Pakistan On Track to End Polio in 2013

[Riaz Haq]

In spite of setbacks from the US CIA's fake vaccination scheme in 2011 and the killing of polio workers by the Taliban in 2012, the WHO says Pakistan is on track to be declared polio free in April this year.

“We believe that Pakistan is on the right track to become free of
poliovirus a  type P3, as the last P3 case was reported in the Bara Tehsil
in Khyber Agency in the second week of April 2012, whereas all recent
sewage samples show no active transmission of the P3 strain across the
country,” Dr Elias Durry, the head of the Polio Eradication Initiative at
WHO Pakistan told Dawn newspaper.  Type 1 and type 2 strain of the poliovirus have already been eradicated in Pakistan.

Until 1988, the disease was endemic to 125 countries,
paralyzing or killing 350,000 people each year--mostly children, according to Time magazine.  Now it remain in only three countries: Afghanistan, Nigeria and Pakistan. There were 57 polio cases in  Pakistan in 2012, significantly down from 198 in 2011. The last reported case of polio in Pakistan was in April, 2012. Pakistan will be declared free of polio by the WHO if there are no cases reported by April, 2013.

Here's an excerpt of a recent story in Time magazine explaining the polio vaccination campaign in Pakistan:

Pakistan is putting institutional power behind the sentimental
appeals. After the December shootings, the government temporarily
suspended the inoculation program, but Prime Minister Raja Pervez Ashraf
quickly issued a statement confirming the country's commitment to the
campaign. He called for an inquiry into the attacks, promised the safety
of polio workers and pledged to proceed with plans to deploy 250,000
health workers to vaccinate 34 million children in 2013. Polio teams
will continue to work at toll plazas, boarding buses and looking for
children who don't have blue ink staining a finger--a mark applied by
field workers after a vaccine has been administered. When they find an
unmarked child, they vaccinate on the spot.  Appeals to religion
and reason are being deployed as well. Health workers in tribal areas
cite Koran verses that encourage the care of children and reach out to
local religious leaders for support.

WHO's  Pakistan representative Dr. Durry said last year Balochistan cut the number of polio
cases by 95 per cent, Sindh by 88 per cent, Punjab by 78 per cent and
the Federally Administered Tribal Areas (FATA) by 66 per cent. “The most
promising sign for Pakistan during the last year was a massive decrease
in the number of polio cases during the high transmission season,” he
said. Dr. Durry explained that all sewage samples collected from cities of
Punjab in recent weeks were found negative. “Most samples
collected from Peshawar, Gadap Town in Karachi and Hyderabad produced
positive results in the past, but they showed negative results now,” he added.

Frontline health workers in Pakistan are in the midst of pulling off a major success under very adverse circumstances. They are taking great risks for a worthy cause and deserve the nation's gratitude for their exemplary commitment.

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[Riaz Haq]

Pakistan, Polio and the CIA
Jonathan Kennedy 8 September 2017

https://www.lrb.co.uk/blog/2017/09/08/jonathan-kennedy/pakistan-pol...

By the mid-2000s, Pakistan had almost eradicated polio: there were only 28 cases in 2005, 1.4 per cent of the global total. But there have been 380 in the last three years, 81 per cent of polio cases worldwide. More than half of them were in the semi-autonomous Federally Administered Tribal Areas (FATA) of northwest Pakistan, where only 2 per cent of the population live.

After the invasion of Afghanistan by American-led forces in 2001, many Taliban fighters relocated to the FATA, from where they launched cross-border attacks. The Pakistani army tried to bring the region under government control but the incursion aggrieved local communities, who joined forces with the militants. The CIA used drone strikes to support Pakistani military action from 2004 onwards. According to the Bureau of Investigative Journalism, there have been 428 drone strikes, leading to between 2511 and 4020 fatalities.
Vaccination campaigns were suspected of being a smokescreen for collecting intelligence ahead of drone strikes. Organisations involved in the Pakistan Polio Eradication Initiative include the Pakistani state and US Centers for Disease Control and Prevention. Polio vaccinators visit the FATA every few months, walking from door-to-door, offering to vaccinate children, and recording who has been vaccinated. The data is collected for public health purposes, but you can see how it might be misconstrued as intelligence gathering.

There have also been complaints that ‘billions of dollars’ are spent on vaccination campaigns when ‘polio infects one child in a million’, while malnutrition and diarrhoea receive far less attention from the international community despite causing much more suffering. Polio workers have been attacked and vaccination campaigns interrupted, reducing the number of children being immunised and leading to an increase in polio cases.

Between 2004 and 2012, the numbers of drone strikes and polio cases corresponded closely. Until mid-2008, the US carried out a small number of drone strikes to assist Pakistani military operations and there were relatively few polio cases. From mid-2008, the number of drones strikes increased rapidly, peaking in 2010 at 128. The number of polio cases also rose markedly, reaching 198 cases the following year. Drone strikes were reduced after 2012 because of concerns they were destabilising Pakistan and generating anti-American sentiment. Polio also decreased rapidly between 2011 and 2012.

But it increased sharply from 2012, hitting 306 cases in 2014. Before the assassination of Osama bin Laden in May 2011, the CIA organised a fake hepatitis B vaccination campaign in Abbottabad in a failed attempt to obtain his relatives’ DNA. When the story broke a few months later, it seemed to vindicate people’s suspicions of the polio programmes in the FATA. ‘As long as drone strikes are not stopped in Waziristan,’ one militant leader declared, ‘there will be a ban on administering polio jabs’ because immunisation campaigns are ‘used to spy for America against the Mujahideen’. More than 3.5 million children went unvaccinated as a result of the boycott and associated disruption, in which several health workers were killed. Polio increased in Pakistan and further afield, as the virus spread to Afghanistan and the Middle East.


The CIA have conducted only a handful of drone strikes in Pakistan in recent years and polio is now at an all-time low. But the plan to eradicate the disease may face further setbacks. ‘We can no longer be silent,’ President Trump said last month, ‘about Pakistan’s safe havens for terrorist organisations, the Taliban and other groups that pose a threat to the region and beyond.’

[Riaz Haq]

#Trump's #Afghanistan policy set to hinder #war on #polio in #Pakistan. #CIA #drones

https://www.theguardian.com/global-development/2017/sep/29/trump-po...

In Pakistan and Afghanistan, the big obstacle, experts say, is not lack of money to fight it, but mistrust of the western governments who bankroll the vaccines.

Now Donald Trump could be about to deepen that mistrust. If the president makes good on his bellicose threats to take a harder line on Pakistan, he will undoubtedly incite anti-US sentiments, which in the past have led to attacks on polio workers and prompted tribal leaders to ban vaccination campaigns.

It would not be the first time the US got in the way of the war on polio.

The fight against polio suffered its biggest blow in 2011 when the CIA concocted a fake hepatitis vaccination campaign as part of its efforts to find Osama bin Laden. The ruse, exposed in the Guardian, only confirmed Taliban claims that inoculation campaigns were smokescreens for espionage. The Taliban issued fatwas and murdered dozens of health workers. In 2014, Pakistan recorded more than 300 polio cases.

But even before the vaccination ploy, polio was gaining ground, coinciding with an intensified US drone campaign. As attacks spiked in 2008, so did polio cases. When drone strikes hit a high of 128 in 2010, the number of polio cases reached 198 the following year.

Drone strikes in Pakistan have now become rare and since 2014, the fight against polio has bounced back. In 2016, only 37 cases were recorded worldwide, 20 of them in Pakistan.

Meanwhile, in his recently announced South Asia strategy, Trump signalled a tougher line on Pakistan:

“We have been paying Pakistan billions and billions of dollars at the same time they are housing the very terrorists that we are fighting. But that will have to change, and that will change immediately,” he said.

Trump has shown a penchant for airpower. In Afghanistan, the US is dropping more bombs than at any point since 2012.

It is hard to predict how local communities will respond to health workers if bombings pick up, said Monica Martinez-Bravo, a researcher at CEMFI and co-author of a new paper on mistrust of vaccines in Pakistan.

But she has documented a clear correlation between support for Islamist groups, at times a result of air campaigns, and decline in immunisation rates.

“Everything the US does that reduces trust will damage the vaccination campaigns,” Martinez-Bravo said.

Bombings complicate access for immunisers, and insurgents have used polio to demand a halt to air strikes in return for allowing vaccinations.

This year, in Kunduz in northern Afghanistan, the Taliban banned inoculators for 15 months, relenting only when a 14-month girl contracted polio.

Polio primarily affects children under five, and is incurable. The virus causes paralysis, sometimes within hours of infection. It often hits the legs and spine, but can also kill victims by immobilising breathing muscles.

Since the Global Polio Eradication Initiative was launched in 1988, an estimated 16 million people have been saved from paralysis, and 1.5 million children from death.

Yet, without sustained efforts, polio could flourish and spread quickly. For every known case, about 200 people carry the disease without symptoms.

[Riaz Haq]

‘What the hell is going on?’ Polio cases are vanishing in Pakistan, yet the virus won't go away
By Leslie RobertsJan. 11, 2018 , 1:00 PM

http://www.sciencemag.org/news/2018/01/what-hell-going-polio-cases-...

Just a year ago, poliovirus seemed on its last legs in Pakistan, one of its final strongholds. Polio cases were steadily falling, from 306 in 2014 to 54 in 2015, 20 in 2016, and, by last count, eight in 2017. Blood tests showed that, overall, immunity to the virus had never been higher, even among children aged 6 to 11 months, thanks to years of tireless vaccination campaigns. Surely, there were not enough susceptible kids to sustain transmission, and the virus would burn itself out within a year.

Unsettling new findings, however, show it is far from gone. In the most extensive effort in any country to scour the environment for traces of the virus, polio workers are finding it widely across Pakistan, in places they thought it had disappeared. They are wondering “just what the hell is going on” and how worried they should be, says epidemiologist Chris Maher of the World Health Organization (WHO) in Geneva, Switzerland, who runs polio operations in the eastern Mediterranean region. Does this mean the virus is more entrenched than anyone realized and is poised to resurge? Or is this how a virus behaves in its final days—persisting in the environment but not causing disease until it fades out?

“We have never had this level of environmental sampling anywhere else. We have nothing to compare it to,” Maher says. “We don’t understand the dynamic,” agrees Michel Zaffran, who leads the Global Polio Eradication Initiative at WHO. “But we take it very seriously.” In response to the sampling data, he and his colleagues are already changing their tactics—and their definition of success.

-----------


One possible explanation for the disconnect is that AFP surveillance is missing cases. Maher doubts that the number is significant, but others suspect that too many children among the mobile populations, including the marginalized Pashtun minority, still aren’t being vaccinated despite ramped up efforts to reach them. “I don’t think polio is entrenched across Pakistan, but this last reservoir of ‘people on the move’ is sustaining the virus,” says Steve Cochi, a polio expert at the U.S. Centers for Disease Control and Prevention in Atlanta.

Maher has another view. “My own suspicion is this is part of what we see at the end,” he says. “The lack of cases means immunity is high, but because of the very difficult circumstance in Pakistan,” the virus still has a tenuous hold. Ultimately, he says, “The virus will die out because it is not getting enough purchase.”

The program is not taking any chances. The response to each positive environmental test is now as aggressive as to a case of paralysis. And the program is hammering the virus with repeated vaccination campaigns throughout the “low season,” between December and May, when cold weather makes it tougher for the virus to survive. Whether the strategy works will become clear later this year when the weather turns warm. But one thing is certain: The absence of cases is no longer enough to declare victory over polio. Going forward, a country will not be considered polio-free until 12 months have passed without a case—or a positive environmental sample.

[Riaz Haq]

#Pakistan's 'final push' against #polio. The number of cases declined from 306 in 2014 to 54 in 2015, 20 in 2016, 8 in 2017 and just 3 this year. https://www.vaticannews.va/en/world/news/2018-08/pakistan-polio-cam...

Poliomyelitis or polio is a highly infectious disease caused by a virus which invades the nervous system, ‎and can cause total paralysis in a matter of hours.
By Robin Gomes

The Pakistani government on Monday launched a week-long anti-polio campaign regarded as the nation’s “final push” to eradicate the crippling disease, says a Pakistani health official.

Dr. Rana Safdar, the campaign's national coordinator, said the campaign was launched on Monday amid tight security in 89 districts and towns with a total of 110,000 health workers who will fan out to vaccinate 19.2 million children under 5 years of age.

Crippling disease

Poliomyelitis or polio is a highly infectious disease caused by a virus which invades the nervous system, ‎and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread ‎mainly through the faecal-oral route or, less frequently, by a common vehicle such as contaminated ‎water or food and multiplies in the intestine.
One in 200 infections leads to irreversible paralysis (usually ‎in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.‎ There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Polio is still endemic in Pakistan, Afghanistan and Nigeria.

Pakistan’s battle

Pakistan regularly carries out anti-polio drives despite threats from the Taliban who claim the campaign is a Western conspiracy to sterilize children.

The country has been battling polio for the past several years and is close to completely eradicating the disease. The number of cases declined from 306 in 2014 to 54 in 2015, 20 in 2016 and eight in 2017.

But with just three cases reported this year, all from Balochistan, Pakistan is close to completely eradicating the disease. 

Targeted regions

In Punjab, the campaign will be carried out in Lahore, Rawalpindi, Dera Ghazi Khan, Muzaffargarh, Rajanpur, Faisalabad, Multan, Rahim Yar Khan and Bahawalpur districts. 

In Khyber Pakhtunkhwa, about 4.5 million children up to 5 years of age will be administered anti-polio drops, during the campaign.

Similarly in Balochistan, anti-polio drops will be administered to more than 1.7 million children.

Safdar says the campaign will last for four days in some areas.

99% fall in world polio

A country must have no cases for three consecutive years in order to be considered to have eradicated polio by the World Health Organisation (WHO).

According to the WHO, the number of polio cases worldwide has fallen by more than 99 per cent since 1988, from an estimated 350,000 cases then to 22 reported cases in 2017. 

Despite the progress achieved since 1988, as long as a single child remains infected with poliovirus, children in all countries are at risk of contracting the disease. The poliovirus can easily be imported into a polio-free country and can spread rapidly amongst unimmunized populations.

Failure to eradicate polio could result in as many as 200 000 new cases every year, within 10 years, all over the world.

[Riaz Haq]

Dr. Fauci says #polio would still exist in the #US if the 'false information' currently being spread existed decades ago. #disinformation #misinformation #COVID19 #vaccine #Pakistan #pandemic https://www.cnn.com/2021/07/17/us/fauci-polio-coronavirus-false-inf...

If the health misinformation currently spreading regarding coronavirus vaccines existed during the days of polio, it would have never been eradicated, Dr. Anthony Fauci, President Joe Biden's chief medical adviser, said Saturday.

Asked by CNN's Jim Acosta about the misinformation spread by Fox News regarding the Covid-19 vaccines, Fauci said, "We probably would still have polio in this country if we had the kind of false information that's being spread now."
He added, "If we had that back decades ago, I would be certain that we'd still have polio in this country."
The statement comes as dangerous falsehoods about Covid-19 vaccines are swirling and as health experts warn of the more transmissible Delta variant's increasing spread among unvaccinated Americans.

Nationwide vaccination rates are dropping, while in 46 states, the rates of new Covid cases this past week are at least 10% higher than the rates of new cases the previous week, according to data from Johns Hopkins University.
Fauci, the director of the National Institute of Allergy and Infectious Diseases, told Acosta the vaccines are shown to be "highly effective in preventing symptomatic, clinically apparent disease."
Yet less than half of the US population -- 48.5%, per the latest data from the US Centers for Disease Control and Prevention -- are fully vaccinated. And it's the communities with lower vaccination rates that are at risk.
"Despite the rise of the Delta variant, still 97% of people who are hospitalized or killed by this virus are unvaccinated," said Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital in Philadelphia and a member of the US Food and Drug Administration's vaccine advisory committee. "If the Delta variant were escaping, essentially, immunity induced by vaccination, then you should have seen a rise in people who are vaccinated, but nonetheless were still hospitalized and killed. And that hasn't happened."
Covid-19 vaccines are effective at preventing severe disease, experts say, as rising cases threaten unvaccinated
Covid-19 vaccines are effective at preventing severe disease, experts say, as rising cases threaten unvaccinated
Among those states that have fully vaccinated less than half of their residents, the average Covid-19 case rate was 11 new cases per 100,000 people last week, compared to 4 per 100,000 among states that have fully vaccinated more than half of their residents, according to a CNN analysis of data from Johns Hopkins University.
"If you look at the extraordinary success in eradicating smallpox and eliminating polio for most of the world -- and we're on the brink of eradicating polio -- if we had had the pushback for vaccines the way we're seeing on certain media, I don't think it would've been possible at all to not only eradicate smallpox, we probably would still have smallpox," said Fauci.
Polio once was a common virus. In some young children it can affect the nerves and cause muscle weakness or paralysis. There is no treatment and no cure but getting vaccinated can prevent infection.
Just in August 2020, polio was eradicated from Africa after governments and non-profits had worked since 1996 to eliminate the virus with sustained vaccination campaigns.
Polio has now been eradicated in the Americas, Southeast Asia, Europe, most of Australasia and in Africa. Wild strains of polio circulate now in only two countries: Afghanistan and Pakistan.