Health
2:59 am
Wed July 30, 2014

Polio's Surge In Pakistan: Are Parents Part Of The Problem?

Originally published on Wed July 30, 2014 2:29 pm

What do the parents think? That's always a crucial question when it comes to vaccinating kids.

And it's particularly important in Pakistan, which is one of the last places in the world where the polio virus is still making kids sick.

Health workers in Pakistan are trying to convince millions of parents to allow their children take the polio vaccine. But the program faces vehement — and at times violent — opposition.

So researchers at the Harvard School of Public Health recently did a poll to find out if parents are part of the problem. The results surprised them.

Imagine you're a parent in northwest Pakistan. You live in a remote village, perhaps in a mud hut on top of a mountain. Every few weeks some strangers carrying vials of a clear liquid come knocking on your door.

"Frankly, if someone came to my house and said, 'You know, you don't know me from Adam, but I'd like to vaccinate your child,' I wouldn't let them," says Sona Bari, of the World Health Organization.

But eradicating polio worldwide depends on these parents in Pakistan saying yes.

Strangers showing up at your door isn't the only hurdle to getting children vaccinated. In Pakistan, the Taliban threaten to kill parents who immunize their kids. More than 60 vaccinators have already been killed in the past two years.

"There have been health worker attacks, and there have been bans on polio campaigns for two years now," says Sherine Guirguis of UNICEF, a co-sponsor of the vaccine poll. "So there's this climate that we're working in."

The result of those bans: a surge in polio cases in Taliban-controlled regions. About 50 kids have been paralyzed this year in the two regions where the polio vaccine is banned, North Waziristan and South Waziristan.

The message to parents from all this: Don't even think of opening your door for a vaccinator.

And it's not just in the regions controlled by the Taliban. Rumors about the vaccine are common across Pakistan, the Harvard poll found.

"The vaccine is not halal, for example," Guirguis says. "Or that it's not made with ingredients that they feel comfortable with."

There's also the belief that the vaccine is a Western plot to sterilize Muslim children, or worse, that the vaccine gives kids AIDS.

On the plus side, only 1 in 10 parents nationwide thought the rumors might be true, the Harvard poll found. And even in the Federally Administered Tribal Areas, or FATA, only about a third of parents thought there might be something to the tales.

But researchers say these rumors can still be a problem. "People don't necessarily have to believe them in full," says Harvard's Gillian SteelFisher, who ran the poll. "But you worry about that kind of atmosphere of misunderstanding about the vaccine."

That's because of another challenge facing the polio eradication effort. With other vaccine initiatives, it's enough to reach a good majority of kids. But when it comes to polio, health workers are trying to wipe this disease off the planet. So even reaching 75 percent of kids isn't good enough, says UNICEF's Guirguis.

"Polio is a 100 percent program," she says. "You need to find every child, living in the most far-flung area, living in the most conflict-affected area."

And vaccinators don't need to reach kids only once, or even twice. They need to convince parents to vaccinate their child at least four times, in a single year. That's what it takes to get full immunity with this vaccine.

And when vaccinators keep showing up, some parents start to get exasperated, the WHO's Bari says. "So this is one of the few services they're seeing come to their door, for free," she says. "And yet it's coming over and over, which is something that's hard for them to understand."

Polio is a big priority for the international community. But it's become rare enough, even in Pakistan, that a lot of parents haven't ever seen it. It's not really on their minds.

The Harvard poll found that many parents don't think polio is that serious — that the paralysis it causes is curable. It isn't.

And yet, for all of these obstacles, when vaccinators can get to homes in the FATA region, parents there aren't turning them away. The poll found that among parents who confirmed that a vaccinator reached their door, 95 percent said that yes, their child did get the vaccine.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, HOST:

And as we've been reporting this week, Pakistan is one of the last places in the world where children are still getting polio. Vaccine programs face intense and sometimes violent opposition. Of course it's crucial for health workers to convince parents to let their children receive a vaccine for polio, just like it would be in any country. So a team of Harvard researchers recently did a poll to find out if parents in Pakistan are part of the problem. NPR's Nurith Aizenman reports that the results stunned those researchers.

NURITH AIZENMAN, BYLINE: Imagine you're a parent in northwest Pakistan. You live in a remote village - think mud huts on mountaintops - and every few weeks, some strangers carrying vials of an odd liquid come knocking on your door.

SONA BARI: Frankly, if someone came to my house and said, you don't know me from Adam, but I'd like to vaccinate your child, I wouldn't let them.

AIZENMAN: That's Sona Bari of the World Health Organization, a key player in a decades long campaign to stamp out polio. And yet that effort's success depends on these parents in Pakistan saying, yes. The weirdness of strangers showing up at your door isn't the only hurdle. In Pakistan's Northwest tribal areas, where most of the polio cases are found, parents face a lot of pressure to say no. I'm talking about the Taliban.

(SOUNDBITE OF ARCHIVED RECORDING)

CROWD: (Chanting) USA, USA.

UNIDENTIFIED MAN 1: Osama bin Laden is dead.

AIZENMAN: Remember in 2011 when U.S. forces tracked down and killed Osama bin Laden in Pakistan. Well, it soon came out that they had used a vaccination campaign as cover during the hunt. Now, it was for hepatitis not polio. Still, the Taliban was furious. Here's Sherine Guirguis of UNICEF which co-sponsored the poll with Harvard.

SHERINE GUIRGUIS: There have been health worker attacks and there have been bans on polio campaigns for two years now. So there's this climate that we're working in.

AIZENMAN: More than 60 polio workers have been killed. And the Taliban still outright bans vaccinators from two areas where they have a lot control. The result of those bans, a surge in polio in that region, more than 50 kids paralyzed just this year. The message to parents from all this, don't even think of opening your door for a vaccinator. And it's not just the Taliban. Across Pakistan, the revelation about the CIA's ploy created suspicion about what vaccinators are really up to.

UNIDENTIFIED MAN 2: (Sindhi spoken).

AIZENMAN: This is a preacher all the way in the Southwest of Pakistan. He's telling his congregation that polio vaccination program, its run by foreigners who are out to sterilize Muslim children. And UNICEF's Sherine Guirguis said that the pollsters they sent, they found that people have heard a lot of rumors like this.

GUIRGUIS: The vaccine is not halal, for example, or that it's not made with ingredients that they feel comfortable with.

AIZENMAN: Or worse, the vaccine gives your kids AIDS. On the plus side nationwide, only 1 in 10 parents thought the rumors might be true. And even in the Northwest tribal areas, only a third thought there might be something to the tales. But researchers say these rumors can still be a problem. Gillian SteelFisher of Harvard ran the poll.

GILLIAN STEELFISHER: Peopled don't necessarily have to please them in full, but you worry about that kind of atmosphere of misunderstanding about the vaccine.

AIZENMAN: That's because of another challenge facing the polio eradication effort. With other vaccine programs, it's enough to reach a good majority of kids. But when it comes to polio, health workers are trying to wipe this disease off the planet. So UNICEF's Sherine Guirguis says even reaching say 75 percent of kids isn't good enough.

GUIRGUIS: Polio's 100 percent program. You need to find every child living in the most far-flung area, living in the most conflict-affected area, living in the hardest-to-reach area.

AIZENMAN: And you don't just need to reach them once or even twice or even three times; you need to convince parents to let you vaccinate their child at least four times in a single year. That's what it takes to get full immunity with this vaccine. And when you keep showing up, parents might start to get exasperated. Here's the World Health Organization's Sona Bari.

BARI: So this is one of the few services they're seeing come to their door for free, and yet it's coming over and over, which is something that's hard for them to understand.

AIZENMAN: See, polio is a big priority for the international community, but it's become rare enough that in Northwest Pakistan a lot of these parents haven't ever seen it. It's not really on their minds. Harvard's Gillian SteelFisher says they brought up a lot of other concerns.

STEELFISHER: They're facing the most fundamental challenges, things like clean water.

AIZENMAN: SteelFisher's team also found that a lot of parents don't think polio is that serious, that the paralysis it causes is curable - it isn't. And when they ask parents - does your child have to take the vaccine every time it's offered? - a lot of parents said, yes, always.

STEELFISHER: But we also had a sizable share of parents who said, sometimes, not necessarily every time.

AIZENMAN: And yet for all of these obstacles, when the pollsters asked parents in the Northwest tribal areas the central question - the question that was most important to their poll - if a health worker came to your door, did you let them vaccinate your child? - practically every parent 95 percent said yes. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.