Pakistan: risk of polio resurgence as vaccination workers fired

Thousands of polio workers laid off as country gives priority to Covid-19 response

A boy gets his finger marked after he is administered polio vaccine drops in Karachi, Pakistan. Reuters

A vaccinator with kit box waits for her colleagues to do an anti-polio campaign in a low-income neighbourhood in Karachi, Pakistan. Reuters

A girl gets her finger marked after she is administered a polio vaccine in Peshawar, Pakistan. Reuters

A Pakistani health worker administers polio drops to a child during a polio vaccination campaign in Karachi. AFP

A Pakistani health worker administers polio vaccine drops to a child during a polio vaccination campaign at a slum area in Lahore. AFP

A Pakistani health worker administers polio vaccine drops to an Afghan refugee child during a polio vaccination campaign in Lahore. AFP

A Pakistani health worker administers polio vaccine drops to a child during a polio vaccination campaign in Karachi. AFP

In April, polio worker Aman Baluch was fired from his job in the port city of Karachi.

"It felt like someone had dropped me from the 100th floor of a building," Mr Baluch, 31, told The National. "I felt crushed."

He was among quarter of a million polio workers reposted to fight the coronavirus outbreak in Pakistan during spring, leading to a surge in other infectious diseases as the country confronted rising Covid-19 infections.

Since March, Mr Baluch has been on the front line of the country’s coronavirus response, carrying out contact tracing of infected patients, random tests in households and fighting misinformation about the virus.

He was laid off a month after Pakistan halted the polio vaccination campaign citing fears that the monthly programme, which is distributed door to door, might leave health staff and communities vulnerable to the new menace.

About 4,800 polio workers in Karachi and 1,900 in Khyber Pakhtunkhwa province have been fired since the pandemic started, challenging the programme's ability to reach vulnerable children after one of the worst years on record for the vaccine campaign.

Health officials have since reported a resurgence in polio cases, and the country has already logged 57 in the first seven months of 2020, up from 43 in the whole of last year.

Other infectious diseases, including measles and tuberculosis have also seen a sharp rise in Pakistan after Covid-19.

The lower rate of hospital visits and disrupted vaccination programmes are projected to cause an extra 1.4 million deaths from tuberculosis in countries including Pakistan, India, and Kenya by 2025.

Health officials warn that critical medical staff have also been pulled out of the Covid-19 response because of a restructuring of the polio programme and budget cuts.

New cases are exploding in Pakistan, which ranks among the top 10 countries with the fastest-growing daily cases of Covid-19.

"Firing health workers during the height of the pandemic is unethical," Alia Haider, a medical doctor affiliated with the Friends of Doctors aid group, told The National.

"The workers weren't protected and the work they were doing was critical."

Not all workers are receiving personal protective equipment when going door to door during contact tracing, Dr Haider said.

"They were capable of getting the virus and they were being put at high risk," she said.

According to data from Johns Hopkins University, almost 5,200 people have died from the coronavirus in Pakistan and more than 249,000 people have contracted the disease.

In June, the World Health Organisation pointed said Pakistan had neither slowed the infection rate nor stalled disease transmission as authorities struggled to cope.

Hospitals report a critical lack of beds, there is a severe lack of testing and health officials say citizens regularly flout the government’s partial lockdown rules.

The strain on Pakistan’s health systems from the virus has deeply alarmed polio workers such as Mr Baluch, who says the fast-moving outbreak might jeopardise the long-term fight against polio.

Since the late 1980s, an international eradication effort has seen polio cases reduced by more than 99 per cent globally.

But the virus remains endemic in Pakistan and Afghanistan, the last two countries where wild poliovirus cases are still circulating.

Pakistan has announced a summer resumption of the programme but pausing it has already had a devastating effect on children.

Last month, Unicef said 40 million children in the country missed doses of the polio vaccine in April, leaving them exposed to the disease.

Mr Baluch said a post-coronavirus world would be left to deal with the effects of missed polio vaccinations, and the likelihood of vaccine refusals has gone up.

“In previous campaigns, we found many vaccine refusals, sometimes thousands of refusals in one trip,” he said.

In Pakistan, rumours still persist that the polio vaccine is a western conspiracy to poison Muslims or render then infertile.

The reduced number of polio workers might also hamper Covid-19 containment efforts, Mr Baluch said.

Medical workers have been tracking Covid-19 and polio at the same time, counting the number of children paralysed by polio and tracking international travellers for Covid-19 infections.

Despite the increased work burden, few government officials acknowledge the indispensable role of these workers.

Mr Baluch said that before they were fired, workers were doing double-duty to minimise both outbreaks.

As the sole breadwinner in his seven-person household, he cannot afford to sit out the pandemic.

“I was the only one working," Mr Baluch said. "I don’t know how I will provide for the household next month."

But he is aware that the coronavirus outbreak has changed the equation for workers like him, taking away their ability to find new jobs as the economic toll of the virus takes hold.

Now, every time Mr Baluch approaches a new employer, he is told that another batch of workers has just been fired.

“I am just waiting for the end of coronavirus,” he said. “Maybe then there will be a chance for hope again.”