Every child behind every door

“Zero polio transmission and health for all”, WHO Director-General Dr Tedros Adhanom coveting 2019 to mark the extermination of the polio transmission chain.

After three decades of struggle to free the world of polio, Pakistan and Afghanistan stand to be the only states with prevalent polio status. The two neighbouring countries are at a pivotal point as the world steps towards achieving an inimitable global health milestone. In the face of myriad challenges, the polio eradication programmes cease to lapse and strive to ascertain a polio-free world which currently seems to be the prospect of a nearby future.

For some, poliomyelitis (polio) is just another ailment — a highly contagious viral disease with the potential to paralyse, for others it is an unbendable reality. With no invented cure, prevention, euphemistically, is considered the cure. And to cure the world of this menace calls for mass immunisation with vaccination of every child behind every door. The World Health Organisation, working diligently to free the world of polio with worldwide vaccination programmes, has succeeded to a significant length in its endeavours but is yet to overcome adversities in some parts of the globe owing to lack of support and concurrent resistance from certain groups.

Currently, and unfortunately so, Pakistan, with a total of nine cases in 2018, still serves as a seminary for polio along with Afghanistan on the list. Both Pakistan and Afghanistan share the same problems of political instability, volatile law and order situations and moreover a parochial religious vision vis-à-vis polio vaccination, hampering polio drives over the years. The failure of mass vaccination coverage serves as the reason of polio prevalence in Pakistan. Initially, it could be ascribed to political instability and inaccessibility of certain areas, in particular, Federally Administered Tribal Areas (FATA) and some pockets in Balochistan. Presently, vaccine hesitancy stands as the major nocuous hinderance to polio eradication efforts by Pakistan’s Expanded Programme on Immunisation (EPI). In short, the challenges jeopardising the campaign today, are more psychological than physical. The walls of a mind are harder to breach than the walls of a city.

As Gil Courtemanche stated, “Propaganda is as powerful as heroin; it surreptitiously dissolves all capacity to think.”

Vaccine hesitancy too has stemmed from misconceptions rooted in anti-vaccination propaganda circulated by certain elements in the state. Disseminated as western propaganda, polio campaign not only faced a backlash at the hands of the clergy but also a Taliban-imposed ban in FATA, 2012. The success of Operation Zarb-e-Azb in eliminating Taliban insurgency does not ensure the conquest of the minds that have been corrupted with anti-vaccination ideology seeded by the very extremist entities. Believed to cause infertility and also declared prohibited in Islam by some clergymen, many stand reluctant to get their children vaccinated.

In essence, the anti-vaccination dogma is crippling, both metaphorically and physically. It is not only detrimental to the current health campaigns but also serves to discourage any future health endeavours that would require immunisation. Furthermore, lack of support and opposition of the cause has amplified the financial burden of these campaigns as well as endangering the lives of the volunteers and workers promoting it. Consequently, not only Pakistan fails to extirpate polio, but remains a ‘potential exporter’ of it; thus, compromising its image at the international front.

Nonetheless, a decline in the number of cases over the years presents a promising premonition. The gist of the polio eradication programme is based on an “all or none” precept; hence, the cause has to be well supported both publicly and politically to ensure that every child gets vaccinated. The need for political advocacy is paramount as it would ensure better plans and policies as well as their implementation. Bearing in mind that a scientific link between polio vaccine and infertility has not been established and Fatwa Councils across the Muslim world have declared vaccination permissible in Islam; ergo, religious scholars and clergy can promote the cause by dispelling myths regarding vaccination in their sermons. Resultantly, sensitisation of the public to the need for vaccination from both political and religious fronts would result in better reception of the anti-polio campaign.

To sum up, the elimination of polio would be a milestone in the truest sense of the word. Not only would the world rid itself of a crippling disease but would be better equipped for future global health ventures. The manpower and resources once aligned to eliminate polio can then be utilised to serve further health causes. The accomplishment of this goal would also encourage the public to extend support to such causes and certainly pave the way for better execution of national health plans. An unprecedented challenge it may seem, but it is a history in the making and what has been done before, can be done again. The attainment of worldwide eradication of smallpox in 1979 is a beacon of hope that revives the dream to one day see the world polio-free.