Polio, in full Poliomyelitis, is an endemic infectious disease caused by the Poliovirus. It leads to irreversible paralysis, that can be fatal when affecting the breathing muscles. Children under the age of five are most affected by Polio. Since there is no cure, prevention through vaccination is the only way to fight the suffering. In most parts of the world Polio seems eradicated. However, there are still countries that fight against the virus. Currently only Afghanistan and Pakistan remain with cases of the Wild Poliovirus. The World Health Organization’s latest report for 2021 showed four Wild Poliovirus cases in Afghanistan, and one Wild Poliovirus case in Pakistan. Further, a Vaccine-derived Poliovirus Type 2 (cVDPV2) exists in several other countries. 2021, it was detected in 21 countries total. With 395 cases, Nigeria reported the highest count.
One of the highest goals of eradicating Polio globally is the interruption of Wild Poliovirus outbreak. Focusing on Afghanistan and Pakistan is seen as a high priority to achieve this goal. However, the challenges of war and violence, the Coronavirus pandemic, hunger, bad infrastructure, miscommunication, and conspiracies are constant hurdles on the path of eradication.
With this project, Mario Kreuzer illustrates the aforementioned situation and the current strategies in Afghanistan and Pakistan. With an isometric landscape model, his intention is to map the key steps of Polio eradication in these countries. The illustration becomes a tool to seek attention for the topic. It gives the readers an interactive way to learn and explore the subject. Click through the scenes and uncover the topic step by step.
To eradicate Polio worldwide, the Global Polio Eradication Initiative was founded in 1988. It is a public-private partnership led and financed by national governments with six partners – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), the Bill & Melinda Gates Foundation, and the Vaccine Alliance Gavi. Additional financial support comes from donations.
The organization runs vaccination campaigns and provides vaccination sites and recruitment of vaccination helpers. In Afghanistan and Pakistan, vaccination helpers are trained to walk from door to door to vaccinate the citizens.
Thanks to the fast, uncomplicated, needle-free, and more accessible oral vaccine, the global Polio eradication became this successful. A child receives a vaccination dose by sipping two drops of vaccination. Four vaccination doses are recommended for a healthy child.
But it comes with a disadvantage. The common type of oral vaccine is based on an active weakened Poliovirus strain. This risks possible infections with a Vaccine-derived Poliovirus. It then can also pass among under-immunized children. However, a new and improved type of oral vaccination (nOPV2) is now seen as a chance to limit Vaccine-derived Poliovirus outbreaks.
The Inactivated Vaccine In more and more industrialized and Polio-free countries the Inactivated Polio Vaccine is used as a standard. In contrast to the Oral Polio Vaccine, it does not contain live strains of the virus and has no risk of causing a Vaccine-derived Poliovirus outbreak. It is injected by needle. However, it can only be used in areas without Wild Polio cases, since it can’t stop the virus transmission.
After the vaccination the child’s pinky is marked with purple color to keep track of vaccinated children. Often the pictures of kids proudly showing off their purple pinky are used for the campaign’s communication.
Houses are marked after the households’ children get vaccinated. The markings record the vaccinations and give an overview of the household’ vaccination status to future vaccination helpers.
In Pakistan 43.5 million children were vaccinated during the December campaign in 2021. In Afghanistan the latest numbers report 2,369 vaccinated children in September 2021.
About 30% of the population in Afghanistan are children under the age of five. Children within this age group are most affected by Polio. One third, around three million, of these children have not had access to vaccines in the past years due to the former vaccination ban of the Taliban.
A Poliovirus infection causes irreversible paralysis (Acute Flaccid Paralysis, AFP), in 1 per 200 to 1 per 1000 cases. In 5–10% of AFP cases it is fatal. The paralyses can’t be cured. It can only be prevented by the Polio vaccination. According to the WHO there are currently 4091 people living with AFP in Afghanistan and 12961 in Pakistan. Worldwide there are 85064 people suffering from AFP.
Clean water and food are rare in Afghanistan. Recurrent violence, a severe drought, hard winters, and the consequences of the Coronavirus pandemic are causing rising poverty and hard living conditions for more and more families in Afghanistan. UNICEF experts estimate that one in two children under five will be undernourished this year. Malnutrition also results in a poor immune system. This means that the four recommended Polio vaccine doses are not enough to immunize these children.
Unsanitary conditions allow the Poliovirus to spread easily. It is transmitted from person to person through contaminated feces. Humans are the only transmitters for the Virus. Infection occurs when the virus enters the mouth, for example when eating with unwashed hands. In some cases, it can also be transmitted through saliva.
In Pakistan environmental samples are taken from 71 detection sites. 8% of these taken in 2021 were positive for the Poliovirus.
Many times, in the past, vaccination helpers have been under attack. Since end of 2021, the Taliban now officially allowed vaccination campaigns. They also announced to provide security for all health workers across the country.
Before the Taliban committed to official vaccination campaigns, vaccination helpers often have been killed in Taliban controlled areas. In March 2021 Semin, 24, Basira, 20 and Negina, 24, were killed on the streets of Jalalabad Afghanistan during their vaccination service.
Along with the new vaccination campaign, the Taliban leadership in Afghanistan now also officially accepted the inclusion of female frontline workers. In September 2021, 432 female vaccinators have been helping in the fight against Polio in Afghanistan. These are 18% of all mobilizers/vaccinators in Afghanistan (2369 total). In Pakistan 209.560 (62%) of 338,000 frontline workers are female.
Since the Taliban took over, working in healthcare is the only exception for women to work in Afghanistan. In general, women are supposed to stay at home for household and childcare. In addition, they are only permitted to move outside their homes with a male consort. Girls above the age of 12 are not allowed to go to school. Women’s faces must be covered either by wearing a hijab or a burqa. Showing female faces in media and advertisement is also banned.
A major hurdle in fighting against Polio are misinformations and conspiracy theories, spread by citizens and certain preachers. There are rumors about Western vaccination campaigns planning to sterilize Muslim children. Others say vaccinators are spies. This origins in 2011, when the CIA used a fake vaccination campaign to find Osama bin Laden in Pakistan.
In Pakistan Twitter, Facebook, and Instagram help to provide information about the vaccination campaigns, to educate and to gain trust. Also, the platforms are used to communicate about other diseases and vaccines, especially during the current Coronavirus pandemic.
UNICEF Afghanistan provided health workers and Rotary volunteers with 7,000 copies of a teaching children book. It contains 16 pages of illustrations, text and a soundtrack recorded in the Afghan languages Dari and Pashto. The goal is to gain trust and to teach the importance of vaccinations.
An online version of the book is published here.
October 24 is World Polio Day. It is held to raise public awareness of Polio. The date refers to the birthday of Jonas Salk, the American virologist and medical researcher who developed the first Polio vaccine in 1955.
In Pakistan children are also vaccinated at permanent transit points along country and district boarders, at railway stations, bus stops, and highways. In December 2021, 900.000 children were vaccinated at 73 Transit Points in Pakistan.
Two months of Coronavirus lockdown in 2020 also stopped Vaccination Campaigns in Pakistan. It led to 1.5 million children in Pakistan missing out vital vaccinations during this time. After the lockdown, people still hesitated to get to vaccination sites for their regular Polio, Measles or Diphtheria vaccinations, due to fear and misinformation.
In Mehrabadi, a colorful vaccination minibus with a megaphone is now being used to reach families and inform them about the importance of vaccinations. Mehrabadi is a very densely populated urban outlying area of Islamabad, Pakistan, where it has been particularly difficult to keep track of vaccinations.
In rural areas vaccination helpers travel with camels, donkeys, or horses to reach every last child. Long distances and environmental challenges make it sometimes impossible to travel by bus or other vehicles.