Vaccinating the Handicaped future (polio)

Vaccinating the handicapped future

Muhammad Shahid Imran

Polio is a highly infectious disease caused by a virus. It cripples the nervous system, and can cause total paralysis in a matter of hours. One in 200 polio infections leads to irreversible paralysis (usually in the legs) and among those 5% to 10% die when their breathing muscles become immobilized.

In 1954 Dr. Jonas Salk invented first polio vaccine for the virus and later Dr Albert Sabine developed oral vaccine which allowed administration of vaccine by trained volunteers. These developments led the world to last case in the Americas in 1991.

The oral polio vaccine used in the developing world, is safe, effective, easy to administer, and inexpensive, but OPV consists of live, weakened viruses, which in very rare cases can cause paralysis. In settings with very low OPV coverage, OPV vaccine viruses can also mutate and begin to circulate in the population, just like wild polioviruses.

Oral polio vaccine is now being replaced by( IPV),  One of the most promising alternatives as inactivated polio vaccine , which is routinely used in most developed countries but has not been broadly used elsewhere because of its higher cost and the need to have a trained provider to administer it by injection.

More than 10 million people are today walking because of polio vaccination, who would otherwise have been paralyzed. An estimated more than 1.5 million childhood deaths have been prevented, through the systematic administration of Vitamin A during polio immunization activities.

The efforts, to eradicate this crippling disease, work when they are fully implemented systematically. We can see India’s success in stopping polio in January 2011, which is inarguably the most diversified challenging place for systematic vaccination. However, collapse in eradication strategies leads to ongoing transmission of the virus. Endemic transmission is continuing in Nigeria, Pakistan and Afghanistan. World should know that failure to stop polio in these last remaining areas could result in as many as 2,00,000 new cases every year, within 10 years, all over the world. 

In 1997, Pakistan reported 1147 polio cases, representing widespread poliovirus circulation nationally and constituting 22% of cases reported worldwide. There were no traces from where Pakistan inherited this virus. However, observation and laboratory data from 1998 indicate that previous widespread poliovirus circulation was geographically localized for the first time. This report describes polio eradication activities in Pakistan, including the impact of routine and supplementary vaccination on polio incidence.

Through November 1998, 277 polio cases reported in 1998 have been confirmed, a 74% decrease from the same period of 1997. Some areas of Karachi (Gadap, Gulshan e Iqbal, Baldia), southern Sindh (Hyderabad division), central NWFP (Peshawar, Kohat, and Malakand divisions) and Balochistan (Quetta, Pishin, and Killah Abdullah) remained highly effected by poliovirus.

Since 2008, more than 20 countries have experienced outbreaks of polio imported from endemic countries like Pakistan. Efforts to reach unvaccinated children are often hampered by security risks, and geographic and cultural barriers. Also the high cost of vaccination campaigns US$1 billion per year worldwide is not sustainable in the long term.

To meet these challenges about 400 scientists and technical experts from more than 75 countries signed the scientific declaration on April 2013 for polio eradication in endemic countries (Pakistan, Nigeria and Afghanistan). The declaration urged scientists, partners, endemic country programme coordinators, state leaders and civil society members to unite to wipe out polio by developing new and better apparatus for prolong eradication, ensuring a sufficient vaccine supply, engaging community and religious leaders to protect vaccinators, strengthening routine immunization and filling the funding gap.

But the deaths of volunteer vaccinators at the hands of militant so called Islamist groups in Pakistan and Nigeria are widely seen as a setback to the eradication efforts.

The volunteers also appear to have been targeted in response to the CIA fake vaccination scheme for gathering information on the whereabouts of Osama bin Laden in Pakistan.

On the other hand, In June 2012 militants in North and South Waziristan banned all polio vaccinations, to protest against the killing of civilians by American drones. Around "200,000 children have been missed by polio immunization drives as a result of the ban, of course meant greater chances of the virus spreading and endangering more children not only in Pakistan but also in polio free world. Even some parents and officials try their best to immunize children but 58 new cases were reported in 2012.

According to the Pakistan Polio Eradication Initiative and UNICEF, over 0.5 million of children were missed in the October, 2012 polio campaign which included 45,000 refusals. These refusals were mainly because of the rumors that polio campaigns were being used for spy purposes and vaccine contains anti-genetic contents which harm reproduction ability of men, a western propaganda.

The April 2013 most recent polio vaccination stats in Pakistan shows that six million families refused to have their children vaccinated. Following these refusals and shortage of vaccine left 1.9 million children unvaccinated.

There is a need to fight with such sociopolitical barriers on war footing and to ask Islamic scholars and institutions to step up their advocacy that all Muslims should aware of their obligation to ensure the vaccination of children against polio, the security of health workers and should have a neutral stance of health services. There should also be increased vaccination in safer areas around the insecure ones and for those travelling through as they will be at high risk.

International health partners should impose a ban on using cover of health services for intelligence spy purposes. There should also low price for IPV and proper training, supply, delivery, and communications infrastructure to expand its use. Political leadership of endemic countries should also be step forward to make possible polio free world.

No country in world is polio free until unless we eradicate this virus from endemic countries so international partners should step forward to eradicate polio on priority basis. 
published in spokesman on April 21
http://www.thespokesman.pk/index.php/opinion/columnists/item/4075-shahid-imran-fighting-disease-and-distrust