 2022 campaign. This is down from 19,874 recorded in December 2021.

Vaccinators also face threats from the defiant parents – and as a result, often record the children as vaccinated to stay safe from reprisals. More than 50 people have been killed, allegedly by militants, since 2012 in various anti-polio drives, mainly in Khyber Pakhtunkhwa, which remained a hotspot of the virus for many years, Pakistan’s oldest newspaper Dawn reported.

Religious scholar Muhammad Sami says polio vaccines aren’t allowed in Islam, and therefore, there is polio vaccine hesitancy. He said his group had “information” that the vaccination was a plot to “render the recipients incapable of producing children and cut down the population of the Muslims.”

However, others in the same area have a different opinion.

“We have been persuading parents to administer OPV to their kids as it is their religious responsibility to protect their offspring from diseases,” says Maulana Sagheer, adding that it was false information that the vaccines caused sterility and infertility.

Zulfiqar Babakhel, spokesperson for Pakistan Polio Programme, told IPS that the detection of this latest case of wild poliovirus wasn’t unexpected.  The Pakistan programme had anticipated this risk and put in place contingency plans to enable a rapid response, he said.

It continues to intensify its efforts to eradicate all remaining residual transmission of any strain of poliovirus.

“The ‘last mile’ has always proven to be the toughest phase of national eradication efforts in all countries. Although challenges remain, the programme is capitalizing on the momentum of recent success and continues to strive for zero-polio. This is the most critical time for the programme,” Babakhel said.

It is important to emphasize that the number of polio cases has been significantly reduced this year due to health workers’ unwavering commitment and communities’ and various stakeholders’ support, he said.

It is the third case of wild polio to be reported globally in 2022. Others were reported from Afghanistan and Malawi.

Pakistan had reported one case last year with onset on January 27, 2021, in Killa Abdullah district, Balochistan province.

Health Secretary Dr Aamir Ashraf told IPS that this was a tragedy for the child and his family. It is also regrettable both for Pakistan and polio eradication efforts worldwide.

“We are disappointed but stay undeterred. The case appeared in Southern Khyber Pakhtunkhwa where the poliovirus was detected late last year and where an emergency action plan is already being implemented,” he says.

“The National and Provincial Polio Emergency Operations Centres have deployed teams to conduct a full investigation of the recent case, while emergency immunization campaigns are underway to prevent further spread of the wild poliovirus in Pakistan,” he says.

Repeated immunizations have protected millions of children from polio, allowing almost all countries to become polio-free, besides the two endemic countries of Pakistan and Afghanistan.

The next sub-national Polio vaccination campaign, expected from 23 – 27 May 2022, will target over 24 million under-five children.

The polio programme had identified Khyber-Pakhtunkhwa as the area most at risk after wild poliovirus was detected in environmental samples in the last quarter of 2021.

“This validates the programme’s concerns about virus circulation in Southern KP and strengthens our resolve to reach every child with the polio vaccine,” said the National Emergency Operations Centre (NEOC) coordinator for polio, Dr Shahzad Baig.

To address the challenges in Southern KP, the Government and global polio partners had already initiated an emergency action plan to address the challenges in this part of the province, he explained.

In 2020, the province of Khyber-Pakhtunkhwa reported 22 cases, while no wild poliovirus cases were recorded in the area last year.

Substantial progress has been made recently, with most areas accessible to implement immunization campaigns, but deep-rooted problems and security concerns remain in a few places. Despite the challenges, the programme’s frontline workers continue to reach children with the life-saving vaccine.

The programme is capitalizing on the momentum gained last year and continues to strive for zero-polio. Parents must continue to vaccinate their children during every immunization round until they reach the age of five.

Pakistan remains one of only two countries globally with circulating wild poliovirus, together with Afghanistan. Polio is a highly infectious virus. Until this last epidemiological block wipes out polio, children worldwide remain at risk of life-long paralysis or fatality by the poliovirus.

IPS UN Bureau Report

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Logistic and communication challenges to rolling out the COVID-19 vaccine are immense in the rural and remote highlands region of Papua New Guinea. Credit: Catherine Wilson

By Catherine Wilson
CANBERRA, Australia , Jul 13 2021 (IPS)

Papua New Guinea (PNG), like many other Pacific Island countries, successfully held COVID-19 at bay last year, aided by early shutting of national borders. However, by March this year, the pandemic was surging in the most populous Pacific Island nation, and by July, it had reported 17,282 cases of the virus and 175 fatalities.

PNG has a steep battle against the virus ahead, made more problematic by a high rate of refusal by health workers to take the vaccine. PNG’s Health Minister, Jelta Wong, stressed in an interview with Australia’s Lowy Institute for International Policy in April that “the vaccine will be the key to containing COVID-19 in our country.”

But in Eastern Highlands Province in the country’s rural interior, Dr Max Manape, the province’s Director of Public Health, told IPS that “in our province, there is a huge COVID-19 hesitancy due to so much negativity of COVID-19 vaccinations in social media and we are finding it very hard to convince our fellow frontline workers, including health workers.” By early July, only 23.3 percent of all health and essential workers in the province were vaccinated, including 329 health workers.

The situation is causing wider community concern. “Health workers are the frontline and first responders in this pandemic, and their refusal places them at a greater risk to contract the virus. This will lead to the feared collapse of our struggling health system, and the roll-on effect of other deaths from preventable diseases and maternal health issues created by a lack of manpower,” a spokesperson for the PNG National Council of Women told IPS.

In April, the country was supplied with 132,000 doses of the AstraZeneca vaccine, the first batch of a total supply of 588,000 doses by COVAX, the global alliance of organizations, including the World Health Organization (WHO), working to achieve equitable vaccine access. The Australian Government also supplied eight thousand doses. The national vaccination rollout began in early May, with priority given to frontline responders.

Yet progress has been very slow. By this month, only 59,125 people in a national population of about 9 million had been vaccinated, including 7,844 health workers. The largest group of healthcare recipients, about 1,150, were located in the capital, Port Moresby.

PNG’s Health Minister says there are numerous challenges to achieving widespread inoculation. “In this country, we’ve never had an adult vaccine go out, we’ve always had the children’s ones, and that has worked really well. It is going to be a real challenge for us to do this vaccination rollout…The biggest thing will be education. Our people need to be educated enough to know that this vaccine will help them in the future,” Wong said.

More than 80 percent of people in PNG live in rural and remote areas where logistic and communication challenges are the greatest. Here scepticism of the vaccine is high. Only 12 percent of all health and essential workers in remote Enga Province in the northwestern highlands region have been vaccinated. “The uptake of the vaccine is very poor in Enga Province. Frontline health workers at the hospital have mostly refused the vaccine,” Dr David Mills, Director of Rural Health and Training at Kompiam District Hospital in the province, told IPS.

However, it’s a nationwide issue. PNG’s newspaper, The National, conducted a public online survey last month, reporting that 77 percent of respondents did not want the vaccine. In May, a survey of students at the University of Papua New Guinea by the Crawford School of Public Policy at the Australian National University, Canberra, revealed a high level of indecision among respondents. Only 6 percent said they would accept the vaccine, 46 percent had not decided either way, while 48 percent planned to refuse it.

Doctors and health care leaders claim that major reasons for the low uptake are cultural and religious opposition, misinformation and conspiracy theories being touted on social media. And lack of public trust in the country’s health system, which, for decades, has struggled with an insufficient workforce, very poor infrastructure, and resources.

However, Dr Mills said that the government was very active in responding to conspiracy theories with facts and authoritative health information. “There is plenty of information, too much information. It’s a blizzard of information but sorting it out is the hard part. Keep in mind that there is a high level of mistrust and scepticism generally in this society. People don’t take anything at face value. It’s fertile soil for believing alternative hypotheses,” he said.

Confusion was one of the biggest reasons for indecision among respondents to the Australian National University’s survey. And they were more likely to trust the information provided by local Christian leaders (32 percent), followed by family and friends (31 percent) and the WHO (29 percent). In contrast, faith in the government as a source of information was negative (-8) percent, leading to the study’s conclusion that ‘distrust of institutions of authority and vaccine hesitance goes together.’

Despite having an economy based on natural and mineral resource wealth, PNG has a relatively low human development ranking of 155 out of 189 countries and territories, and basic service delivery beyond urban centres, hindered by lack of investment and corruption, has been deficient for decades. There are 0.5 physicians and 5.3 nurses per 10,000 people in the country, according to the WHO.

Distrust of the vaccine by healthcare staff has consequences. “High vaccine refusal amongst health workers, particularly nurses, confuses the general public and fosters vaccine scepticism. And unvaccinated health workers can be a danger to the very vulnerable patients that we have as inpatients in hospitals,” Professor Glen Mola, Head of Reproductive Health, Obstetrics and Gynaecology at the School of Medicine and Health Services, University of Papua New Guinea in Port Moresby, told IPS.

Although uptake by health staff in the capital could change following a new ruling at the Port Moresby General Hospital. “Recently, the hospital board approved a policy of the hospital management that any new health workers, contract renewals and trainees, like interns and medical students, must be vaccinated before they can enter the clinical care areas of the hospital,” Professor Mola said.

However, in the highlands, Dr Mills said the challenges were too great for vaccinating everyone. “For the broader population, vaccination was never going to be the way out (of the pandemic). The uptake is too small, the delivery too small, and delivery mechanisms too weak. We will get to herd immunity the hard way, which is by getting most people infected,” he claimed.

Nevertheless, in June, further funding of US$30 million was approved by the World Bank to boost PNG’s COVID-19 inoculation program, where it is now being offered to all citizens aged 18 years and over.

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