Polio vaccination in Pakistan

Abstract

Syed Hussain and colleagues (April 18, p 1509) praised the Pakistani Government for arresting parents who refused poliovirus vaccination for their children, calling it a bold move to address the serious issue of polio in Pakistan. This statement gives the impression that parental refusal of child vaccination is the main reason for the failure of polio campaigns in Pakistan; however, this is not the case. Of 34·7 million children targeted for vaccination in March, 2015, only 33 695 (<1%) children were missed because of their parents’ refusal. Roughly 33·6 million (79%) children were vaccinated, whereas the remaining children (20%) were missed mainly because of security issues, such as death threats from militant groups who perceive polio vaccination campaigns as a cover to serve the intelligence purposes of the Central Intelligence Agency. We believe that Hussain and colleagues ignored important considerations. First, most of the parental refusal is because of their religious misconceptions about vaccination and distrust in government offi cials. Moreover, with the arrest of citizens, no evidence exists to confi rm that parents’ beliefs about vaccination can be changed and their trust in the governent regained. Second, some of the people arrested for refusal of polio vaccination were still single and had no children, and some people did not refuse polio vaccines for their children. We believe that arresting people for refusal will not help them to understand the gravity of the issue, rather thoughts against the state will breed in arrested parents and might further strengthen their misconceptions towards polio vaccination. Third, the security of the general population and polio vaccine workers seems to be a much bigger problem. Lastly, the eff ectiveness of used vaccines is also a concern because in February, 2015, a Federal Investigation Agency sealed 11 800 vials of spoiled polio vaccines in the National Institute of Health, Pakistan. The Pakistani Government should provide security to the public and the polio vaccine workers. Evidence-based approaches should be adapted to change the misconceptions of parents. Government officials should launch the campaign with full dedication and honesty, since previous campaigns have been dented by political corruption and mismanagement. These are the bold moves that are needed to liberate Pakistan from polio.