The effect of the killing of polio vaccine workers in Pakistan will have repercussions for its neighbour Afghanistan, which, together with Pakistan itself and Nigeria, is one of the remaining polio-endemic countries. Genetic analysis shows that two of the three chains of polio transmission in Afghanistan are from Pakistan. Other neighbouring countries have also been put at risk. For instance, polio broke out in China in 2011 for the first time since 1999 after being imported from Pakistan; 18 people were paralysed and one died.
Heidi Larson, an anthropologist who studies public trust in vaccines and immunisation at the London School of Hygiene and Tropical Medicine, pointed out that the killings of health workers in Pakistan could be a “game changer” in the global efforts to eradicate polio, calling for a rethink of delivery strategies.
She compared it with the 2003—04 immunisation boycott in northern Nigeria, led by religious and political leaders, who claimed that the oral polio vaccine could cause sterility. This boycott led to poliovirus not only rebounding in Nigeria, but also spreading to 15 African countries and to Indonesia. The boycott and its effect prompted discussions between WHO, the Organization of Islamic States, and local religious leaders to help address the rumours and contain the further spread of polio.
Indeed, the insecurity of and inaccessibility to vaccination have become the major impediments to the final push for polio eradication. Last year, Kathleen O'Reilly and colleagues reported in The Lancet the effect of mass immunisation campaigns and new oral poliovirus vaccines on the incidence of polio in Pakistan and Afghanistan. They reported that decreases in vaccination coverage in parts of Pakistan and southern Afghanistan had severely restricted the effectiveness of bivalent oral poliovirus vaccines.
To eradicate polio, the work that the brave polio health workers died for must be continued in 2013. Furthermore, it is imperative not only to ensure immunisation workers' security, but also to address the determinants behind the shooting of polio health workers—ie, to win the hearts of the public, to go beyond the “polio only” agenda, and to enhance polio vaccination's integration into the routine health and immunisation programme.