Polio: The final battle

BBC by By Shumaila Jaffery

The girl is no more than five. She cowers in her room, crying incessantly.

“I don’t want to die,” she sobs.

Her parents have finally been persuaded the vaccine is safe. She is brought out to watch her siblings stick out their tongues for drops.

But she continues to wail. The fear in the house is palpable. The polio workers were earlier barred by her relatives who were bearing rifles. The team called in help from Dr Uzma Hayat Khan, a public health adviser.

Khan, who monitors Pakistan’s vaccination campaigns, is experienced in dealing with refusals. But she was nervous as she approached the house.

She had been greeted by a group of men with no intention of letting her inside. The stand-off only ended when another relative appeared – a doctor. The polio team then managed to vaccinate all the children except the sobbing girl. They decided to try again the next day.

Many people in Pakistan are suspicious of the polio vaccine, despite the fact it saves lives. But tensions were running even higher than usual.

The day before their visit, a mass vaccination at a village school in the suburbs of Peshawar had ended in violence and arson.

The headmaster of the school, in Mashokhel village, had previously refused to allow the polio vaccine. This time he had bowed to government pressure and the innoculations had gone ahead. But shortly afterwards he rang parents to tell them their children were fainting and vomiting.  

Dozens of students from the school were taken to hospital. All were found to have no symptoms and were discharged. But it was too late to contain the panic, which had spread quickly via social media.

Furious parents gathered outside a local government health facility, broke down its boundary wall with hammers and sticks, kicked down the front gate, and barged inside to burn it down. All of this was shown live on local TV, which sparked even greater alarm in Peshawar.

In all, about 30,000 children from various schools in the city were taken to hospital, according to the government. In a press conference, the provincial health minister said the panic had been further fuelled by local mosques urging parents via loudspeaker to rush their vaccinated children to hospital. All the children had been found to be well, the minister said.

But the incident threatened to derail an already fragile vaccination programme. That month’s vaccination round, held for three days in April, culminated in three deaths – one of a polio worker, two of policemen accompanying them.

“People were harassing us on the streets, village shopkeepers told us to go away – one of them even said, ‘You are here to poison our children!’” says one woman in Khan’s team.

The government has since suspended the national campaign until the atmosphere is less febrile.

But health workers are clear that the vaccinations are important.

They are the only defence against a dangerous childhood disease which invades the nervous system and causes paralysis in one in 200 cases. Polio can be fatal within a few hours if it paralyses the lungs. There is no cure.

Vaccinations have been largely successful in eradicating it from the world, and only three countries are still home to endemic polio – Pakistan, Afghanistan and Nigeria. Nigeria, which has not had any cases since August 2016, is expected to be declared polio-free in the next few months.

Pakistan had been largely on track to be declared polio-free before too long. It has reduced annual cases from 22,000 in 1994 to fewer than 100 from 2015 onwards.

But this year has been considered a relative disappointment. The Pakistani government reports 21 cases of endemic polio – known as Wild Polio Virus or WPV1 – as of early June, compared with eight in 2017.

The WHO (World Health Organization) has issued a statement saying it is “gravely concerned” that the country’s battle with polio is going in the wrong direction.

And more refusals potentially heighten the risk to polio teams.

“Whenever I knock on a door, I am never sure what reaction I will get,” says Khan.


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