Research on new approaches to eradicate polio

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

The threat of polio in conflict-hit areas of Pakistan can be reduced through a package of community-based strategies integrating maternal child health services and routine immunizations, according to a new study published in The Lancet Global Health.

The research conducted by health experts from the Aga Khan University in partnership with the Peshawar Medical College, the London School of Hygiene and Tropical Medicine and Canada’s Centre for Global Child Health at the Hospital for Sick Children, Toronto, tested a range of interventions in 387 insecure areas of the country in Bajaur, 

Karachi and Kashmore where children are especially vulnerable to contracting polio: a disease that has been eradicated in all countries except for Pakistan, Afghanistan and Nigeria. During the study, researchers identified a range of problems leading to new cases of polio being reported in the country every year. 

These challenges included children not being present at home during immunization drives, healthcare workers being denied access to particular areas or being unable to cover all homes in an area, distrust of vaccination activity among the population, and fatigue caused by recurrent polio-focused immunization drives. 

The researchers were able to expand coverage of the polio vaccine in insecure areas by deploying a wide range of approaches. 

These interventions included the introduction of pictorial health awareness campaigns, community mobilization and engagement through local volunteers, and the running of holistic health camps after national immunization drives that addressed the unmet need for mother and child health services in these areas. 

These steps enabled low cost, accurate health information as well as vaccinations to be provided to over 50,000 families, helped address the problem of children being missed in national drives and alleviated the potential hesitancy of those refusing polio vaccines delivered through frequent door to door immunization campaigns. 

Furthermore, by focusing each intervention in a distinct cluster, researchers were able to assess the effectiveness of each approach and to recommend which measures would help meet global and country polio eradication targets most effectively. 

“Ensuring that no child is missed in polio vaccination campaigns is especially challenging in areas in Bajaur and parts of Karachi where the law and order situation limits access to vaccinators. There is also widespread suspicion of immunization activity across the country which is why one of the approaches we tested involved building trust within communities,” Dr Sajid Soofi, associate professor in paediatrics and child health at AKU, remarked. 

Dr Saeed Anwar, associate professor in community health sciences at Peshawar Medical College, added that healthcare teams, consisting of community mobilisers from the area, were trained to deliver accurate information about immunization to parents and local healthcare providers. Focused sessions were also held with community leaders, religious figures, teachers and other prominent officials at the union council level. 

Speaking about the value of these approaches, Dr Anwar said: “By employing local influencers to manage projects and by focusing on personalised sessions with local stakeholders we were able to gain access to previously unreachable areas and thereby protect more children from this preventable disease.” 

The study also disproved a view that providing an anti-polio injection, the inactivated poliovirus vaccine (IPV), alongside polio drops, the oral poliovirus vaccine (OPV), would result in opposition from the community. Researchers noted that data showed that eight out of ten families agreed to their child receiving the IPV when it was delivered as part of a comprehensive health package that provided vital hygiene, nutrition and antenatal services to mothers and children. 

“Since the eradication of polio is a national and global imperative, we worked closely with the World Health Organization, UNICEF, the Bill and Melinda Gates Foundation, as well as federal and provincial governments to generate evidence that can help achieve the objectives of the National Emergency Plan and the WHO’s Polio Eradication Initiative. Importantly the study’s findings also contribute to targets related to vaccine coverage and immunization against communicable diseases under Goal 3 of the Sustainable Development Goals,” the senior author of the study Professor Zulfiqar A. Bhutta, founding director of AKU’s Centre of Excellence in Women and Child Health and the Chair in Global Child Health at the Centre for Global Child Health in Toronto, observed. 

“Our package of interventions enabled us to boost coverage of the oral polio vaccine by 8.5 per cent in areas where there was previously fierce opposition to immunization campaigns. Our steps to organise temporary health camps providing broad-based health services ensured that we reached two-thirds of targeted children and families and helped us to provide booster injections to ensure that every child stayed on track with the four-dose schedule needed to eradicate polio,” he added. 

Previous research by the Aga Khan University, which was published in Science Direct in 2013, demonstrated that the use of booster doses of the IPV enhanced immunity in children and contributed to the eventual introduction of IPV in Pakistan’s routine immunization programme in late 2015. 

This study also generated evidence that strengthened the case made by the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) for booster doses of IPV to be made a part of Routine Immunization programmes around the world. 

Dr Mohammad Assai, Pakistan Country Head for the WHO, said: “The eradication of polio worldwide requires global partnerships that combine medical expertise with strong community health research capabilities. Working in partnership with a range of universities and multilateral organisations has helped us generate the evidence to strengthen immunization systems and to expand vaccine coverage so that the world stays on track with targets under the global Polio Eradication and Endgame Strategic Plan which aims to eradicate the disease by 2018.” 

He added that initiatives focused on engaging communities and officials at the grassroots level were enabling people to get involved in local efforts to boost public health and well being which were translating into more effective polio campaigns in Pakistan. 

The study Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial was funded by the Bill and Melinda Gates Foundation and was completed over a period of four years of planning and execution