Pakistan Poses Threat to Global Polio Eradication Efforts

--by Jenara Nerenberg

The Gist

Polio is a crippling disease that is only present in three countries in the modern world. Researchers in Pakistan—one of the last remaining host countries of the disease—have found that it is local beliefs and attitudes that largely stand in the way of children receiving routine polio vaccinations, according to research published this week in the World Health Organization Bulletin.

The study authors chose the city of Karachi to administer surveys to parents, because the city represents a cross-section of Pakistan's diverse communities. They found that concerns over the sterility of the vaccine and irreligious ingredients in the vaccine were standing in the way of parents immunizing their children against polio. 

Measures to educate the citizenry have been implemented in the form of media and education campaigns, such as public service announcements, and public health workers in the country have found that community-oriented interventions are essential for changing beliefs, attitudes, and behaviors. Pakistan has large numbers of nomadic people, and the country is still recovering from floods and other geopolitical challenges, which makes person-to-person education and immunization support critical for eradicating polio from the country. Community-based initiatives are known as supplementary immunization activities (SIAs).

The Expert Take

"It threatens the global polio eradication effort if certain populations with high rates of migration are refusing to be immunized," study co-author Anita Zaidi of the Aga Khan University in Karachi tells Healthline.  

Global public health entities, such as the World Health Organization, UNICEF, and the Gates Foundation, have focused intensely in recent years on eradicating polio, but missed vaccinations or vaccination refusal puts those efforts at risk.

"For example, the polio outbreak in western China last year has been linked to a virus spread from Pakistan," says Zaidi.

The Takeaway

People in polio-affected areas should contact their doctors to find out about necessary immunizations, especially for children. And because media efforts cannot reach everyone, those who are aware of the disease and vaccination should take the time to talk to neighbors, friends, and family members about the importance of immunizing their children.

Source and Method

1,017 parents were interviewed and given surveys in 2011 to determine their attitudes and beliefs about polio and its vaccine. 41 percent had no knowledge of polio, and those who refused to participate in a community-based effort to promote the vaccine (13 percent of those interviewed) mentioned their "fear of sterility, lack of faith in the polio vaccine, skepticism about the vaccination program, and fear that the vaccine might contain religiously forbidden ingredients."

Other Research

A 2011 article published in The Lancet echoes this latest research out of Pakistan that attitudes and beliefs can get in the way of routine vaccination, particularly in poor, dense, and low-resourced areas of the world.

A 2005 study in the Annual Review of Microbiology looks at what happens if polio is eradicated—and what risks remain regarding the rare but serious cases of vaccine-induced polio.

And a 2009 article in the Bulletin of the World Health Organization gives an overview of the effectiveness of communication and community-based strategies to raise awareness and increase rates of polio immunizations in India and Pakistan. Multi-layered, dynamic interventions involving policy makers, government leaders, and peer-to-peer support have proven to be highly effective at improving countries' chances of eradicating polio, but such interventions should continue to be refined and adapted to hyper-local contexts.