This Lancet editorial discusses the "devastating setbacks" that hampered the global effort to halt all wild poliovirus transmission (WPV) by the end of 2012 as established by the 24-year-old Global Polio Eradication Initiative (GPEI). In mid-December 2012, 9 health workers were shot dead while travelling from house to house to administer polio vaccine to children during the national anti-polio campaign in Pakistan. Then, on January 1 2013, 6 female Pakistani aid workers and a male doctor were shot dead. As noted here, it is female health workers who "are standing fearlessly and selflessly on the frontline of Pakistan's war against polio, because culturally only women are allowed to enter into houses to talk to mothers and vaccinate their children."
In June 2012, in Federally Administered Tribal Areas (FATA), the Pakistani Taliban banned polio vaccination in retaliation for the use of unmanned drones by the United States (US). Now, due to safety concerns, the United Nations (UN) has been forced to halt its participation in the vaccination campaign, and the campaign itself has been suspended temporarily by the Government of Pakistan and the affected provinces. More than 3.5 million Pakistani children have missed vaccinations as a result of the campaign's suspension.
The editorial notes that the effect of the killing of polio vaccine workers in Pakistan will have repercussions for its neighbour, Afghanistan. Heidi Larson, an anthropologist who studies public trust in vaccines and immunisation at the London School of Hygiene and Tropical Medicine, pointed out that the killings of health workers in Pakistan could call for a rethink of delivery strategies. She compared what has happened in Pakistan with the 2003-2004 immunisation boycott in northern Nigeria, led by religious and political leaders who claimed that the oral polio vaccine (OPV) could cause sterility. This boycott led to poliovirus not only rebounding in Nigeria but also spreading to 15 African countries and to Indonesia. The boycott and its effect prompted discussions between the World Health Organization (WHO), the Organization of Islamic States, and local religious leaders to help address the rumours and contain the further spread of polio.
In conclusion, it is "imperative not only to ensure immunisation workers' security, but also to address the determinants behind the shooting of polio health workers - ie, to win the hearts of the public, to go beyond the 'polio only' agenda, and to enhance polio vaccination's integration into the routine health and immunisation programme."
Please note: On January 8, 2013, following the publication of this editorial, Pakistan's ambassador for polio eradication re-launched the anti-polio campaign in Sindh province amid increased security. For more on this, click here.
The Lancet, Volume 381, Issue 9860, Page 1, January 5 2013; and email from The Lancet Journal Office to The Communication Initiative on January 17 2013. Image credit: © Corbis