The recently-introduced requirement that travellers from Pakistan be vaccinated against polio was not going to have the desired effect and drew away resources needed to eradicate the disease-causing virus, according to one public health expert.
Alarmed by the spike in polio cases that occurred during 2013 and subsequently, the World Health Organization declared in May this year that the international spread of naturally-occurring ‘wild’ polioviruses constituted a Public Health Emergency of International Concern. Some 60 per cent of polio cases last year were, it said, the result of the virus spreading to other countries and there was increasing evidence that adult travellers had contributed to this spread.
Pakistan, along with Cameroon and Syria, were categorised as ‘States currently exporting wild polioviruses’ and asked to take measures that included vaccinating international travellers. (Equatorial Guinea was later placed in the same category.)
“In my view, vaccinating travellers will be ineffective and it could make polio harder to eliminate in the poor and conflict-ridden parts of Pakistan. It is largely here that the final battle to eradicate polio from the world will be won or lost,” observed Zulfiqar Ahmed Bhutta, director of the Centre of Excellence in Women and Child Health at the Aga Khan University in Karachi, Pakistan, and co-director of the Sick Kids Center for Global Child Health in Toronto, Canada, in a comment just published in Nature .
“Where borders are porous and land routes largely unregulated, vaccinating air travellers principally as a means of control is unproven and vaccinating at arrival problematic,” noted Dr. Bhutta in an email.
“I and several colleagues had feared that this [vaccination of international travellers] would become a huge distraction and it has,” he said in another email. It also led to resources, human and financial, being diverted.
Those resources should instead be used for scaling up efforts to immunise children among over eight lakh people displaced by the military offensive against the Taliban in North Waziristan region of the Federally Administered Tribal Areas (FATA), argued Dr. Bhutta in his Nature article. Much of Pakistan’s polio cases occurred in the FATA regions where polio vaccination teams had been denied access.
“Providing polio vaccines as part of a package of health services is a better way to engage local communities and religious leaders than through a narrow, polio-specific programme,” he noted in the article. The emphasis on polio, to the neglect of other health services, had long fuelled beliefs that polio immunisation was an external initiative operating for outsiders’ benefit.
“Whilst I agree with Prof. Bhutta that polio eradication currently hinges on events in Pakistan, I don’t think it is a question of routine health services versus immunisation of travellers — rather the two are just part of the many efforts that will be required to finally achieve a world free of polio,” observed Nicholas Grassly, an epidemiologist at the Imperial College London in the U.K., who has worked extensively on polio.
Giving a boostGiving travellers a boost with oral or inactivated poliovirus vaccine before they set out minimised the risk of international spread of the virus from currently infected areas, including Pakistan, he observed in an email.
“Of course, this should not and I believe has not distracted from the major effort to eliminate transmission in remaining reservoirs, especially FATA.” Indeed, efforts to immunise children of that region had been stepped up.
T. Jacob John, who is well-known for his work on polio vaccination in India, also took a similar view.
Dr. Bhutta was mixing up two issues, namely the need to eradicate polio by tactical application of polio vaccines and minimising the risk of exportation of the virus through travellers. “These are not mutually exclusive or contradictory. Both need to be done,” he told this correspondent.
