Ashfaq Yusufzai
PESHAWAR, Aug 17 2006 (IPS) – The reliability and safety of oral polio vaccine (OPV) has been put under scrutiny in Pakistan after wild rumours that it causes impotency snowballed into a writ petition in a high court.
On Jul. 6, the Peshawar High Court put on notice Pakistan s federal and provincial governments, and the World Health Organisation (WHO) in a petition filed by a resident of the city seeking closure of the 10 billion rupee (some 167 million US dollars) programme to eradicate the childhood disease.
The petitioner, Ghulam Nabi from Peshawar, has repeated claims that scientists have found the vaccine to be contaminated by estrogen, which has a direct impact on the reproductive system a charge denied by the WHO and argued that its distribution in Pakistan violates the right to life and family guarantees made by the constitution.
Pakistan s Polio Eradication Initiative (PEI) launched in 1994 as a joint programme of the ministry of health s Expanded Programme on Immunisation (EPI) cell and WHO has been dogged by superstition and the very real problems of a poor health infrastructure and political meddling.
Paramedics here in the North West Frontier Province (NWFP) have refused to work like everywhere else in Pakistan, as area supervisors for the PEI, unless they are redesignated as campaign support officers, which would earn them substantially more money a stand that has the backing of the provincial health minister.
A health official who did not want to be named blamed the staffing problem on lack of planning. The WHO has failed to stem the tide of polio virus, especially in NWFP and Balochistan, owing to lack of proper strategy and coordination with the health department. The health department staff claimed that the WHO staff receive huge salaries, while they are given a paltry sum for their services, he rued.
Pakistan is among just nine polio endemic countries in the world. The virus, which typically affects children under the age of five, causes irreversible paralysis. A total of 641 cases of polio were recorded up to June 2006, according to a WHO report. The majority of cases were from Nigeria (521) followed by India (60), Somalia (26), Afghanistan (14), Ethiopia (3), Niger (4), Yemen (1), and Indonesia (2).
Resistance from religious groups in Pakistan s Sindh province to their children being administered OPV, has sparked fears that Pakistan may become like Nigeria. It is thought that polio resurfaced in Nigeria after a northern state banned vaccines in mid-2003 because Muslim elders said they were part of a plot to spread HIV and infertility. The vaccinations resumed after 10 months, a WHO official told IPS. None of the officials IPS spoke to were willing to be identified.
Indications are that Pakistan will suffer the brunt of the propaganda against the OPV. This year, we have 11 cases, which is a huge failure on our part, said a health official associated with the anti-polio campaign since 1995.
Surprisingly, all the four cases reported so far in the NWFP had received anti-polio drops, a pediatrician, Dr Zaheer Khan at the Khyber Teaching Hospital, said.
One of them is a 14-month-old girl, Safia, from a locality in Peshawar. Her father, Jamaluddin, told IPS that she was confirmed as a polio patient despite receiving 10 anti-polio doses. Health officials said 15-month-old Ataullah of Bajaur Agency (NWFP), Bilal from Peshawar district and Tasleema from Tank district were similarly infected by the virus after they had been immunised. PEI conducts seven rounds of immunisation annually. The most recent was in early August.
Questions have been raised about the possibility of the virus sneaking in from neighbouring Afghanistan. We suspect that the polio problem could be the result of a cross-border movement (of Afghan refugees), because Afghanistan has recorded 14 polio cases this year, another official said.
But the bigger concern is the efficacy of the vaccine that is administered in Pakistan. WHO s PEI team leader Dr Abraham Mullugutta told IPS that the anti-polio drops may be ineffective only under certain conditions.
Sometime the child suffered from diarrhoea, dysentery or low immunity which rendered the drops ineffective, he said. Also, as the vaccines are required to be stored at a certain temperature, the frequent electricity breakdowns could make it ineffective, he added.
One problem is that the vaccinators are overburdened with work, and there are not enough doctors who can check if the children are healthy enough to ensure the effectiveness of the vaccine, said another WHO official.
Worried that the rumours could affect the anti-polio campaign in Pakistan, WHO s regional director for the Eastern Mediterranean, Hussain A. Gezairy, wrote on Jul. 12, to federal health minister, Naseer Khan, urging his intervention.
I am very concerned that the rumors about vaccine safety are spreading to other provinces, particularly in Sindh à It is unfortunate that à (Pakistan s) achievements are being put in jeopardy and the children à threatened of being deprived of living in a polio-free country because of issues not relevant to the programme such as what continues to happen (regarding) the paramedics à and lately due to the unfounded rumors spreading in NWFP about the safety of the vaccine.
I am calling on Your Excellency à to address the underlying causes of these setbacks and to challenge these unfounded, unsubstantiated claims about vaccine safety, Gezairy who looks after 22 countries wrote. WHO remains committed to support national efforts in polio eradication and we are ready to assist national efforts to dispel these rumors as Your Excellency feels appropriate.