title: Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue.
abstract: Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 the global incidence of poliomyelitis has fallen by nearly 99 %. From a situation where wild type poliovirus was endemic in 125 countries across five continents, transmission is now limited to regions of just three countries - Pakistan, Afghanistan and Nigeria. A sharp increase in Pakistan's poliomyelitis cases in 2014 prompted the International Health Regulations Emergency Committee to declare the situation a 'public health emergency of international concern'. Global polio eradication hinges on Pakistan's ability to address the religious, political and socioeconomic barriers to immunisation; including discrepancies in vaccine coverage, a poor health infrastructure, and conflict in polio-endemic regions of the country. This analysis provides an overview of the GPEI, focusing on the historical and contemporary challenges facing Pakistan's polio eradication programme and the impact of conflict and insecurity, and sheds light on strategies to combat vaccine hesitancy, engage local communities and build on recent progress towards polio eradication in Pakistan.
authors.affiliation: Conflict and Health Research Group, King's Centre for Global Health, King's College London, Suite 2.13 Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK. shoaib_fahad.hussain@kcl.ac.uk.
authors.forename: Shoaib Fahad
authors.identifier: 0000-0003-3551-3781
authors.initials: SF
authors.lastname: Hussain
authors.affiliation: International Prevention Research Institute, Lyon, France.|University of Strathclyde Institute of Global Public Health @iPRI, Lyon, France.
authors.forename: Peter
authors.initials: P
authors.lastname: Boyle
authors.affiliation: Department of War Studies and Conflict and Health Research Group, King's College London, London, UK.
authors.forename: Preeti
authors.initials: P
authors.lastname: Patel
authors.affiliation: Conflict and Health Research Group, King's Centre for Global Health, King's College London, Suite 2.13 Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Sullivan
mesh_terms: D060740:Disease Eradication / Q000379:methods*; D006801:Humans; D009934:Organization and Administration / Q000191:economics / Q000592:standards; D010154:Pakistan; D011051:Poliomyelitis / Q000517:prevention & control*; D011634:Public Health / Q000191:economics; D012637:Security Measures / Q000592:standards / Q000706:statistics & numerical data; D012923:Social Class; D014611:Vaccination / Q000379:methods* / Q000523:psychology*; D014857:Warfare; D000078329:Workforce
keywords: Conflict and health; Global health; Pakistan; Polio; Socioeconomic factors; Vaccine coverage