Polio haunts health workers as 18th case surfaces

The number of confirmed polio cases in Pakistan this year has risen to 18, with 11 of them in the southern province of Sindh.

The latest case - in Karachi - is the third in July; two other cases were detected in Swat Valley, northwestern Pakistan.

“This is indeed a big setback for us,” Sagheer Ahmed, the Sindh health minister, told IRIN in Karachi, the provincial capital of Sindh. “Such cases will crop up as we enter the last leg of the eradication phase,” he said.

In view of the growing number of cases in Sindh, the provincial health ministry has formed a task force to oversee the formation of polio steering committees at provincial and district levels. A 28-30 July immunisation drive is nearing completion in Sindh, parts of Balochistan, the North West Frontier Province (NWFP) and Punjab.

In June Mohammad Helmy Wahdan, special adviser to the regional director of the World Health Organization - Eastern Mediterranean Regional Observatory (WHO-EMRO) on polio eradication, expressed serious concern over new cases in Karachi and warned that the city was “virtually sitting on a time-bomb”.

The latest victim, eight-month-old Qayyum, who has died, had been administered oral polio vaccine nine times - three doses during routine immunisation and six during an immunisation drive.

Since the beginning of the year, Sindh Province has reported the largest number of polio cases - 11, followed by five in NWFP and two in Balochistan.

In 2005, five polio cases were found in Sindh. In 2006 and 2007 that figure rose to 12 in each year in the province.

Pakistan is among four polio-endemic countries - the others being Afghanistan, India and Nigeria. When the anti-polio initiative started in 1988, polio was listed as affecting 125 countries.

Photo: Zofeen Ebrahim/IRIN
A young child receives polio drops

The missing five percent

With a population of 42-44 million in Sindh, it is the missed five percent (of the 6.5 million under-fives) which is undermining the Polio Eradication Initiative (PEI), launched in 1994 by the Health Ministry’s Expanded Programme on Immunisation (EPI) in collaboration with the Global Polio Eradication Initiative.

Since the launch of the initiative in 1988, the number of reported cases worldwide has fallen from 350,000 to 1,968 - a decrease of over 99 percent.

“There are pockets that are never reached, you have to accept that,” said Mubina Agboatwala, in charge of the polio clinic at the Karachi Civil Hospital. She feels that the campaign has to be revamped and a new strategy thought of, as a certain amount of fatigue seems to have set in, both among the teams of volunteers and the city health administration.

In June, Dawn newspaper reported that the British High Commission had protested over alleged misuse by the Finance Ministry of the £15 million (about US$30 million) assistance for procuring polio vaccine.

Migrants missed

“It is the migrant population that are missed,” said Salma Kausar Ali, a former head of EPI, in Sindh. “Karachi faces a huge influx of people from across Pakistan and we keep missing them as they are always mobile.” She also said the nomadic population that come down from the mountains of Balochistan seasonally to earn money are often missed out by the polio teams.

As a first step, the Health Ministry has ordered reactivating the EPI centres at all entry points - bus-stands, the port, airports, etc - so that no child enters or leaves the province un-vaccinated.

However, Karachi Civil Hospital’s Agboatwala thinks these excuses have been used too many times. “If that was the case, Balochistan and NWFP should have had a bigger pandemic with so many people crossing the border with Afghanistan. Karachi, being a big urban city should have less of a problem when it comes to targeting missed children.”

Photo: Salma Zulfiqar/IRIN
Karachi faces a huge influx of people from across Pakistan and we keep missing them as they are always mobile, says Kausar Ali


She pointed out various lapses identified by the volunteers. “It is an open secret that the teams are not making house-to-house calls, as they are supposed to. Then there are lapses in maintaining the cold chain.” Agboatwala said strict monitoring was the only solution. “Without this, all the campaigns and the money spent are an exercise in futility.”

One recommendation to come out of a recent meeting was that only finger marking done by teams after vaccinating a child should be considered as proof of vaccination during monitoring.

“Even the honorarium of Rs 150 [about $2] per day for each team member, does not keep them motivated,” said an official who requested anonymity. “No one is willing to take up this arduous task for such a pittance… Young teenagers are volunteering but they cannot convince parents to get their children vaccinated.”

Another reason cited by Agboatwala is that routine immunisation coverage remains dismal - 30-70 percent. Thus, many children may not receive any or all of their scheduled vaccination doses through the EPI programme. “Routine immunisation is the backbone of the polio eradication campaign. The National Immunisation Days should supplement routine immunisation, not replace it,” she said.