The global battle against polio has seen remarkable progress over the past few decades, with significant reductions in cases worldwide. But Pakistan is an exception with the country posing a threat to spreading it to other nations.
However, the recent surge in vaccine refusals in Pakistan, particularly in Sindh province, has raised serious concerns among health authorities and international organisations.
In the last month (October) alone, over 43,000 cases of polio vaccine refusals were reported, marking an alarming trend that could jeopardise the country’s polio eradication efforts.
According to an editorial recently published in Pakistan’s one of the leading English dailies, The Express Tribune, these refusals have come at a critical juncture as Sindh faces a severe polio crisis, with an alarming 66 percent of environmental samples testing positive for the poliovirus this year.
The province has reported 13 out of the 50 confirmed polio cases nationwide, compared to one case each in Punjab and Islamabad, 11 in Khyber Pakhtunkhwa (K-P), and 24 in Balochistan. While K-P and Balochistan can attribute their challenges to lawlessness and insecurity, Sindh cannot cite violence as a justification for its shortcomings in addressing vaccination gaps and controlling the spread of the virus, the editorial read.
This disturbing development requires immediate and concerted action to prevent a resurgence of this crippling disease in a country that has long struggled to eliminate it.
Polio, or poliomyelitis, is a highly infectious disease caused by the poliovirus.
It primarily affects children under five, leading to irreversible paralysis or even death in severe cases.
Despite being preventable through vaccination, polio continues to exist in certain pockets of the world, with Pakistan and Afghanistan being the last remaining polio-endemic countries.
Pakistan has made significant progress in its polio eradication campaign, with reported cases dropping from hundreds annually in the early 2000s to just a few isolated cases in recent years. The success of this campaign has largely been attributed to the country’s robust vaccination drives, which have reached millions of children nationwide.
However, the recent surge in vaccine refusals threatens to undo years of hard work and progress. The reasons behind the increase in vaccine refusals are complex and multifaceted.
Several factors have contributed to this alarming trend:
Misinformation and mistrust: In many parts of Pakistan, vaccine hesitancy is fuelled by misinformation.
Myths and conspiracy theories about the polio vaccine being harmful or a tool for sterilisation have circulated widely, often amplified by social media.
These unfounded claims have sown deep mistrust among communities, making parents reluctant to vaccinate their children.
Religious and cultural beliefs: Some conservative religious groups view vaccination campaigns with suspicion, perceiving them as foreign interventions.
In rural and tribal areas, cultural norms and traditional beliefs further compound the resistance to vaccines.
Political instability and insecurity: Ongoing political instability and security challenges in certain regions of Pakistan, including parts of Sindh, have made it difficult to implement vaccination campaigns effectively.
Health workers often face threats, violence, and even fatal attacks, deterring them from reaching vulnerable populations.
Inadequate awareness campaigns: While the government and international organisations have invested heavily in raising awareness, the penetration of these campaigns has been uneven.
In some areas, the lack of tailored messaging that resonates with local communities has limited their effectiveness.
Fatigue from repeated campaigns: Frequent polio vaccination drives, often conducted door-to-door, have led to fatigue among families.
Parents, particularly in urban and peri-urban areas, question the necessity of repeated vaccinations, perceiving them as redundant.
Situation in Sindh: Sindh, Pakistan’s second-most populous province, has emerged as a critical region in the country’s fight against polio.
While the province has achieved substantial coverage in previous vaccination drives, recent data indicates a troubling rise in vaccine refusals.
According to reports from October 2024, over 43,000 refusal cases were recorded, with many concentrated in urban centers such as Karachi, Hyderabad, and Sukkur.
These cities, characterised by their dense populations and diverse communities, present unique challenges for health workers.
Urban slums in Karachi, for example, are home to large migrant populations, many of whom lack access to reliable healthcare services.
Here, misinformation spreads rapidly, and mistrust in government initiatives is high.
Meanwhile, rural areas in Sindh face infrastructural barriers, including poor road connectivity and limited access to health facilities, further complicating vaccination efforts.
The implications of this surge in vaccine refusals are dire.
Polio is highly contagious, spreading through contaminated water and food.
Even a single infected child can pose a threat to an entire community, particularly in areas with low vaccination coverage.
If vaccine refusals continue to rise, Pakistan risks experiencing a resurgence of polio cases.
This would not only endanger the lives of thousands of children but also tarnish the country’s image globally, jeopardising its ability to achieve the status of being polio-free.
Moreover, the resurgence of polio in Pakistan could have international ramifications.
The World Health Organization (WHO) has long emphasised that polio anywhere is a threat to children everywhere.
Unvaccinated populations create pockets where the virus can circulate and mutate, potentially sparking outbreaks in neighbouring countries and beyond.
The rise in polio vaccine refusals in Sindh and other regions of Pakistan is a stark reminder of the complex challenges that continue to hinder global health initiatives.
With more than 40,000 refusals reported in a single month, the situation demands immediate and sustained action from all stakeholders.
Failure to address this alarming trend could reverse decades of progress, not just for Pakistan but for the global polio eradication effort.
According to analysts, by strengthening awareness campaigns, ensuring the safety of health workers, and fostering trust within communities, Pakistan can overcome these hurdles and move closer to its goal of a polio-free future.
“A comprehensive strategy is needed to address vaccine refusal, with updates to both the carrot and the stick on offer,” The Express Tribune’s editorial read.
“Awareness must be coupled with some form of punitive measures, either against parents who refuse, or even community leaders, if the rate of refusal is unusually high,” the editorial added. “In fact, only 69 percent of children under five are fully immunised in Sindh, reflecting the extent of the risk posed by polio.”