Pakistan's polio eradication problem

by Salman Hameed

Pakistan had successfully reduced the polio cases to 28 in 2005, down from 1155 in 1997. But now it seems that there is an increase again. Last week's Nature has a short piece on it:

Pakistan is one of four countries in which polio is still endemic (see 'Stubborn holdouts'), but with 144 confirmed cases in 2010, it is the only country in which polio is making a comeback. The worsening situation in Pakistan could put gains elsewhere at risk. "As long as there's polio in any one country it's a threat to every country in the world," says David Heymann, chairman of the board of the UK Health Protection Agency and a former assistant director-general of the WHO involved in polio eradication.

The issue of polio eradication is a worldwide issues, and if it holds out on one place, there will always be a chance for its spread again. It is unclear what is the cause of this resurgence in Pakistan again - but climate and population density are two of the issues mentioned in the article. Couple of years ago, there was also a reaction against vaccination campaigns in the northern areas of Pakistan - and that may have exacerbated the situation as well (see Between Fatwas and Polio and "Infidel Vaccine: Polio Vaccination Controversy in Pakistan). But now there are cases in other parts of the country as well. One of the new problems now in containing the disease may be related to the decentralization of the health ministry - and I hope this doesn't end up as a self-infected wound:

Pakistan's government has not ignored the problem. In January, the country rolled out an emergency action plan, with the goal of halting virus transmission by the end of 2011. The plan seeks greater accountability at all levels of government to boost immunization rates, and it calls for health officials to work with the military and local leaders in tribal areas to build support for vaccination. Frustrated with the lack of progress reported at the April meeting, President Zardari also ordered an investigation into recent polio outbreaks in Sindh and Balochistan, and formed a new oversight committee to keep him personally informed about eradication efforts.

Yet some fear that looming constitutional reforms could make it harder for Pakistan to exterminate polio. The country is set to devolve its Ministry of Health by the end of June, part of a long-delayed move to transfer more power to provincial governments. Bill Gates, whose Bill & Melinda Gates Foundation in Seattle, Washington, funds polio eradication programmes, has expressed concern about the changes directly to Zardari. Sania Nishtar, a health-policy expert who heads Heartfile, an independent health-policy think tank in Islamabad, worries that without a central health authority to coordinate international donors' efforts and vaccine procurement and distribution, Pakistan's polio campaign will suffer.

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