Defeating Polio in its ultimate Strongholds-Pakistan and Afghanistan

Abstract

Poliomyelitis is a disabling and highly contagious disease caused by the poliovirus. The virus can infect a person’s spinal cord, leading to partial or full paralysis. In 1988, when polio was widespread in 125 countries worldwide, it disabled about 350,000 people annually. The use of polio vaccines has prevented nearly 24 million cases from 1988 to 2021. Global immunization efforts, along with extensive surveillance systems, have led to the certification of the last wild poliovirus type 2 case in 2015 and the last wild poliovirus type 3 case in 2019. As polio nears elimination globally, Pakistan and Afghanistan remain the only two countries where continuous endemic transmission of poliovirus type 1 persists. Despite early successes in the polio eradication program established in 1994, Pakistan has been unable to control polio transmission, facing a range of challenges. The success of this initiative, however, would largely depend on commitment to immunization, adequate funding, sufficient vaccine supplies, the security arrangements for health-care workers, and public awareness campaigns. Even routine polio vaccination in these countries is far less than 90%, which is an essential requirement for herd immunity. The situation is creating a vast pool of children that may lead to more polio outbreaks in these countries.  This study evaluates the factors hindering the polio eradication efforts in Pakistan and Afghanistan and proposes solutions to prevent ongoing transmission and potential outbreaks.