PAKISTAN: Fatal Polio Thrives on Conflict Along Porous Border

The battle against polio in Pakistan has been hampered by poor vaccination strategy by the World Health Organization (WHO) and military activity in northwestern Pakistan, the IPS reports.  Prof Abdul Hameed, president of The Pakistan Pediatric Association (PPA), charges that the WHO did not seek the assistance of the PPA, and did not administer a sufficiently broad type of vaccine. 

The type of vaccine administered was the monovalent oral polio vaccine-1, instead of the trivalent oral polio vaccine.  The trivalent vaccine confers protection against three types of the polio virus, instead of just one type.  The oral polio vaccine is preferred in regions where polio is endemic, such as Afganistan, Pakistan, India, and Nigeria, because it is a live but weakened virus that can pass from one person to another; this is called the"herd" effect;  even people who are have not been directly immunized will benefit from the vaccination of others.  In the United States, the Oral Polio Vaccine (OPV) was replaced with a much more costly injectable vaccine because of concerns that in about 1 out of 750,000 cases, the OPV could revert back to a wild-type virus and cause vaccine-associated paralytic poliomyelitis (VAPP).  Since polio is nearly erradicated in the United States, the potential benefit of the "herd" effect conferred by the OPV is considered to be lower than the potential risk of VAPP. 

Thompson et al analysed the risks, costs and benefits of using no polio vaccine, oral polio vaccine, and injected polio vaccine in different income groups, and found that in all income groups except high income groups, in a region where polio is essentially erradicated, dropping polio vaccination altogether makes more economic sense than continuing OPV or switching to injectable polio vaccine. 

Jenkins et al performed a decision analysis on how to best manage a polio outbreak in the United States, which could occur through bioterrorism or laboratory mishandling of specimens.  The OPV-1 vaccine was considered to be the best vaccine to contain the outbreak at high vaccination rates.  This suggests that the outbreak in Pakistan has less to do with the choice of vaccine, and more to do with the ongoing military conlfict preventing adequate humanitarian intervention. 

The Bill and Melinda Gates Foundation has teamed up with Rotary International to help erradicate polio.

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