Nearly eradicating polio worldwide, yet fabricated records, a flawed vaccine, and misguided actions facilitated a resurgence.
The Global Polio Eradication Initiative (GPEI) faces significant obstacles in its mission to eradicate polio, with Afghanistan and Pakistan remaining the last strongholds of wild poliovirus type 1 (WPV1) transmission.
In these two countries, challenges include mismanagement and falsification of vaccination records, the use of oral polio vaccine (OPV) complications, security and socio-cultural barriers, cross-border transmission, and weak health infrastructure.
Internal documents reveal that officials in Pakistan and Afghanistan have falsified vaccination data, selected unqualified vaccinators, failed to deploy teams during campaigns, and ignored concerns about the OPV's role in outbreaks. The oral vaccine, while critical historically, has been linked to vaccine-derived poliovirus (cVDPV) outbreaks, complicating eradication efforts.
Security threats and misinformation have further hindered the campaign. Hundreds of polio workers and security personnel have been killed in attacks linked to vaccine campaigns, fueled by mistrust and false rumors. Some religious and cultural leaders oppose vaccination, and in some regions, public trust in vaccine campaigns has been undermined.
The porous border between Afghanistan and Pakistan facilitates virus spread, and both countries have weakened healthcare systems that hamper routine immunization and campaign quality. More than two dozen current and former senior polio officials have stated that the agencies involved haven't been willing to consider revising their strategy to account for some of the campaign's problems.
Efforts to overcome these challenges emphasize context-specific, tailored vaccination strategies, improved surveillance, and synchronized cross-border collaboration. The necessity of maintaining sensitive surveillance systems globally to detect and respond to importations or outbreaks promptly is also emphasized.
Globally, vaccination coverage remains below ideal targets but has slightly improved, with 2024 third-dose polio vaccine coverage at 84% worldwide. The Americas region continues to focus on strengthening immunization and surveillance to prevent outbreaks.
Despite these challenges, the GPEI continues its efforts, aiming for global eradication by 2029. However, eradication efforts require urgent reforms in management, improved vaccine strategies, and enhanced community engagement to reach this goal.
Dr. Tom Frieden, a former director of the US Centers for Disease Control and Prevention, has urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly. In rare instances, the live virus from the OPV can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low.
For Sughra Ayaz, a vaccinator in southeastern Pakistan, the challenges are evident. She travels door to door, administering polio vaccines, but faces refusal from some parents due to practical concerns and unfounded fears. In some instances, she has witnessed "fake finger marking" - placing the ink used to show a child is vaccinated on their pinky even when no vaccine has been given.
[1] World Health Organization. (2022). Polio eradication: Challenges and solutions in Pakistan and Afghanistan. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/polio
[2] Barrett, S. (2019). Polio: The Unfinished Story. Princeton University Press.
[3] Centers for Disease Control and Prevention. (2022). Polio. [online] Available at: https://www.cdc.gov/vaccines/vpd/polio/index.html
[4] United Nations Children's Fund. (2022). Polio. [online] Available at: https://www.unicef.org/polio
[5] World Health Organization. (2022). Polio Eradication Initiative: Progress and Challenges. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/polio-eradication-initiative
- Despite the global progress in vaccination coverage, the World Health Organization (WHO) highlights significant challenges in eradicating polio, especially in the middle eastern countries of Afghanistan and Pakistan.
- The obstacles in these nations include mismanagement of vaccination records, security threats, cultural barriers, and weak healthcare infrastructure, as revealed by internal documents.
- The global health-and-wellness community now advocates for context-specific vaccination strategies, improved surveillance, and coordinated cross-border collaboration to address these issues.
- In the effort to combat polio, experts suggest the adoption of new methods for faster identification of polio cases, addressing vaccine-derived poliovirus outbreaks, and enhancing community engagement.
