By A. Sami Malik
Eradicating polio in Pakistan has been an ongoing effort for more than 20 years. The campaign has met some resistance in urban slums and rural areas where the oral polio vaccine is commonly refused because of misconceptions or religious beliefs. But the recent introduction of the more widely accepted injectable vaccine is showing great promise.
LAHORE, Pakistan, 2 September 2016 – Razia, 28, is a mother of three. Her youngest child, Sarmad is 9 months old and has not been vaccinated against polio. Living in an urban slum near Lahore, Pakistan, Sarmad’s parents are strongly influenced by their community to be sceptical of the Oral Polio Vaccination (OPV), generally known as ‘polio drops’. They believe that polio drops contain elements that are forbidden by religion, and whenever the polio teams come to their neighbourhood, they either hide the children or adamantly refuse to let the teams administer polio drops.
Strangely enough, while many residents of urban slums and rural areas in Pakistan are averse to polio drops, they are resolute about getting their children immunized against other childhood diseases. Parents make an effort to take their children to vaccination centres for routine immunizations against diseases like varicella (chickenpox), tetanus, pertussis (whooping cough), measles, mumps, rubella (German measles), diphtheria, hepatitis B, Haemophilus influenzae and pneumonia. All of these vaccines are injectable.
When Uzma Imran, a Female Community Mobilizer visits Razia’s house to remind her that the next round of routine immunization is due for her child, she is alarmed to discover that the child has not been vaccinated against polio. She explains that Sarmad could be in danger of contracting the virus.
After discussing the community’s widely held misconceptions about polio drops, Uzma asks if Razia would be willing to let her son be vaccinated through an injectable Inactive Polio Vaccine (IPV). Surprisingly, Razia has no objection, and agrees to let Sarmad get an IPV shot during the next round of routine immunizations.
“We have been facing the problem of refusal to [accept] polio drops in these slums for a long time,” says Uzma. “People have misconceptions about the oral vaccine and they question why their children have to take these drops repeatedly. Apart from that, most residents in these slums change their accommodation frequently, which makes it difficult for us to keep track.”
She goes on to explain that parents in these areas have more confidence in an injection than a tablet or drop. “If they are unwell, they insist that the doctor gives them an injection. They think of it as a quick cure, more effective than any other treatment,” she says.
This perception, along with introduction of IPV, has worked wonders for polio eradication efforts. Many families that earlier refused to let their children have polio drops, happily agree to getting them vaccinated through an injection.
Regaining lost ground
Pakistan is one of the two polio endemic countries in the world that have been trying to eradicate polio for over two decades. After a setback in 2014, when a record number of polio cases were registered, the Government of Pakistan and its partners formed new strategies to eliminate the virus once and for all.
As part of these efforts, IPV – the new and injectable vaccine for polio – was introduced through a national launch, led by the Minister of State for National Health Services, Regulations and Coordination, Mrs. Saira Afzal Tarar. The launch reignited hope and vigour among polio partners in the country.
Ever since, the introduction of IPV has proven to be a major leap forward in polio eradication efforts and has brought the country even closer to achieving a polio-free status.
“The introduction of IPV in 2015 under routine immunization along with the switch from trivalent to bivalent OPV is a major landmark in accelerating the interruption of polio virus in Pakistan,” says Saadia Farrukh, UNICEF Health Specialist (EPI). “Pakistan is one of the 126 countries across the globe that are using IPV as part of their routine immunization programme. We aim to vaccinate around 6.4 million children under the age of one year through IPV till 2018.”
IPV in routine immunizations
At the District Headquarter Hospital (DHQ) Lahore, Shakeela bibi, a Lady Health Visitor (LHV) is on duty to vaccinate children.
“When IPV was introduced, we had a lot of difficulty explaining to people that the polio vaccine can now be given through an injection. They asked questions such as ‘Why were drops given earlier and now an injection?’ and ‘Why do you insist that drops should also be given even if a child has been given an injection?’ We really had to convince parents that IPV with OPV give better protection to their children,” she says.
As she visits with a new patient, she carefully looks at the child’s yellow vaccination card to determine which vaccine is needed, then unpacks a new syringe and draws the appropriate antigen from the vial. All antigens are kept in a vaccine box to maintain their prescribed temperature, which ensures their efficacy.
When Razia walks into the vaccination room at DHQ, she grows nervous when she sees children crying after receiving the injections. She knows that the prick of the needle is going to hurt Sarmad, but also realizes how important it is to get him fully immunized. With Sarmad hopping in her arms, she waits patiently for his turn.
Looking at Sarmad’s vaccination card, Shakeela bibi notes that he needs a pentavalent vaccine, which protects against five diseases, a pneumococcal vaccine to protect against pneumonia and also an IPV shot as he has never been vaccinated against polio. She prepares the injections one by one and administers them carefully.
Though Sarmad is uncomfortable, the two women know that he will now have life-saving protection against all vaccine-preventable diseases.
“[The] introduction of IPV has not only made a huge difference towards polio eradication, it has also strengthened routine immunization [overall],” says Shakeela bibi.
Along with the World Health Organization (WHO), UNICEF has played a pivotal role in introducing IPV in Pakistan. To support the Government of Pakistan’s Expanded Programme for Immunization (EPI), UNICEF manages advocacy, communication, social mobilization and the cold chain management of the vaccine. One dose of IPV is now a part of the EPI schedule which has been beneficial not only in polio eradication but also in strengthening routine immunization which has further reinforced the public health system in the country.
Gavi – the vaccine alliance, which is a major donor to UNICEF for procurement of vaccines globally, has contributed generously in procurement of IPV for Pakistan. As a leading international organization, Gavi brings together the public and private sectors towards a shared goal of equal access to new and underused vaccines for children living in the world’s poorest countries.