A brief history and epidemiology of poliomyelitis. Also, a thorough description of the Global polio eradication initiative with the barriers to its eradication in Pakistan.

1. Poliomyelitis And
Barriers to Its
Eradication in Pakistan
Ateeqa Ijaz
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2. What is
Poliomyelitis?
It is a highly infectious, life-threatening, and disabling
disease that causes acute paralysis, autonomic dysfunction,
and muscle weakness in the infected person.
 In 1789, it was known as “debility of lower extremities." &
later in the 19th century was called as “wrath of God.”
 It has its roots in Egyptian times from 1403 to 1305 BC
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FAMOUS DOORKEEPER ROMA EGYPTIAN

3. Poliomyelitis Epidemiology and Pathogenicity
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Poliovirus (genus
Enterovirus &
family
picornavirodae)
Children Under Five
Years Of Age &
Unvaccinated Adults
Strictly
Related
Humans
Fecal-oral Route
Found In A
Temperate Climate
With Poor
Sanitation And
Hygienic
Conditions
Non-paralytic Polio
= 3 To 6 Days &
Paralytic Polio = 7
To 21
 It Is One Of The Four Internationally Notifiable Diseases. It Is Believed That For Each Paralytic Polio Case; There Will Be
Around 200 For Type I And 2000 For Type II Affected Children In That Community (What Is Polio - FAQ, 2019, CDC)
Susceptibl
e
Population
Reser
voir
Path
oge
n
Environ
ment
Trans
missio
n
Incubatio
n Period

4. Poliomyelitis Epidemiology and Pathogenicity
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It has
three
subtypes
type I , II
and III
Type I
•Still a Public Health Threat
Worldwide
Type II
•Eradicated in September 2015
Type III
•Eradicated in October 2019

5. Historical Timeline
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ENDEMIC PHASE
EPIDEMIC PHASE
VACCINE PHASES

6. Global Polio Eradication
Initiative
 During a lameness survey in late 1970, it was revealed
and brought to the forefront that the polio virus is highly
prevalent in developing countries and requires a
collaborative effort to bring change.
 Soon after that, in 1988, GPEI was established, and
efforts were put in to eradicate the polio virus from the
world.
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7. 7

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Despite profound information on the pathophysiology of the virus, preventive and protective factors, and management of disease, the type I
polio virus is still not been eradicated, mainly in two countries, named, Pakistan and Afghanistan, causing concern about its resurgence
(Mehndiratta et al., 2014; Shabbir et al., 2022

9. 9
The incidence rate of polio cases has been reduced to 99%, but there is no further progress & an increasing trend has been
observed in the past few years (Shabbir et al., 2022).

10. 10
Failing Trajectory of Pakistan Polio Eradication Drive

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12. Vaccine Hesitancy
The Religious misconception regarding vaccines is that there are some haram
ingredients (not permissible in Islam - religion), i.e., pig-by-products in it, causing the
refusal of vaccine uptake.
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Vaccine hesitancy is deeply rooted in caregivers’ beliefs, misconceptions,
knowledge, and attitude toward the polio vaccine and polio eradication drive.
Demographic belief revolves around the concept that the vaccine will
cause sterility in their community.
A geopolitical concern among a high-risk population is the involvement of foreigners in
this campaign, raising suspicions.
 Fueled by fake polio vaccination drive in search of Bin Ladin by CIA U.S.
(Ataullahjan et al., 2021; Hussain et al., 2016).
 Causing trust Issues and elevating vaccine resistance

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14. Lack Of Governance, Climate & Insecurity Threat
 Governance has played a critical role in the failing trajectory of the Pakistan Polio Eradication
Programme.
 The lack of adherence to protocol, rules, and regulations, not taking accountability for it, security
issues, job insecurity, lack of transportation, delayed promotion, insufficient training, and choosing
incompetent workforce due to nepotism are the key issue that arises due to lack of governance and
henceforth failing of the program.
 Lastly, the climate shock, i.e., floods and terrorism in the northern and southern parts of Waziristan,
has also played a critical role in the failure to eradicate polio.
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16. A way Forward
• Addressing the challenges rather than focusing on
vaccination only will likely to increase the chances of
polio eradication in Pakistan.
• This includes engaging local communities and involving
community leaders to provide essential health literacy
information and clear misconceptions.
• Moreover, the issues related to governance should also
be resolved, and the healthcare workforce should give
proper training before they engage with the community.
These strategies will increase the vaccine intake among 16