Zero End Game for Polio in Pakistan

Pakistan and Rotary are cutting through a whirl of migrating families and cultural barriers to turn what was 'a badge of shame' into a model for disease eradication.

Setback year

In 2014, Pakistan’s effort to wipe out polio, a disease that can paralyze, was in crisis.

Political pressure to root out the virus was being tested, reports of violence against vaccinators were common, and perceptions that the country was an incubator of the disease grew. Massive population movement and displacement had pushed the anti-polio campaign to its limit. 

The consequence? Reports of the disease spiked to alarming levels. 

The explosive outbreak that year totaled 306 reported cases, up from 93 the previous year. Pakistan had 82 percent of the world’s cases of polio in 2014. One newspaper editorial at the time called the epidemic Pakistan’s “badge of shame.”

A pointed 2014 report from the Independent Monitoring Board of the Global Polio Eradication Initiative spotlighted Pakistan’s missteps, humbling government leaders and health officials, who scrambled to find solutions. 

“We were emotional and somewhat defensive,” says Dr. Rana Safdar, director of the National Emergency Operations Center in Pakistan. “But the report pushed us to get our act together on polio, for first time. Our program was a threat to the global polio eradication efforts. The upsurge we had in Pakistan was unprecedented.”

The government effectively declared war on polio, condemning the outbreak as a national disaster. Words were soon matched with action.

“The motivation and the commitment of the vaccinators on the front line and government officials became stronger,” says Aziz Memon, chair of Rotary’s Pakistan PolioPlus Committee. “We had more reason to say, ‘Yes, we need to get rid of this disease and fulfill the promise we made to the children of this country: No child in the future will be crippled by this disease.’”

Led by this renewed commitment, the country rallied, intensifying immunizations through new strategies that resulted in a dramatic decrease in polio cases over the next two years. 

The number of new infections dropped from 306 in 2014 to 56 the next year, a decrease of 82 percent. In 2016, only 15 cases of polio caused by the wild virus were reported. 

‘A paradigm shift’ 

To quell spread of the disease and reduce the risk of exporting cases to neighboring countries, Pakistan adopted a National Emergency Action Plan. The immediate goals: to cut off transmission of the virus in high-risk areas and to reach missed children.

Routine vaccination campaigns that immunize children door to door were no longer enough. Calling it a “paradigm shift in strategy,” Senator Ayesha Farooq, who leads the anti-polio strategy for the prime minister in Pakistan, says the revitalized program focuses heavily on children who have routinely missed vaccinations.

“Despite the fact we were receiving 80 percent coverage in every campaign, the other 10 to 20 percent that we were missing out on were sustaining the virus,” she says. 

Rotary launched the world’s first global polio immunization program, PolioPlus, in 1985. In 1988, it became a founding partner of the Global Polio Eradication Initiative (GPEI). It continues to work for polio eradication with the World Health Organization, UNICEF, the U.S. Centers for Disease Control and Prevention, and the Bill & Melinda Gates Foundation.

Rotary has contributed more than $1.6 billion and countless volunteer hours to immunize more than 2.5 billion children worldwide. Polio cases have plummeted by more than 99.9 percent, from 350,000 cases in 1988 to 27 in 2016.