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CWA # 1540, 21 November 2024
Polio: Why is Pakistan vaccine hesitant?

  Abhiruchi Chowdhury

On 15 November, a new case of polio was identified from Balochistan which made the total number of cases in the country to reach 49. The case was reported from Jaffarabad, a small district from Balochistan, that joined the infamous list of provinces encountering positive cases of polio. Province wise, Balochistan accounts for almost half the number of reported cases in the country in 2024 amounting to a total of 24 cases followed by 13 cases from Sindh, 10 from Khyber Pakhtunkhwa and one each from Punjab and Islamabad Capital Territory.

The above data shows that the problem exists primarily in the three provinces Balochistan, Sindh and Khyber Pakhtunkhwa. There are numerous reasons which make eradication of polio difficult. It thus becomes important that each of the issues which lead to aggravation of the polio problem receives separate attention. Among all the major issues, vaccine hesitancy seems to be a major roadblock towards the fight to eliminate polio. Unexpectedly, vaccine hesitancy and low education levels have a very little correlation. Experts have pointed out that vaccine hesitancy is higher among parents who are educated. Interestingly, vaccine refusals were also found higher in countries like Argentina (Buenos Aries) and Australia among mothers who were socio-economically superior.  

Misconceptions about the vaccine
A study by WHO in Quetta and its associated cities in Balochistan identified two main reasons for vaccine hesitancy in Quetta which were “Misconceptions about vaccine” that comprised 56.4 per cent of the total children whose parents’ refused vaccination and “religious reasons” which had 16 per cent share in refusals. Other reasons such as children being asleep during the vaccine team’s arrival, children being sick and repetitive campaigns were also identified as causes behind vaccine hesitancy.

A study published by MDPI looked in to the reasons for vaccine hesitancy by questioning households of Persistently Missed Children (PMC) in Karachi, Sindh. Results indicated that among households, that refused to vaccinate children, 37.3 did not have faith in the “quality” of the vaccine, 10 per cent were skeptical about the “side-effects”, 14 per cent were not allowed by the “elders” in the house for inoculation, 13 per cent reported of seeing videos on “social media” that discouraged them to vaccinate their children and 6.7 per cent reported of “trust” deficit with the polio teams.

Misinformation
The data clearly shows that the main reason for vaccine hesitancy is misconception and fear regarding the effects of polio vaccine. Reducing vaccine hesitancy remains a challenge and it has been observed that approaching parents with messages that enumerate facts about the disease and vaccine have minimal effect. The problem of vaccine hesitancy is not only prevalent in Pakistan but has grown in other countries as well for other diseases. The wide reach of misinformation existing on social media has led to increase in misconceptions about vaccine.

Lack of positive intervention
Previous, research studies have depicted how moral messaging can lead to a reduction in vaccine hesitancy. Parents who rationalize vaccine refusal through their well thought out reasoning would find it difficult to do so when faced with moral predicament. Individuals who prioritize purity moral foundation which is one of the six moral categories as defined by Moral Foundation Theory, would view vaccines as foreign impure substance and instead of getting inoculated they would rather rely upon their own immune system. A case study from Argentina shows how communications regarding vaccination which violate the purity moral foundation, can significantly reduce vaccine hesitancy. The study used a post “It is important to vaccinate your children following the schedule to keep them free from disgusting diseases like polio and measles” and found that respondents who were exposed to the message were less likely to be vaccine hesitant. The words “disgusting and “disease” are a violation of purity moral foundation which reduces vaccine hesitancy in people who want to safeguard their purity.

There are numerous other examples around the world at which Pakistan can look upon for controlling the spread of polio. However, the concerned health authorities are at the best position to decide which model would be best suited for the country.

President of Pakistan Pediatrics Association Khyber Pakhtunkhwa Mohammad Hussain cited the problem of low inoculation rates as the reason for the spike in the polio cases observed in the country. Hussain pointed to one of the main causes behind low inoculation rates which was vaccine hesitancy that was still very prevalent among the society. During the anti-polio campaign from 28 October to 3 November in Khyber Pakhtunkhwa, roughly 24000 children missed vaccination out of which 8234 were not vaccinated because of their parents not giving consent.

It thus remains to be seen how Pakistan combats the problem of vaccine hesitancy that could possibly lead to eradication of polio.

References
Ikram Junaidi, “Another polio case takes this year’s tally to 49,” Dawn, 15 November 2024

Faiza Ilyas, “Karachi has highest rate of polio vaccine refusal in country, experts say,” Dawn, 23 February 2024

Ashfaq Yusufzai, “Amid vaccination reluctance, experts fear more polio cases,” Dawn, 22 October 2024

Ashfaq Yusufzai, “KP’s polio fight suffers setback due to unvaccinated children,” Dawn, 10 November 2024

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