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Health officials struggle to quell polio outbreak in Middle East
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Polioviruses are once again demonstrating their ability to find susceptible individuals and cause disease. Syria, which has been polio-free since 1999, is experiencing an outbreak that has left 10 children paralyzed and threatens thousands more. Due to the conflict in Syria, polio vaccine coverage has fallen from 90% to 68%, leaving thousands of children susceptible to polio. Preliminary evidence indicates that the epidemic poliovirus strain originated from Pakistan. The same virus also has been found in sewage samples from Egypt, Israel, the West Bank and Gaza Strip.
The international response to the outbreak in Syria and the potential for wider spread in the Middle East is impressive and laudable. UNICEF will have 1.7 billion doses of vaccine available for administration by year’s end. Polio vaccine campaigns will take place in Syria, Jordan, Iraq, Turkey, Egypt, Lebanon and Pakistan. And, although such efforts are essential for the containment of polio, I remain skeptical that mass immunization alone will result in the eradication of polio.
Propagation of misinformation
I am currently working in a pediatric hospital operating under the auspices of Medicines San Frontiers in Pakistan. I have seen one child with paralytic polio and would not be surprised to see more. A substantial part of the population takes its direction for immunizations and other health initiatives from local religious and community leaders. However, myself and many others are concerned that not all of these community leaders have the necessary education or information to make informed decisions about what to recommend to their constituencies.
For example, when the Ministry of Health introduced iodinated salt to prevent goiters, some community leaders advised against this, telling the people the iodinated salt would cause sterility. The same was said of vaccines. When vaccines were promoted at the same time as family planning, the myth that vaccines were being used to sterilize the population was further promulgated.
The net result is inadequate polio coverage and ongoing endemic disease in Pakistan, despite that polio vaccine campaigns have been initiated by the Ministry of Health in support of WHO’s Expanded Program on Immunization.
The poor reception of polio vaccine efforts in Pakistan was amplified when it was learned that polio immunization was used to cover a clandestine effort to obtain material for genetic testing to verify the location of Osama bin Laden. Some international leaders believe a ban posed on polio vaccination by Tehrik-e-Taliban Pakistan is the leading reason for missed polio vaccination. The political motivation to resist immunization efforts has been taken to the extreme of killing polio vaccinators. It will take a concerted effort to convince some segments of the population that there is not an ulterior motive for immunization campaigns, be it sterilization or espionage.
Potential for hope
On the brighter side, the Darul Afta (fatwa council) of Pakistan Ulema Council (PUC) issued a fatwa in October that said the administration of polio vaccine to children is not forbidden in Islam. The fatwa goes on to say that prominent scholars and experts of the Muslim world are convinced that polio vaccine does not contain anything that is harmful to health or against Sharia. Will this information be conveyed to the local leaders who guide the parents of children needing the vaccine? I believe it will not be, unless steps are taken to gain trust at the community level.
Negative stain image of the poliovirus.
Source: CDC/Immunization Action Coalition
Public trust is dependent on perceptions about vaccines and their safety, historical experiences, political and religious considerations, and cultural characteristics. To rebuild and maintain the public trust in Pakistan, it is necessary to have a thorough understanding of specific vaccine concerns, historical experiences, religious and political affiliations, and the local culture. With this understanding, the vaccine-policy leaders must engage and listen to stakeholders, and be open and honest about uncertainty and risk.
Polio can be eradicated in Pakistan with buy in from religious and community leaders at the local level and their active support of immunization campaigns.
Other outbreaks on horizon
Meanwhile, another outbreak of polio might be brewing in Sudan, where efforts to vaccinate 165,000 children against polio in Sudan have been blocked by the government and rebels, according to information published by the BBC (www.bbc.co.uk/news/world-africa-24910178).
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Disclosure: Powell reports no relevant financial disclosures.