Polio surge in Pakistan 2024

After recording just six cases of polio, wild poliovirus type 1 (WPV1) in 2023, the nation has already reached at least 59 polio cases this year, with a month still left to go.

Today, the Regional Reference Laboratory for Polio Eradication at the National Institute of Health has confirmed the detection of three polio cases in children in Pakistan.

One polio case each from DI Khan, Karachi Keamari and Kashmore was reported today.

Of the 59 cases reported this year, 26 are from Balochistan, 16 from Khyber Pakhtunkhwa, 15 from Sindh, and one each from Punjab and Islamabad.

The genetic sequencing of the samples collected from the children show that they are genetically linked to the same WPV1 virus genetic cluster which has been prevalent in the country all year.

The 59 cases confirmed in 2024 to date is the most reported since 2020 when 84 cases were reported.

This is an 883% increase in cases compared to last year’s total of 6. The hardest hit province, Balochistan, with 26 so far this year, last recorded a case in 2021.

With the 23 cases reported in Afghanistan in 2024, this brings the total with the two polio endemic countries to 82, up from 12 in all of 2023.

In a editorial today in the Pakistani news source, The News, the authors write: That the virus continues to persist is pretty much entirely due to self-imposed shortcomings. Thousands of parents, often from underprivileged backgrounds, still refuse to let their children take the vaccine that will keep them safe and healthy. What efforts the state has made to convince these parents otherwise appear to have hit a wall. Sindh alone recorded over 43,000 cases of vaccine refusal last month. Then there are the gaps in our healthcare networks and the disruptions caused by the security situation that lead to many children simply falling through the cracks. According to a report by the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) released in September, over four million planned vaccinations were missed during immunisation campaigns across the country in 2024. The provinces with the most tenuous security situation, Balochistan and Khyber Pakhtunkhwa, also lead the country in polio cases.

To make matters worse, the polio workers fulfilling a vital mission and the police guarding them are often underpaid, underequipped and targets of violence. This last trend ties into vaccine refusal. That so many people still do not trust the government with their children’s health and continue to believe in malicious and unscientific anti-vaccine propaganda is an indictment of the state’s ability to build trust with all citizens and educate its people. Nothing can be more frustrating than children being paralysed or dying because the adults around them do not know better or children missing out on vaccination due to poverty or living in areas going through conflicts they did not start. Polio workers and those protecting them do not deserve to be shot at or maligned but should be paid on time and equipped with the tools they need. That this is not already the case and children are suffering needlessly is nothing short of a debacle.

The Pakistan Polio Eradication Programme says in the early 20th century, polio was one of the most feared diseases in industrialized countries, paralyzing hundreds of thousands of children every year. Soon after the introduction of effective vaccines in the 1950s and 1960s, however, polio was brought under control and practically eliminated as a public health emergency in these countries.

It took somewhat longer for polio to be recognized as a major problem in developing countries. Lameness surveys during the 1970s revealed that the disease was also prevalent in developing countries. As a result, during the 1970s, routine immunization was introduced worldwide as part of national immunization programmes, helping to control the disease in many developing countries.

In 1988, when the Global Polio Eradication Initiative began, polio paralyzed more than 1000 children worldwide every day. Since then, global incidence of polio has declined by 99%, and more than 2.5 billion children have been immunized against polio thanks to the cooperation of more than 200 countries and 20 million volunteers, backed by an international investment of more than US$ 11 billion.

There are now only 2 countries that have never stopped polio transmission: Pakistan, and Afghanistan.

There has also been success in eradicating certain strains of the WPV. For example, the last case of type 2 was reported in 1999 and its eradication was declared in September 2015. Meanwhile, the most recent case of type 3 dates to November 2012.

However, tackling the last 1% of polio cases has still proved to be difficult. Conflict, political instability, hard-to-reach populations, and poor infrastructure continue to pose challenges to eradicating the disease. Each country offers a unique set of challenges which require local solutions.