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Polio eradication efforts not reaching most vulnerable

Note for the media

Polio will not be stamped out in Pakistan unless the national programme reaches out to parents from high-risk groups, such as low-income Pashtun communities who suffer the greatest burden of this disease, according to a study published this month in the Bulletin of the World Health Organization.

The study surveyed 1017 parents of children aged under five years in Karachi between September and October last year. It found that 41% (412) of them said they had never heard of polio and that 11.4% (116) said they refused to let their children be vaccinated.

Pakistan is one of only three endemic countries

Pakistan is one of only three endemic countries that have never stopped polio transmission. Eradicating polio – completely removing the disease worldwide – hinges on making progress in a few parts of these countries, of which the mega-city of Karachi, in Pakistan, is one.

“Parents who refused vaccination were from low socio-economic Pashtun families and cited lack of permission from family elders as the main reason,” said lead author Dr Anita Zaidi, a professor in the Department of Paediatrics and Child Health at the Aga Khan University in Pakistan. “Or they were from high-income families of all ethnic backgrounds and believed that the vaccine was harmful or unnecessary.”

Reaching out to high-risk groups

The study provides new evidence suggesting that polio can be stamped out more quickly if national programmes reach out to high-risk groups and engage with them. In Pakistan, the Pashtun community represents only 15% of the population, but more than three-quarters of confirmed polio cases have occurred in this community this year.

“Once the national programme knows which communities vaccination services are not reaching and why, the Government of Pakistan supported by its partners can design strategies that are culturally appropriate to reach out to these populations and gain their confidence,” said Dr Bruce Aylward, Assistant-Director General for Polio, Emergencies and Country Collaboration at the World Health Organization (WHO). “And this is something that the government ‘has started doing in earnest this year”.

Recruiting more vaccinators and social mobilizers

This year, the government started to recruit more Pashtun vaccinators and social mobilizers – activists from the community who work within it – in collaboration with WHO and the United Nations Children’s Fund (UNICEF). Other recent efforts to engage this community include new strategies to reach Pashtun travellers as they move in and out of Karachi and a nation-wide media campaign that includes messages in the Pashto language.

According to the study, other factors hampering the programme’s success in Pakistan include military conflict, massive floods, poor routine immunization services and large nomadic and internally displaced populations.

Global Polio Eradication Initiative

WHO is one of the four spearheading partners in the Global Polio Eradication Initiative along with Rotary International, the US Centers for Disease Control and Prevention and UNICEF.

This year the World Health Assembly, which governs WHO and the Global Polio Eradication Initiative, declared the completion of polio eradication a “programmatic emergency for global public health”. It urged Pakistan as well as Afghanistan and Nigeria, the other countries where polio is still endemic, to make the fight against polio a “national public health emergency”.

If successful, polio would become only the second infectious disease that affects humans to be wiped out after smallpox was eradicated in the 1970s. Polio is a highly infectious viral disease that mainly affects young children causing paralysis and, in a small proportion of cases, death.

“This study comes at a pivotal moment for the polio programme with the lowest number of polio cases reported (154) in the fewest number of countries (4) this year since certified surveillance began in 2000,” WHO’s Aylward said.

Also in this month’s issue:

  • New era for organ donation and transplantation in China.
  • Distractions en route to universal coverage.
  • A global research and development agreement.
  • Health systems research strategy unveiled.
  • Efforts to revise guidance on pandemic influenza preparedness.
  • Arsenic exposure in Bangladesh revisited.
  • Diabetes and coronary heart disease: from evidence to policy.

The Bulletin of the World Health Organization is one of the world’s leading public health journals. It is the flagship periodical of WHO, with a special focus on developing countries. Articles are peer-reviewed and are independent of WHO guidelines. Abstracts are now available in the six official languages of the United Nations.

For further information please contact:

Fiona Fleck
News Editor
Bulletin of the World Health Organization
Geneva, Switzerland
Telephone: +41 22 791 1897
E-mail: fleckf@who.int

Dr Anita Zaidi
Chair of the Department of Paediatrics and Child Health
Aga Khan University
Karachi, Pakistan
Telephone: +92 21 3486 4721
Mobile: +92 300 823 4427
E-mail: anita.zaidi@aku.edu

Sona Bari
Spokesperson for polio eradication
World Health Organization
Geneva, Switzerland
Telephone: +41 22 791 1476
Mobile: +41 79 475 5511
E-mail: baris@who.int

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