Before the development of the first poliovirus vaccine in 1955, poliomyelitis paralyzed half a million people each year.
By 2000, mass vaccination campaigns, equipped with new types of oral polio vaccines, had virtually eradicated wild poliovirus, except in a few isolated areas.
In 2020, the entire African region was declared free of wild poliovirus, leaving just two countries that have yet to stop the spread of the disease – Afghanistan and Pakistan.
Mass vaccination programs had Pakistan on the verge of eradicating polio by 2023, with just six remaining cases of the wild form of the virus. But now, cases are climbing again – 73 cases were reported in 2024.
“It has spread to all the districts of Pakistan. We have snatched defeat from the jaws of victory,” said Zulfikar Bhutta, MD, Hospital for Sick Children, Toronto, Canada.
The reason, Bhuta writes in a commentary in the Lancet, is that poliovirus cases are spreading across the border from Afghanistan. The genetic strains of wild poliovirus in Pakistan are all from Afghanistan.
Why is poliovirus spreading from Afghanistan to Pakistan?
Bhutta leads groups working on child immunity strategies in conflict areas. Hey was involved in the largest trials of poliovirus vaccine interventions in Afghanistan, working “very successfully” with the Taliban until a year ago.
But poliovirus eradication programs have faced several setbacks in the years since the Taliban takeover of Afghanistan in 2021.
Bhuta, who returned to Afghanistan in December, said the Taliban does not allow female health professionals to work and that it disrupts public health programs, including vaccination programs.
“Some health workers have joined the communities. But they have somehow spread the goddamn poliovirus throughout the region,” Bhuta said.
Now, health officials do not have reliable data on the number of poliovirus cases in Afghanistan. Poliovirus can cause paralysis in extreme cases, especially young children, and can be fatal if the virus affects the breathing muscles.
“This is a virus that doesn’t want to be eradicated, so give it an inch and it’ll take a yard,” Bhuta said.
Coming back to successful mass polio vaccination programs
Pakistan has spent an estimated $10 billion on poliovirus vaccination programs in the region since 2011. Despite two decades of challenges including political instability orders.
But there are different provinces in Pakistan various vaccination councilsIn Punjab, 85% of children are vaccinated, in Balochistan the rate is less than 30%. Until vaccine coverage reaches 85–90% in all provinces, it is unlikely that wild poliovirus will be completely eradicated from the region.
Bhutta is calling for a major strategic review to strengthen routine immunization programs not only for polio, but also for other infectious diseases.
“This is how countries like India eradicated polio. They stopped their routine vaccination programs at the same time [as trying to eradicate polio],
“It can certainly work in Pakistan. It’s a question of where you want to put resources.”
Bhutan: Work with Taliban on polio eradication
It is impossible to eradicate poliovirus in the region, Bhuta said, unless international and Pakistan-based health officials, along with the Taliban government in Afghanistan, say they are at this time. Until then, cases will continue to spread across the border, he said.
International health agencies have worked with the Taliban to distribute smallpox vaccines during periods of peace before the outbreak, when health workers can administer and administer the vaccine.
“The Taliban are not the enemy. After all, they have the same health concerns that everyone else does,” Bhuta said.
What is important to eradicate polio in the region, he said, is to address general health programs for women and children, not just polio. Without proper sanitation and comprehensive disease prevention programs, polio just wants to come back.
according to data from WHOSuspected cases of several infectious diseases, including pneumonia, dengue fever and measles, have increased in Afghanistan over the past six months.
“There are a lot of health needs in the region, for children with malnutrition, for children with disease prevention and management,” Bhuta said. “All we want to do is contain polio, it’s not said, ” Bhuta said.
Edited by: Zulfikar Abani
Source:
The Long Last Mile in Global Poliovirus Eradication: What Should Pakistan Do? By Zulfikar Bhutto, published in Lancet https://www.thelancet.com/journals/lancet/article/piis0140-6736(25)00007-8/abstract (abstract)
