Fake records, imperfect vaccine, missteps aided cause comeback of polio

Karachi: : For the past decade, Sughra Ayaz has travelled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio to wipe out the paralytic disease.

She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines.

Amid rampant misinformation and immense pressure for the campaign to succeed, Ayaz said, some managers have instructed workers to falsely mark children as immunised. And the vaccines, which must be kept cold, aren’t always stored correctly, she added.

The World Health Organisation and partners embarked on their polio campaign in 1988 with the bold goal of eradication — a feat seen only once for human diseases, with smallpox in 1980. They came close several times, including in 2021, when just five cases of the natural virus were reported in Pakistan and Afghanistan. But since then, cases rebounded, hitting 99 last year, and officials missed at least six self-imposed eradication deadlines.

Afghanistan and Pakistan remain the only countries where transmission of polio.

Officials have falsified vaccination records, selected unqualified people to dole out drops, failed to send out teams during mass campaigns, and dismissed concerns about the oral vaccinesparking outbreaks according to documents shared with AP by staffers from GPEI.

Officials tout the successes – 3 billion children vaccinated, an estimated 20 million people who would have been paralysed spared – while acknowledging challenges in Pakistan and Afghanistan.

Dr. Jamal Ahmed, WHO’s polio director, defended progress in those two countries, citing workers’ tailored response in resistant pockets.

Dr. Zulfiqar Bhutta, who has served on advisory groups for WHO, the Gates Foundation and others, said campaign officials should listen to the criticism of its tactics.

Documents show years-long problems on polio vaccination teams.

The documents flagged multiple cases of falsified vaccination records, health workers being replaced by untrained relatives and workers improperly administering vaccines.

Vaccination teams worked “in a hurried manner,” reports said.

A team in Nawzad, Afghanistan, covered just half of the intended area in 2017, with 250 households missed entirely. Village elders said no one visited for at least two years.

In an email response to AP’s questions about officials’ knowledge of the issues, WHO polio director Ahmed noted “operational challenges” in Afghanistan and Pakistan and said the program has “robust monitoring and evaluation processes.”

Ayaz described “fake finger marking” — placing the ink used to show a child is vaccinated on their pinky even when no vaccine has been given.

WHO says that as long as a single child remains infected, kids everywhere are at risk.

In even rarer instances, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low.

Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year.

Dr. Tom Frieden, a former director of the US Centres for Disease Control and Prevention who sits on an independent board reviewing polio eradication, said it would be impossible to eliminate polio without the oral vaccine. But he’s urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly. Since 2011, he and colleagues have issued regular reports about overall program failures.

Last year, former WHO scientist Dr. T. Jacob John twice emailed WHO Director-General Tedros Adhanom Ghebreyesus, calling for a course correction. John shared the emails with AP and said he’s received no response.

In his response to AP, WHO polio director Ahmed said the oral vaccine is a “core pillar” of the eradication strategy and that “almost every country that is polio-free today used (it) to achieve that milestone.”

Mistrust of the polio eradication effort persists. With an annual budget of about USD 1 billion, the polio initiative is among the most expensive in all of public health. This year, the US withdrew from the WHO, and President Donald Trump has cut foreign aid. WHO officials have privately admitted that sustaining funding would be difficult without success.

Some say the money would be better spent on other health needs. “We have spent more than USD 1 billion in the last five years in Pakistan alone, and it didn’t buy us any progress,” said Roland Sutter, who formerly led polio research at WHO. In Karachi, locals told AP they didn’t understand the government’s fixation on polio and complained of other issues — dirty water, heroin addiction.