Poliomyelitis was responsible for paralysing and killing up to half a million people every year before the development of the poliovirus vaccine in 1955. By 2000, through mass vaccination campaigns of oral polio vaccines, the world had almost eradicated poiliovirus barring a few regions.

However, the global fight against polio has encountered a significant setback, as cases of the disease have begun to rise again in Pakistan. Despite being on the brink of eradication in 2023, with only six reported cases of the wild form of the virus, the number of cases has surged to 73 in 2024. This alarming trend has prompted concerns among health experts, who point to the ongoing conflict in Afghanistan as a major factor contributing to the spread of the disease.

Per data from the WHO, infectious diseases such as pneumonia, dengue fever and measles have also been on the rise in Afghanistan since the last six months.

Zulfiqar Bhutta, a renowned expert on child immunisation strategies in conflict zones, said that the genetic strains of wild poliovirus in Pakistan are all from Afghanistan, per a report on Deutsche Welle.

Bhutta, who has worked extensively in the region, attributes the resurgence of polio cases in Pakistan to the spillover of the virus from Afghanistan. “It has spread to all districts of Pakistan. We’ve snatched defeat from the jaws of victory,” Bhutta lamented.

“It’s a virus that does not want to be eradicated, so give it an inch and it will take a yard,” Bhutta said.

The challenges facing polio eradication efforts in the region are multifaceted. Bhutta cites the Taliban’s restrictions on female health professionals, poor sanitary conditions, and regional insecurity as significant obstacles. The lack of reliable data on poliovirus cases in Afghanistan further complicates efforts to combat the disease.

Pakistan has invested heavily in poliovirus immunisation programs, with an estimated $10 billion spent since 2011. Despite these efforts, the country’s progress in eradicating the disease has been uneven, with varying immunisation rates across provinces. In Punjab, 85% of children are vaccinated, while in Balochistan the rate is as low as 30%. Until the coverage reaches 85-90% in all provinces, it is not possible to eradicate it, Bhutta said. He also emphasises the need for a comprehensive review of immunisation strategies, highlighting the importance of strengthening routine immunisation programs for all infectious diseases, not just polio.

Bhutta’s expertise in working with the Taliban in Afghanistan offers valuable insights into the complexities of delivering healthcare services in conflict zones. He stresses that the Taliban are not the enemy and that they share the same health concerns as everyone else. Bhutta’s experience in working with the Taliban to deliver smallpox vaccines during periods of negotiated peace underscores the potential for collaboration in addressing health needs.

The resurgence of polio cases in Pakistan serves as a stark reminder of the need for sustained efforts in combating infectious diseases. Bhutta’s call for a comprehensive review of immunisation strategies and his emphasis on addressing broader health needs in the region offer a way forward in the fight against polio. Ultimately, eradicating poliovirus in the region will require a concerted effort from international and local health authorities, as well as collaboration with the Taliban government in Afghanistan.
 

In a major setback to the efforts to eliminate the highly infectious polio disease in Afghanistan, the Taliban leadership has called off a nationwide vaccination campaign. The unexpected decision was taken by the Taliban government only a few days before the campaign was about to start. With 18 confirmed cases this year (three times the number reported in 2023) Afghanistan is now at risk of a resurgence of the highly contagious disease. The World Health Organization warns that unvaccinated populations of children, especially in areas with expanding polio outbreaks, could undo years of global efforts to eradicate the virus.

“The reason behind the postponing of the polio campaign is the issues with the modality of implementation,” the health official explained to The Guardian on condition of anonymity. “The leadership of the current government has ordered us to not conduct door-to-door campaigns.”

Instead, the Taliban government wants to shift vaccination efforts to local mosques, with the expectation that families would bring their children to get doses.

“This is very bad news for the polio programme,” the official said. “For the eradication to be successful, we need to cover more than 95% of the children with two doses of the vaccine.

“But without the door-to-door campaigns, we will not be able to reach [that target]. It puts the whole country at risk, even the region.”

According to The Guardian, while the Taliban have banned women from working in various sectors, women in healthcare have largely been allowed to remain in their jobs.

However, the healthcare worker said: “Women in the southern region face restrictions from local authorities in participating in the programme, particularly in the rural areas.”

The health official agreed. “Women have been crucial to the success of the door-to-door campaigns and raising awareness of the vaccines among mothers and families since, in a deeply conservative society, men would not be allowed into those spaces,” they said.

According to the United Nations, Afghanistan and Pakistan are the only two remaining polio-endemic countries in the world. In Afghanistan, despite continuous concerted efforts by the polio program to achieve polio-free status, the battle to finish the last mile has become a pivoting challenge, resulting in an increase in the number of polio cases during the last three years. Unfortunately, poliovirus is currently spreading to the provinces that have remained polio-free for a long time.

A woman receives polio drops while waiting to cross main Afghanistan-Pakistan land border crossing, in Pakistan. File
| Photo Credit: REUTERS

Pakistan has reported the fourth polio case of the year, jolting the country’s efforts to eradicate the crippling disease.

The case was reported on Saturday as the government appointed a new head of the polio eradication programme after his predecessor stepped down during the week.

The Dawn newspaper reported having a document showing that the victim was a 30-month-old child hailing from the Lakhi region of the Shikarpur district of the Sindh province.

The child was taken to a hospital after he suddenly developed weakness in both lower limbs and could not hold his neck up, according to the report.

This case was the first to be reported from the Sindh province, as the previous three victims belonged to Balochistan.

According to the National Institute of Health in Islamabad, the newest case was also of the Type-1 Wild Poliovirus (WPV1), just like the previous three cases.

The Prime Minister’s coordinator on National Health Services, Dr. Malik Mukhtar Bharat, said teams have been deployed to conduct a full case investigation.

Meanwhile, the Ministry of National Health Services appointed Muhammad Anwarul Haq, the ministry’s joint secretary, as the National Emer­gency Operation Centre for Polio Eradication coordinator on Saturday.

He replaced Dr. Shahzad Baig, who resigned on Friday, citing personal reasons.

Additionally, a new campaign to vaccinate over 16.5 million children under the age of five in 66 districts will be launched on Monday.

The drive, planned ahead of the peak travel season of Eidul Azha, will fully cover 36 districts and partially 30 districts.

These areas included Islamabad, 20 districts of Balochistan, 23 of Khyber Pakhtunkhwa, 16 of Sindh and six of Punjab. It will be the fifth polio vaccination campaign of the year.

Pakistan and Afghanistan are the only countries in the world where polio remains endemic, according to the World Health Organisation.

A man in the US has spent more than seven decades inside a 600-pound iron lung after being struck down by polio at the age of six. Paul Alexander has been paralysed from the neck down since 1952 due to the disease, leaving him unable to breathe by himself. According to New York Post, “Polio Paul” has refused to upgrade to a modern machine. In March, Guinness World Records (GWR) declared the 77-year-old as the longest iron lung patient ever.

Mr Alexander has faced many challenges since he was born in 1946. He endured the worst polio outbreak in US history with almost 58,000 cases – mostly children.

As per the Post report, the disease severely affected Mr Alexander, requiring him to use a machine to breathe.

Polion, or Poliomyelitis, is a disabling and life-threatening disease caused by the poliovirus. The virus spreads from person to person and can infect a person’s spinal cord, causing paralysis. It made Mr Alexander too weak to breathe.

A polio vaccine was approved and widely administered to children across the US in 1955. The country was declared polio free in 1979, but it was too late for Mr Alexander by that time.

He underwent an emergency tracheotomy and was placed in an iron lung to help his body combat the deadly disease. He has relied on the neck-to-toe machine to survive since then.

An old report in The Guardian said the machine doesn’t allow him to move, cough or wheeze. His field of view is also limited.

Talking about his other children who underwent the same surgery, he was quoted as saying by outlet, “As far as you can see, rows and rows of iron lungs. Full of children.”

Mr Alexander said he couldn’t make any friends because “every time I’d make a friend, they’d die”.

He recalled doctors talking about him that “he’s going to die”, “he shouldn’t be alive”. It made him furious. It made him want to live.

He explained to The Guardian that by the time newer machines were developed, he had become used to his “old iron horse”.

It employs a technique called “frog breathing,” which uses the throat muscles to force air past the vocal cords, allowing the patient to swallow oxygen one mouthful at a time, pushing it down the throat and into the lungs.

After finishing school, Mr Alexander graduated with a law degree and practiced law for several years. He says his never giving up spirit has brought him this far.