Delays in polio vaccination programs due to COVID-19 in Pakistan: a major threat to Pakistan's long war against polio virus

The disruptions caused by the COVID-19 pandemic have devastating impact over vaccination programs around the globe especially in underdeveloped countries. The delays in immunization campaigns could increase infectious diseases such as polio, measles, and human papillomavirus. The pandemic is overstretching the health-care sectors and countries with limited capacity to deal major outbreaks are at breaking point. In accordance with World Health Organization (WHO), more than 116 million infants were vaccinated in 2019, and still more than 13 million children miss vaccination around the world and that the number could have been increased due to COVID-19.¹

During the ongoing COVID-19 pandemic, Pakistan has had to delay vaccination for another life-threatening contagion, poliovirus. Since April, around 40 million children missed the polio vaccination due to the cancellation of vaccination campaign nationwide. Pakistan stopped the mass vaccination on the 26th of March under the commands of Global Polio Eradication Initiative (GPEI). Millions of the children are at risk of missing lifesaving vaccines due to rising urge of social distancing, vaccine supply disturbance, blocked borders, and elevated shipment costs which led to the deferment of polio campaigns.

Although majority of the countries have already removed all the three types of polioviruses, Pakistan, alongside Afghanistan, is one of the two countries in the whole world where polio is still endemic. It was nearly close to become polio free with only 12 reported cases in 2018 but unfortunately, the number of cases rose to 147 in 2019.^{2 , 3} In the same year, Pakistan was accused of facing the emergence of the P2 virus strain with 22 reported cases. This strain was thought to have been removed in 2014. The year 2020 was thought to be the year for the transformation in polio campaigns to halt transmission in 2021 but the country is now facing COVID-19 operations. Therefore, any disruption due to COVID-19 in the polio program plans would have significant and drastic impact on this objective.

It could be concluded that diverting public health funds to fight against other outbreaks disrupted polio eradication plans, which could lead to the spread the of poliovirus in areas of low immunization coverage and immunity. Pakistan could face setbacks due to suspension in the polio vaccination due to COVID-19. On July 26 of 2020, there have been 107 reported cases of polio in Pakistan.² The immunization campaigns have been paused or delayed in various countries as the local health-care authorities are putting all their efforts to control coronavirus. Therefore, the planned vaccination in many countries may now not take place. This will cause a serious threat to the recently born infants who might now miss out their routine vaccination services. Moreover, those children who have not yet received the significant amount of polio vaccine are also at high risk.

The WHO is ready to resume the vaccination plans but as Pakistan is witnessing an increase in the number of COVID-19 cases, with the next few weeks crucial, the resumption of polio vaccination campaigns might be delayed. Meanwhile, if the polio outbreak gets out of hand, it would pressurize the already overstretched health-care sectors across the countries. At worst, it could even lead to the next global health emergency. The health-care experts in Pakistan, agree to resume the polio vaccination campaigns, otherwise the COVID-19 would destroy all the progress being carried out in the last thirty years against the polio virus.

The consequences of gaps in vaccination programs could have long lasting drastic effects. The GPEI has recommended the countries to postpone the vaccination programmed until the second half of the 2020, taking the decision in deep regret by knowing that as a result of delaying immunization plans, more of the children may get paralyzed by polio. Postponing or pausing the routine vaccination campaigns for now seems to be the correct decision, given the urge to avoid further transmission of COVID-19. However, the fear is that having won the fight against the novel threat basically exhausted and overburdened the health-care sector which could be inundated with other infections especially polio cases.

In accordance with WHO, past outbreaks have clearly showed that when the health-care sectors are overwhelmed, mortality from vaccine preventable and other treatable diseases also increase drastically. In fact, during the 2014–2015 Ebola outbreak, majority of the deaths caused by malaria, measles, AIDS, TB and polio, and these deaths exceeded from the deaths due to Ebola.⁴

Given the complexity of the issue, the health-care authorities do need to prioritize the fight against COVID-19, they must try to mitigate the effect of older diseases reappearing. There is an urge to resume the polio vaccination campaign to aid protecting children's lives in outbreak. Similar to the climate crises, the COVID-19 pandemic could be regarded as a child-rights crisis because it will have life-threatening impact over all the children, who need immunization, now and in long-term. Therefore, the health-care authorities must intensify the efforts to track the unvaccinated children so that most susceptible populations such as Pakistan, can be supplied with the polio vaccines as soon as possible. Otherwise, the impact could span the generations and even borders.