Providing basic medical services, including polio vaccinations, to children in Pakistan’s poorest and most conflict-ridden areas is the key to ending polio worldwide, argues Dr Zulfiqar Bhutta in a comment piece in this week’s Nature.
Dr Bhutta, who is the Founding Director of the Centre for Excellence in Women and Child Health at Aga Khan University and Co-director of the Centre for Global Child Health at The Hospital for Sick Children, is of the opinion that eradicating polio from the planet depends most of all on eliminating polio in Pakistan, where cases have spiked this year.
“Following recommendations by the World Health Organization, the Pakistani government last month implemented vaccination requirements on everyone entering and leaving the country – but the real priority should be improving basic health services,” he adds.
Travel restrictions could be ineffective and also feed beliefs that polio immunization is part of a foreign agenda, says Dr Bhutta. A better strategy, he writes, is to bundle polio immunizations into health-care packages that include vaccines for other diseases such as measles and diphtheria. The vast majority of polio cases in Pakistan are occurring in tribal areas where polio-vaccination programmes, which are better resourced than other health campaigns, are regarded with suspicion by some Taliban and local religious leaders.
With the recent government military offensive on the Taliban, about 800,000 people in these areas have been displaced, and could now be accessible to polio workers for the first time in years. Dr Bhutta suggests that the government and health agencies devote their energies to scaling up immunization efforts in these populations, rather than diverting resources to international travellers. “This is a chance to eradicate polio from the planet,” he concludes.