Emerging polio hotspots in Pakistan: Challenges and the way forward
Authors: Usman Ayub Awan, Muhammad Wasif Malik, Aamer Ali Khattak, Haroon Ahmed, Muhammad Imran Khan, Humera Qureshi, Muhammad Sohail Afzal
Journal: Journal of Infection (2021)

We read with great interest the article entitled "Impact of COVID-19 pandemic on Measles surveillance in Pakistan" by Rana et al. The authors of this article discuss the various infectious diseases that surfaced during the COVID-19 pandemic.1Rana M.S. Usman M. Alam M.M. et al.Impact of COVID-19 pandemic on Measles surveillance in Pakistan.J Infect. 2021; 82: 414-451Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Therefore, the current article will spotlight the re-emergence of polio in Pakistan, which is another serious public health concern. It is estimated that after the Global Polio Eradication Initiative (GPEI) unveiling in 1988, the global incidence of polio has been reduced by 99%.2Global Polio Eradication Initiative (GPEI)- Pakistan. 2021. https://polioeradication.org/where-we-work/pakistan/. Accessed 01-07-2021.Google Scholar The tremendous efforts of GPEI to eliminate polio for the last three decades are now on the verge of downfall owing to the COVID-19 pandemic. Pakistan is the fifth most populated country and has a population of over 200 million with an annual growth rate of 2.04% and is listed as a polio-endemic country.3Silva N.M. Santos N.C. Martins I.C. Dengue and Zika viruses: epidemiological history, potential therapies, and promising vaccines.Trop Med Infect Dis. 2020; 5: 150Crossref Scopus (43) Google Scholar,4Pakistan Polio Eradication Program - Polio Cases in Provinces. 2021. https://www.endpolio.com.pk/polioin-pakistan/polio-cases-in-provinces. Accessed 15-06-2021.Google Scholar The catastrophic impacts of COVID-19 in Pakistan are exacerbated by the disruption of routine immunization against a myriad of vaccine-preventable diseases. In amidst of 2020, all immunization operations in Pakistan were halted owing to the lockdown, depriving 40 million children of the polio vaccine.5Din M. Ali H. Khan M. et al.Impact of COVID-19 on polio vaccination in Pakistan: a concise overview.Rev Med Virol. 2020; 31: e2190https://doi.org/10.1002/rmv.2190Crossref PubMed Scopus (25) Google Scholar Pakistan's Polio program has operated commendably through 2015, reducing 306 Wild Poliovirus (WPV) cases to 54 in 2015, 20 in 2016, 08 in 2017, 12 in 2018, and re-emergence reported in 2019 with 147 new cases. Geospatial analysis revealed that the worst-affected regions in Pakistan from WPV were the slum and squatter territories in Khyber Pakhtunkhwa province (Fig. 1). Between 2015 to 2020, the prevalence of WPV cases was significantly higher in Khyber Pakhtunkhwa (51%), followed by Sindh (23%), Balochistan (17%), and Punjab (9%) (Fig. 2).4Pakistan Polio Eradication Program - Polio Cases in Provinces. 2021. https://www.endpolio.com.pk/polioin-pakistan/polio-cases-in-provinces. Accessed 15-06-2021.Google ScholarFig. 2Number of WPV Polio cases reported in different provinces of Pakistan from the year 2015–2020. Comparative analysis showed the highest number of polio cases were seen in 2020 due to halting vaccination program.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Several conspiracy theories have previously been used to sabotage the country's Polio vaccine campaigns, including myths regarding vaccine quality, religious beliefs, and the presence of live viruses in the vaccine, which have resulted in vehement parental refusal to vaccinate their children. Pakistan's initiative to eradicate polio GPEI was endeavoring to overcome these obstacles, but regretfully, a pandemic hit Pakistan, and a lockdown was imposed, thus suspending the country's whole immunization program. A comparative survey of child polio vaccination statistics revealed that the number of daily vaccination visits decreased by 52.8%. Dreadfully, only 92,492 children received vaccinations, compared to 608,832 children who received vaccination shots before the lockdown.6Chandir S. Siddiqi D.A. Setayesh H. Khan A.J. Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan.Lancet Global Health. 2020; 8: e1118-e1e20Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar Discontinuation of polio immunization in Pakistan may not affect immediately, but a surge in polio cases might potentially result in the importation of infections to vulnerable countries.2Global Polio Eradication Initiative (GPEI)- Pakistan. 2021. https://polioeradication.org/where-we-work/pakistan/. Accessed 01-07-2021.Google Scholar Thus, following established World Health Organization (WHO) processes and preventive measures, Pakistan's government and policymakers should actively implement supplementary immunization activities (SIAs) and mop-up immunization strategies in hotspot areas. Additionally, inter-district mobility, particularly between districts with positive environmental samples, should be closely monitored, and susceptible children should be permitted to travel only after receiving immunization. In particular, health practitioners must educate and address vaccine adverse effects with the people in Pakistan to ensure effective polio immunization. Usman Ayub Awan: Conceptualization, Visualization, Formal analysis, Data curation, Writing – original draft, Writing – review & editing. Muhammad Wasif Malik: Writing – original draft, Formal analysis, Conceptualization, Writing – review & editing. Aamer Ali Khattak: Writing – original draft, Formal analysis, Conceptualization, Writing – review & editing. Haroon Ahmed: Supervision, Writing – review & editing. Muhammad Imran Khan: Conceptualization, Visualization, Formal analysis, Data curation, Writing – review & editing. Humera Qureshi: Conceptualization, Visualization, Formal analysis, Data curation, Writing – review & editing. Muhammad Sohail Afzal: Supervision, Writing – review & editing. The authors declare that there is no conflict of interest or financial disclosure about this publication. There is no role of any funding agency related to this study.