Pakistan considers a new way to boost polio vaccination: Jail

Authorities in one Pakistan province are turning to a controversial new tactic in the decades-long initiative to wipe out polio: prison.

Last month, the government in Sindh introduced a bill that would imprison parents for up to one month if they fail to get their children immunized against polio or eight other common diseases.

Experts at the World Health Organization and elsewhere worry the unusual strategy could further undermine trust in the polio vaccines, particularly in a country where many believe false conspiracies about them and where dozens of vaccinators have been shot and killed.

Adding to the problems faced by experts trying to persuade people of the vaccines’ safety: The oral vaccines themselves now cause most polio cases worldwide.

WHO’s polio director in the Eastern Mediterranean warned the new law could backfire.

“Coercion is counterproductive,” said Dr. Hamid Jafari.

He said health workers have typically succeeded in raising immunization rates in vaccine-hesitant areas by figuring out the reasons for people’s refusal and addressing those concerns, like bringing in a trusted political or religious leader to talk with people.

“My own sense is that Pakistan wants to have this legislation in their back pocket in case they need it,” Jafari said. “I would be surprised if there’s a willingness to actually enforce these coercive measures.”

Pakistan and neighboring Afghanistan are the only countries where the spread of polio has never been stopped. The potentially fatal, paralyzing disease mostly strikes children up to age 5 and typically spreads in contaminated water.

WHO and its partners have administered billions of vaccine doses since they first began trying to eradicate the disease in 1988. The effort costs nearly $1 billion a year and is largely funded by donor countries and private organizations including the Bill & Melinda Gates Foundation.

The immunizations, given to children as drops in the mouth, have reduced polio cases by more than 99%. But in very rare cases, the live virus in the vaccine can cause polio or mutate into a strain that triggers a new outbreak.

So far this year, there have been seven cases of polio caused by the wild virus — all in Pakistan and Afghanistan. Meanwhile, more than 270 cases have been caused by a virus linked to the vaccine in 21 countries across three continents.

In January, roughly 62,000 parents, mostly in Pakistan’s Sindh province, refused polio vaccinations for their children, prompting authorities there to propose the new law with penalties.

The bill is in the final stages of becoming law after the provincial assembly approved it in August. It would punish parents with up to a month in prison for failing to vaccinate their children against certain diseases; they could also be fined up to 50,000 rupees ($168). Officials said their primary aim was to boost polio immunization rates, though diseases including measles, pneumonia and pertussis are also in the legislation.

Rukhsana Bibi, a health worker in Karachi, hopes the new law will reduce vaccine refusal rates and protect health workers. Karachi is considered at high risk for a polio resurgence.

Bibi noted that in the past, abusive or threatening parents have been detained by police. They were released on the condition that they have their children immunized, and that they help the polio team with outreach efforts.

There are multiple factors fueling vaccine hesitation in Pakistan.

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