Poliomyelitis and Pakistan – By Prof Waheed Uz Zaman Tariq

Poliomyelitis and Pakistan
A Crippling  Isolated Nation

Tariq.jpgaDuring all of my life as a Professor and Consultant of Clinical virology, I was concerned with the eradication of Poliomyelitis. After the end of dark era of Smallpox endemicity, we thought that Poliomyelitis and Measles were our next targets. We had learnt that awareness, commitment, vaccination and mop up operation may be key of our success. Paralytic polio is a crippling, incapacitating and immobilising disease. Its aftermaths are horribly visible. It is caused by three types of viruses, which propagate in human intestines and have no nonhuman animal reservoir. These three types of Polioviruses (P1, P2 and P3) are transmitted by faeco-oral route, which means that the causative virus passes in the stool of infected individual for week and then goes to drain wherefrom it makes its way back to uninfected and unimmunised individuals. Those who get these viruses are mainly affected asymptomatically and they have no knowledge of having had that infection, unless tested for immunity or for the presence of the virus, during early stages. A point to remember is that out of all infected persons, less than one percent develop a paralytic disease. The vast majority would remain unaffected. Who would have permanent flaccid paralysis, nobody knows. The virus is there is the drains, watery environments and polluted food and beverages. Testing the drains of any city would tell the presence of wild virus in the environments. The vaccine virus is also there in the drains but we may differentiate between a wild and vaccine virus.

While, I was being trained in Clinical Virology in England, I was told by my British colleagues in 1980s that paralytic Poliomyelitis was the disease, which ushered beginning of a civilisation and would be wiped out by the maturity of the civilisation. Its end would denominate an era of perfection of a  civilised society. A civilised culture is a dream of every society. It needs a discipline, responsibility and obligations. Public health is an integral part of the developed society.I had a desire to see ourselves civilised and responsible and find the end of Poliomyelitis from our soil of the pure people, where impurities of mind, environments, water and air is a norm. I had a longing to see everyone vaccinated and have an easy access to the health care and education.

 Vaccination is the responsibility of the Public Health but it is only possible, if all take their responsibility with all obligations. Naturally, those who do not take interests in such healthy pursuits do not fulfil their obligation. Those who resist are enemies of the society and those who fight against such efforts are the enemies of the humanity. Mormons of German descent in the United States have often refused to get their children vaccinated, as they considered it against their belief.  Methodist Christians from Holland and Canada did the same in 1970s and 1980s. That was the time when the Muslims were taking the vaccines all over the world. During the last decade or so, in certain extremist sectors of Pakistan, the vaccine was rejected and a resistance was started against such campaigns. Then the worst scenario was created and the vaccinators were attacked and killed.

We have joined the global efforts of Polio eradication. Routine. Polio vaccine was available to our children by 1990s. We were giving booster doses. Polio days were celebrated all over the country and vaccine was delivered door to door, by volunteers and school teachers. Despite our difficulties in the maintenance of cold chain, vaccine was efficacious. Foreign aid was coming and WHO office was active for a war against Poliomyelitis.

It was end of the 1996. I remember that Malik Miraj Khalid was the Care Taker Prime Minister of Pakistan. We were celebrating a Polio vaccination day. The vaccine had been imported by a reputed company AMSON,  from Sienna, Italy by a chartered plane. It was stored in the National Institute of health Pakistan and released to the vaccination centers. Suddenly, a wave of propaganda had started that the vaccine was inefficacious. Those firms, which had lost the bid, wanted to take their revenge. The matter had been passed  tothe Federal Investigation Agency (FIA)  and ministry of Interior was involved. Friday was a public holiday. On that day the Ministry of health sent a letter to the Secretory Defence to requisition my services as an expert. I was called by Lt Gen Salim, who was our Surgeon General, in his home. He asked me how would he vaccine would be tested and what would the fate of national vaccination day, if we have to be asked. I was given full authority, by the Government of Pakistan to do whatever I could, once I had explained him about my plan. I told him, that Polio day would be celebrated as it was going to be, otherwise. Even if the vaccine was subsequently proven to be of no use, it would be harmless. I had contacted Dr David Wood of national Institute of Biological Standards and Quality Control of the United Kingdom, at Porters Bar. David and I had shared an office for three years in the North Manchester Regional Virus Laboratory, as colleagues. He had offered me to get the vaccine tested free of cost. Then I was with team of FIA. I remember two very professional FIA officer; Mr Nawaz ulHaq and MrMubashir, who helped me in investigations. We took the matter with calmness and allayed the panic.

We told to the authorities to go ahead with vaccine. Meanwhile, we took the vaccine sample from the National Institute of Health and some vaccination centers. We had met a lot of resistance but we did the job. The vaccine samples were sent to London, by the earliest PIA flight having packed, sealed and stamped by the FIA and signed by me. After two weeks we got the answer. The vaccine was found effective and meanwhile the vaccination day had been celebrated. The national enthusiasm was such that President Farooq Lughari was at his native town of Dera Ghazi Khan to give the vaccine by himself. The commitment of the nation was there.

For a decade, I have been  an active member of WHO's Committee of experts on  Polio Eradication Certification. We had been working hard day and night and made excellent plans and executed them. We had intensified our efforts for vaccination, testing and environmental monitoring. We were tracing the cases and created a ring of vaccinated people around them. We kept a strict record of the cases. We were making all efforts for educating the nation, conducting workshops and celebrating Polio days. We had two campaigns o vaccinating all children below the age of five years.

Our efforts had become fruitful. We had been left with 28 symptomatic cases of Poliomyelitis during that year of 2006. All were due to Poliovirus type 1. Those too were mainly imported from Afghanistan. We were far ahead of India, in our campaign. I dreamed that we are just a year beyond the eradication of that scourge from Pakistan. Then came a propaganda campaign against Poliomyelitis. It was told that the vaccine contained spermicidal medicine in it. The sperms are not produced in the children and the vaccine is given to them.

Security in pakistanThen we found that it was contradictory to the faith of some people. Conspiracy theories came in. Propaganda and false claims have polluted the minds. Terrorism became bioterrorism when a wild virus was allowed to prevail in our country. The fanatics fought against our healthcare system. They killed innocent unarmed girls, who were involved in vaccination. They had no moral values. No argument worked. All three types of Poliovirus came back and we became hub of viral activity. The viruses circulated in our population. Intestines of our young children became nature's test tubes for the propagation if virus. Then, we started exporting the virus. Obviously, we had to face travel sanctions.

There are critics of Pakistan Army, who want Army  to have no role in the national affairs of the country. I wish that the civilian institutions become so strong that Army goes out of civil sectors and do her job. Unfortunately, when the law and order situation becomes such that Army personnel are compelled to provide escort to the vaccinators or are directly asked to vaccinate, it means that the  nation has failed to take her responsibility. To the best of my understanding that is unwanted situation. A decade earlier, I could not even think that a day would come when it would not be possible to go to vaccinate our children, without the support of Army. Why had all that happened? It means that something is wrong somewhere.

Today we are facing worst situation. We are targeting the vaccinators, vaccine suppliers and even the vaccinees. The killing was not limited to the FATA but the vaccination staff was under the fire, even in the metropolis if Karachi. Are we the barbarians or people of stone ages? As I mentioned that those anti-vaccine elements are the enemies of the humanity. Bill Gate had pledged the required resources for Polio eradication. The United arb Emirates have donated six million dollars to the Government, to eradicate Polio from the country. If Pakistan harbours all three types of the wild Poliovirus, the countries in the vicinity may import the virus. A Poliovirus secreting normal traveler may go anywhere in the world. Obviously, travel restriction would be imposed. If the fight against Polio vaccination continues, the nation will be isolated from rest of the world, with which we have already been left with limited links.

The world cannot close its eyes on the grave situation of our Polio endemicity. We have been asked to not to travel abroad without showing an evidence of having been vaccinated against Poliomyelitis. Here again false certificates were sold in the market by travel agencies. Our record is worst and we are in the list of last three countries having Polio circulating in our water ways. We are being crippled. Others are spending a lot to save us but we are resisting with full force. Those who talk against the vaccination campaigns from the pulpits, classrooms of Madrasahs and hiding places,  cannotperhaps understand the realities and scientific facts. Even then, there might be some hidden agenda of those who wanted to push to an isolation, in the league of nations.  Indeed, educated lot of religious scholars is already participating in the campaigns against Poliomyelitis and their efforts are commendable. Those who maintain  their misconceptions must know that the life of their own children and grandchildren may be in danger.

 

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