Africa polio-free, and Pakistan?
In the midst of the unrelenting news about the coronavirus pandemic, one piece of good news on the global health front is the announcement by the World Health Organisation (WHO) that Africa is now polio-free. No cases have occurred on the continent for the last four years. The last case was in Nigeria in 2016, a country where eradication efforts had been hampered by the terrorist group Boko Haram. This is the second virus that has now been eliminated in Africa, the first being smallpox. The Africa Regional Certification Commission (ARCC) for Polio Eradication said since 1996, polio eradication efforts had prevented 1.8 million children from suffering the crippling lifelong paralysis caused by the disease and saved around 180,000 lives. Poliomyelitis, the proper medical term for the disease, is an acutely infectious and contagious virus that attacks the spinal cord and causes irreversible paralysis in children, and even death in some cases. The disease was endemic worldwide until a vaccine was developed in the 1950s. However, the vaccine remained out of reach for the poorer countries of Asia and Africa. In 1988, WHO, Unicef and Rotary launched a worldwide eradication campaign when there were some 350,000 cases globally. In 1996, there were over 70,000 cases in Africa alone. The global effort over 30 years, with financial backing of $ 19 billion, effectively wiped out the disease. The only exceptions remain Afghanistan and Pakistan, which between them recorded 87 cases this year. Poliomyelitis is typically spread in the faeces of an infected person and transmitted through contaminated water or food. There is no cure for the malady, but mass vaccination prevents infection, breaks the cycle of transmission, and eventually eliminates polio in the wild. In this massive global effort to save the world’s children from this crippling disease, some 20 odd workers lost their lives. Surely they are deserving of appropriate recognition.
While Africa and the world can justifiably celebrate the victory over polio, the troubling question remains why the virus is still active in Afghanistan and Pakistan, the last two countries still afflicted. In the case of Afghanistan, the long drawn out wars over decades in that country can be counted as the major factor in the health system being unable to carry out systematic mass vaccination. The influence of religious extremists who have crafted fanciful stories about the effects (e.g. sterility) and purposes (conspiracy to render Muslims sterile) of the vaccination efforts may also have played a part. But why is Pakistan still in this list of just two countries that have not been able to eliminate the virus? Despite the efforts of the authorities, in which 32 million children have been vaccinated in 130 districts throughout the country with the help of 225,000 trained vaccinators carrying out door-to-door campaigns, the task of the complete elimination of the virus remains unfinished. Celebrities, intellectuals and some religious leaders have supported the efforts. But there have also been persistent reports over the years of religious fanatics parroting the ‘conspiracy theories’ mentioned above and leaning on public opinion and parents in their areas of influence to refuse vaccinations. Where such counter-campaigns have found fertile soil, cases of refusal and even attacks on vaccinators have been reported. One can only tip one’s hat at the courage and bravery of these vulnerable health workers who have persisted despite such threats and discouragement. What remains therefore for the health authorities to now focus on is the number of children in the country who have missed vaccination, pockets of refusal, and reservoirs of polio circulation. Large-scale national and sub-national campaigns are planned in September-December 2020. While all this is encouraging, and the vaccination coverage must be ensured as total where children are concerned, perhaps the health authorities also need to focus on modern toilet facilities that if put on the ground could help eliminate the origin of the virus and the source from which it spreads, i.e. faeces. Open defecation and lack of toilet facilities in the rural areas and small towns need to be brought into the light of modern day systems of disposal of human waste to ensure from the other end of the vaccination effort that our children are safe from the dreadful disease.
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