Abstract
ABSTRACTCommunity and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a distrust of government and international actors that provided few services but administered polio vaccine door-to-door every month. Addressing this discrepancy could therefore be key to eliminating polio. The authors suggest short-term improvements to routine immunization and sanitation in key polio endemic areas, coupled with ...
Highlights
In Pakistan, recent improvements in operations and access led to a reduction in polio cases, from 328 wild and circulating vaccine-derived polio cases in 2014 to 55 in 2015
Both vaccine refusals and operational issues contribute to immunity gaps in polio-endemic areas of the country (GPEI, 2015a; Independent Monitoring Board of the Global Polio Eradication Initiative (GPEI), 2015; SteelFisher et al, 2015)
Drawing on research conducted in early 2012, we focus on SITE Town, an area that in recent years has harbored poliovirus (Table 1)
Summary
In Pakistan, recent improvements in operations and access led to a reduction in polio cases, from 328 wild and circulating vaccine-derived polio cases in 2014 to 55 in 2015. Both vaccine refusals and operational issues contribute to immunity gaps in polio-endemic areas of the country (GPEI, 2015a; Independent Monitoring Board of the GPEI, 2015; SteelFisher et al, 2015). In SITE, vaccine acceptance and worker motivation were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Addressing this discrepancy could be key to eliminating polio. Most are ethnic Pashtuns from the Federally Administered Tribal Areas and Khyber-Pakhtunkhwa in Northwestern Pakistan. These IDPs have had a chilly reception in Karachi. Note: there were no confirmed cases in 2012, environmental surveillance picked up wild poliovirus in Karachi’s sewage in that year (Kazi, Murtaza, Khoja, Zaidi, & Ali, 2014)
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