Polio Eradication Strategies and Challenges: Navigating Hidden Risks

 Author's note
An opinion short paper based on my extensive field experience, exploring the strategies and challenges in the quest to eradicate polio. The paper delves into hidden risks, including missed populations, refusals, and inaccessible groups, hindering complete eradication despite progress. Emphasizing the importance of Inactivated Poliovirus Vaccine (IPV), the author discusses issues such as environmental sample alerts, population movement, malnutrition, refusals, fake vaccination practices, and monitoring gaps. The paper advocates for community engagement, mobile vaccination units, global health security collaboration, and a shift towards quality-focused campaigns. It underscores the significance of surveillance, genetic sequencing, cross-border collaboration, routine immunization strengthening, and environmental surveillance intensification. The conclusion emphasizes the need for a multifaceted approach, strengthened alliances, and unwavering commitment to overcoming persistent hurdles in the pursuit of a polio-free world

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Polio Eradication Strategies and Challenges

               Navigating Hidden Risks               



Polio eradication campaigns have made remarkable progress, yet challenges persist, hindering the goal of complete eradication. Despite successful mass campaigns and widespread efforts, certain segments remain vulnerable. Hidden children, missed from Oral Polio Vaccine (OPV) programs, persist, along with refusals and inaccessible populations. Malnourished children face compromised immunity, and the movement of populations poses a substantial risk.

Amidst these challenges, the emphasis on Inactivated Poliovirus Vaccine (IPV) administration for children under 2 years old is crucial. While quality mass campaigns have effectively targeted zero-dose populations, more focus is needed on defaulted individuals. A key concern involves the administration of inadequate Polio vaccine doses, which can potentially render the vaccine less effective.

Mass Campaigns and Hidden Challenges

While commendable efforts have been made through quality mass campaigns, the focus needs to shift towards children who have defaulted from Oral Polio Vaccine (OPV) and are yet to be reached. The emergence of hidden children poses a risk, coupled with the challenges of refusals and the inaccessibility of certain populations. Malnutrition exacerbates the vulnerability of children, compromising their immunity and putting them at higher risk.

Environmental Sample Alerts

Recent environmental samples have detected the Type-1 Wild Poliovirus, emphasizing the urgency of addressing gaps in vaccination strategies. Positive samples in various districts raise concerns, signalling the need for a comprehensive, adaptive approach to tackle the evolving landscape of the polio virus.

The Menace of Population Movement

The movement of populations, a dynamic aspect of modern society, poses a substantial threat to polio eradication efforts. The challenge lies not only in reaching transient populations but also in maintaining consistent vaccination coverage as people move from one place to another. This fluidity introduces an element of unpredictability that demands innovative solutions.

Malnutrition and Immunity Compromise

Malnutrition compromises the immunity of children, making them more susceptible to poliovirus infections. Prioritizing malnutrition-prone areas in vaccination campaigns can enhance overall effectiveness.

Refusals and Unavailability

Refusals pose a significant hurdle, impacting not only the vaccinated but also exposing the community to potential outbreaks. Identifying and addressing the reasons behind refusals is crucial for overcoming this challenge.

Fake Vaccination Practices

Fake vaccination practices are a significant concern, driven by factors such as the pressure to meet numeric targets, community demands, and inadequate monitoring. The study reveals that teams, caught between social influences and program pressures, resort to shortcuts like fake finger marking, creating a delicate balance to appease both sides.

Monitoring and Programmatic Gaps

The research highlights ineffective monitoring, with area supervisors often unaware of fake vaccination practices. Limited incentives and job security, coupled with social unacceptance of NGO work, create demotivating factors for frontline workers. The crucial aspect of enforced vaccination and its impact on community trust remains a focal point for discussion.

Community Engagement and Trust Building

Cultivating trust within communities is paramount. Engaging with local leaders, addressing concerns, and dispelling misconceptions can contribute to increased participation in vaccination programs.

Mobile Vaccination Units

To counter the challenge of population movement, deploying mobile vaccination units that can adapt to changing locations and timings is essential. Collaboration with transportation authorities can facilitate vaccinations during travel.

Global Health Security Collaboration

Recognizing that the movement of people transcends borders, collaborating with neighbouring countries is imperative. Synchronizing efforts and sharing information can create a cohesive front against the poliovirus.

Quality vs. Quantity: Focusing on IPV

While quantity-focused campaigns have been successful in reaching a vast number of children, the emphasis must shift toward quality. Zero-dose cases demand increased attention, and defaulted cases should be the new focal point. Prioritizing Inactivated Polio Vaccine (IPV) administration in the under-2 age group can contribute significantly to long-term immunity.

Surveillance and Response

Strengthening disease surveillance systems is critical for detecting and responding to new cases promptly. Timely responses, such as supplementary immunization activities, are essential to contain outbreaks in regions with positive samples.

Genetic Sequencing and Analysis

Utilizing genetic sequencing provides valuable insights into the origin and transmission patterns of the virus. Analyzing genetic links between samples informs targeted interventions and enhances the understanding of the virus’s evolution.

Community Engagement

Engaging communities is essential to address vaccine hesitancy and refusal challenges. Collaboration with local leaders and influencers can play a pivotal role in advocating for the importance of immunization.

Cross-Border Collaboration

Collaborating with neighbouring countries is crucial to prevent the cross-border spread of the virus. Sharing information and coordinating vaccination efforts help create a unified front against polio.

Routine Immunization Strengthening

Reinforcing routine immunization programs ensures that children receive timely and complete vaccinations. Focusing on underserved populations is crucial for improving vaccine coverage.

Environmental Surveillance Intensification

Increasing the frequency and coverage of environmental surveillance helps promptly detect the presence of the virus in sewage samples, contributing to more effective intervention strategies.

Conclusion: Bridging Gaps and Forging Alliances

In conclusion, the battle against polio demands a multifaceted approach. Addressing hidden children, refining strategies for population movement, and unmasking and countering fake vaccination practices are imperative. Quality mass campaigns are undeniably impactful, yet they must adapt to the evolving challenges. The alliance between communities and frontline workers must be strengthened, dispelling mistrust and fostering a shared commitment to polio eradication.

As we stand at the intersection of progress and persistent hurdles, the resolve to eradicate polio remains unwavering. The road ahead requires continued collaboration, innovation, and an unwavering commitment to leaving no child behind in the quest for a polio-free world.


By the same Author on PEAH 

The Gray Houses Polio Eradication Initiative: A Case Study on Identifying and Vaccinating Hidden Children 

Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve?

Decision Makers’ Perception of the Performance and Salary of UC Polio Officers in Pakistan

Polio Eradication Programme in Pakistan: Critical Analysis from 1999 to 2023