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The polio eradication campaign in Pakistan has faced serious problems with an alarming rise in the number of reported cases, which has raised doubts about the quality of vaccination reports and prompted officials to review their approach to the fight against the disabling disease.
The country is one of the three countries in the world where polio is endemic, with neighboring Afghanistan and Nigeria, but vaccination campaigns have sharply reduced the disease: only a dozen cases last year, compared with 306 in 2014 and more than 350,000 in 1988, according to health officials.
However, there has been a worrying increase this year: 41 cases have been recorded, including 33 in Khyber Pakhtunkhwa, where many people are offending intrusive and coercive vaccination campaigns that often involve repeated visits, officials said.
Just as alarming for health services, environmental sampling has shown the presence of the virus in some parts of the country, a clear sign of gaps in immunization, which must cover the whole of the population to be effective.
The hopes of ending the transmission of the disease this year have been abandoned.
"We must take the bull by the horns and accept the problems," said Babar Bin Atta, the Prime Minister's main interlocutor for the eradication of polio.
In addition to the difficulty of reaching very isolated areas and keeping track of people pbading through large cities like Karachi, it has also been difficult to collect reliable data, exacerbated by resistance to efforts to force vaccination.
Read: Polio data manipulated, PM says
KP and the Federally Administered Tribal Areas have long witnessed cases of refusal of vaccination. According to provincial officials and anti-polio campaign documents, the suspicions about the vaccine would stem from misconceptions about the oral polio vaccine (OPV) that has persisted since 2004, when obscurantist elements and activists in the region spread rumors that some hormones have been deliberately added OPV to make Muslim children sterile.
Local officials said that parents suspicious of mbad vaccination campaigns were stealing special markers, which health workers used to put a stain on the little finger of vaccinated children.
"They would mark the fingers of their children, in case of official visit control of vaccinated children," said a senior badociate with an international organization. Reuters in Peshawar.
Officials believe that the so-called falsification of the fingers, sometimes in collusion with health workers, hides the true refusal rate – and thus the gaps in immunization.
In some areas, up to 8% of families may refuse or avoid vaccination, which means that the disease is not eradicated.
A senior official in the KP's health department said local health authorities were deliberately afraid of hiding the data, fearing responsibility for their inability to provide full coverage.
"And the result of the concealment of numbers has led us to face a situation similar to an epidemic today," he said.
Resistance
Poliomyelitis, a sewage-transmitted disease that can cause crippling paralysis, especially in young children, is incurable and remains a threat to human health until it has been eradicated. Vaccination campaigns have been successful in most countries and have moved closer to Pakistan, but problems persist.
International observers have been watching the situation for some time now.
In October, the Independent Monitoring Observatory, which oversees polio eradication efforts around the world, wrote in its annual report that there was "something serious about the program in Pakistan." ".
Read: The polio program decides to implement the DGI report
In April, fueled by rumors on social media that children were poisoned by vaccinations, crowds rioted at the KP and at least three polio workers were killed.
Even without violence, many people consider polio an "American disease". Faced with more immediate threats such as the lack of drinking water, many do not see why their families should be bothered by what they consider to be intrusive campaigns sponsored by strangers.
Health workers, whose proximity to the communities in which they work are essential to building trust, face difficult choices in remote areas where kinship and power structures local authorities can often force them not to report cases of non-compliance.
Related: Peshawar police arrest a man alleging that rubella vaccines cause fainting and death of children
According to many officials, persistent hostility to campaigns and high rates of avoidance highlight the problems posed by the many repeat visits of health agents and police officers who are s & # 39; s ## 147 ## # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # 39, take it from families who refuse vaccination.
"Why are markers in stores? Because parents want to buy them, they are fed up with repeated vaccines," said Atta.
Officials are now exploring more targeted approaches in areas where there are problems in overcoming resistance to vaccination involving more persuasion and education.
A spokesman for the World Health Organization, Oliver Rosenbauer, said that resistance to vaccination hampered the eradication effort, though other factors, including the movement people in Pakistan and the Afghan border are potentially more important.
He added that officials were badyzing the range of problems that the program was facing in order to put in place a new approach.
"What is very clear to everyone is that if things continue as before, we will not eradicate polio in Pakistan," he said.
"We can keep an eye on it, but it's not the goal, the goal is to eradicate it."
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