Preprint / Version 1

The Factors and Implications of Polio Vaccine Hesitancy among Pashtuns in the Polio-Endemic Countries of Pakistan and Afghanistan

##article.authors##

  • Parivash Khattak Polygence

DOI:

https://doi.org/10.58445/rars.2860

Keywords:

Polio eradication, Pakistan, Afghanistan, Polio Vaccine

Abstract

This project will be a literature review analysis of the impact of vaccine hesitancy upon polio cases in South Asian countries like Pakistan and Afghanistan, specifically regarding the Pashtun ethnic population. This paper will study socio-cultural (such as societal perceptions), political, educational, and regional factors contributing to vaccine hesitancy in South Asia, as well as evaluate public health implications on efforts to combat this resistance to vaccination. It will also discuss parallels between polio vaccine hesitancy and uncertainty surrounding other vaccines such as the Covid-19 vaccines, showcasing a recurring global theme amongst disease or pandemic outbreaks. By synthesizing findings from existing sources, this paper aims to provide insights on how lessons learned from polio-eradicating campaigns among Pashtun people in South Asia can support further strategies for current and future global health initiatives.

References

References:

Afghanistan UNICEF. (2022). Country Office Annual Report 2022. https://www.unicef.org/media/135286/file/Afghanistan-2022-COAR.pdf

Balzer, D. (2016, March 10). Pandemic vs. Endemic vs. Outbreak: Terms to Know. Mayo Clinic. Retrieved July 22, 2025, from https://newsnetwork.mayoclinic.org/discussion/pandemic- versus-endemic-versus-outbreak-terms-to-know/

Basharat, S., & Shaikh, B. T. (2017). Polio immunization in Pakistan: Ethical issues and challenges. Public Health Reviews, 38(1), 1-6. https://doi.org/10.1186/s40985-017-0049-4

Bjork, A., Akbar, I. E., Chaudhury, S., Wadood, M. Z., Ather, F., Jorba, J., & Martinez, M. (2023). Progress toward poliomyelitis eradication. Afghanistan, January 2022?June 2023. MMWR. Morbidity and Mortality Weekly Report, 72(38), 1020-1026. https://doi.org/10.15585/mmwr.mm7238a1

Bullard, E. (2025). Pashtuns. EBSCO. Retrieved July 23, 2025, from https://www.ebsco.com/research-starters/ethnic-and-cultural-studies/pashtuns#:~:text=Pashtuns%20are%20an%20ethnic%20group,minority%20in%20Pakistan's%20northern%20regions.

CDC. (2024a, July 9). Polio Vaccination. Centers for Disease Control and Prevention. Retrieved July 23, 2024, from https://www.cdc.gov/polio/vaccines/

CDC. (2024b, October 15). Polio Disease and Poliovirus Containment. Centers for Disease Control and Prevention. Retrieved July 22, 2025, from http://cdc.gov/poliovirus- containment/diseaseandvirus/

ECDC. (2023, November 28). Disease Factsheet About Poliomyelitis. European Centre for Disease Prevention and Control. Retrieved July 22, 2025, from https://www.ecdc.europa.eu/en/poliomyelitis/facts

Faizan, A., Rehman, T., & Mughal, S. (2024). Re-Emergence of Polio in Pakistan: Can the Nation Achieve the WPV1 Eradication Goal? Health Science Reports, 7(2). https://doi.org/10.1002/hsr2.1862

Farivar, M., Hussain, I., & Noorzai, R. (2024, October 24). How Afghan, Pakistani Clerics Battle Polio Vaccine Misinformation. Voice of America English News. Retrieved July 23, 2025, from https://www.voanews.com/a/how-afghan-and-pakistani-clerics-are-battling-polio- vaccine-misinformation-/7838106.html

Hamidi, R. (2024, September 21). Community Leaders' Role in Polio Eradication: Fighting Rumors and Promoting Vaccination. PolioFreeAfghanistan. https://poliofreeafghanistan.af/community-leaders-role-in-polio-eradication-fighting-rumors-and-promoting-vaccination/

Hawkins, J. (2009). The Pashtun Cultural Code: Pashtunwali. Australian Defense Force Journal, 16-27. https://search.informit.org/doi/pdf/10.3316/informit.095746022930497

Hussain, S. F., Boyle, P., Patel, P., & Sullivan, R. (2016). Eradicating Polio in Pakistan: An Analysis of the Challenges and Solutions to this Security and Health Issue. Globalization and Health, 12(1). https://doi.org/10.1186/s12992-016-0195-3

Khan, M. U., Ahmad, A., & Balkrishnan, R. (2017). Polio and cross-border management. The Lancet Infectious Diseases, 17(2), 136. https://doi.org/10.1016/s1473-3099(17)30012-9

Khowaja, A., Ali Khan, S., Nizam, N., Bin Omer, S., & Zaidi, A. (2012). Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in karachi, pakistan: A mixed methods study. Bulletin of the World Health Organization, 90(11), 822-830. https://doi.org/10.2471/blt.12.106260

Khyber Pakhtunkhwa Education Sector Analysis 2019. (2019). Institute of Social and Policy Sciences, 1-188. https://www.globalpartnership.org/node/document/ download?file=document/file/2022-09-khyber-pakhtunkhwa-pakistan-esa.pdf

Lai, Y. A., Chen, X., Kunasekaran, M., Rahman, B., & MacIntyre, C. R. (2022). Global epidemiology of vaccine-derived poliovirus 2016?2021: A descriptive analysis and retrospective case-control study. EClinicalMedicine, 50, 101508. https://doi.org/10.1016/j.eclinm.2022.101508

MacDonald, N. E., & SAGE Working Group on Vaccine Hesitancy (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161?4164. https://doi.org/10.1016/j.vaccine.2015.04.036

Morris, V. (2017, August 25). Reconsidering Afghanistan's Center of Gravity: The Taliban, Pashtunwali, and Tribal Social Systems. The Strategy Bridge. Retrieved July 23, 2025, from https://thestrategybridge.org/the-bridge/2017/8/25/the-case-for-an-afpak-fata

Over a Million K-P Parents Refused Polio Vaccination in 2019. (2019, December 22). Tribune. https://tribune.com.pk/story/2122950/million-k-p-parents-refused-polio-vaccination-2019

Rana, M. S., Asghar, R. J., Usman, M., Ikram, A., Salman, M., Umair, M., Zaidi, S. S. Z., Anas, M., & Ullah, N. (2022). The resurgence of wild poliovirus in Pakistan and Afghanistan: A new setback for polio eradication. Journal of Infection, 85(3), 334-363. https://doi.org/10.1016/j.jinf.2022.05.038

Saeed, A. (2024, September 25). In Northwestern Pakistan, Religious Leaders Convert the Vaccine-Hesitant. Gavi. Retrieved July 23, 2025, from https://www.gavi.org/vaccineswork/ northwestern-pakistan-religious-leaders-convert-vaccine-hesitant?

Saif, S. K. (2022, September 2). Reversing Years of Opposition, Taliban Initiate Polio Vaccination Campaign; Tedros Meets Afghan Health Minister in Geneva. Health Policy Watch.

Salarzai, B., & Khan, U. (2014, May 14). Girls' Education in Tribal Regions. Tribune. Retrieved July 23, 2025, from https://tribune.com.pk/letter/2255757/girls-education-in-tribal-regions

Serfling, R. E., & Sherman, I. L. (1953). Poliomyelitis Distribution in the United States. Public health reports (Washington, D.C. : 1896), 68(5), 453?466.

Shah, S.F.A., Ginossar, T. & Weiss, D. (2019) "This is a Pakhtun disease": Pakhtun health journalists' perceptions of the barriers and facilitators to polio vaccine acceptance among the high-risk Pakhtun community in Pakistan, Vaccine, 37(28), 3694-3703.

Sirajuddin. (2019, April 23). Peshawar Police Arrest Man Alleging Anti-Polio Vaccines Cause Children to Faint, Die. Dawn. Retrieved July 23, 2025, from https://www.dawn.com/news/1477890

Soofi, S. B., Vadsaria, K., Mannan, S., Habib, M. A., Tabassum, F., Hussain, I., Muhammad, S., Feroz, K., Ahmed, I., Islam, M., & Bhutta, Z. A. (2023). Factors associated with vaccine refusal (Polio and routine immunization) in high-risk areas of Pakistan: A matched case-control study. Vaccines, 11(5), 947. https://doi.org/10.3390/vaccines11050947

Tanis, F. (2025, June 25). RFK Jr. Says U.S. Will Stop Funding Global Vaccine Group Over 'Vaccine Safety' Issues. NPR. Retrieved July 23, 2025, from https://www.npr.org/sections/ goats-and-soda/2025/06/25/g-s1-74554/rfk-jr-vaccine-safety-gavi#:~:text=RFK%20Jr.-,says%20U.S.%20will%20stop%20funding%20Gavi%20over%20'vaccine%20safety'%20issues,vaccine%20safety%20in%20its%20campaigns.

United Nations. (2022). SDG 6 Country Acceleration Case Studies 2022 Pakistan. UN Water. Retrieved July 23, 2025, from https://www.unwater.org/sites/default/files/2022-09/ CountryAccelerationCaseStudies_2022_Pakistan_ENGLISH.pdf

Walsh, D. (2007, February 19). Clerics: Polio Vaccine 'An American Plot'. Mail & Guardian. Retrieved July 23, 2025, from https://mg.co.za/article/2007-02-19-clerics-polio-vaccine- an-american-plot/

World Health Organization. (2021). Polio Eradication Strategy 2022?2026: Executive summary. World Health Organization. http://www.jstor.org/stable/resrep47869

World Health Organization. (2022a). Current Health Expenditure Per Capita (Current US$) - Middle East, North Africa, Afghanistan & Pakistan [Chart]. World Bank. https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=ZQ

World Health Organization. (2022b, November 23). Nearly 40 Million Children are Dangerously Susceptible to Growing Measles Threat. World Health Organization. Retrieved July 23, 2025, from https://www.who.int/news/item/23-11-2022-nearly-40-million-children- are-dangerously-susceptible-to-growing-measles-threat

World Health Organization. (2023, December 27). Statement Following the Thirty-Seventh Meeting of the IHR Emergency Committee for Polio. World Health Organization. Retrieved July 23, 2025, from https://www.who.int/news/item/22-12-2023-statement- following-the-thirty-seventh-meeting-of-the-ihr-emergency-committee-for-polio

Zaman, A. (2021). The Context of Increasing Resistance to Polio Vaccinations Among the Pashtun Community in Rawalpindi, Pakistan: An Ethnographic and Qualitative Study. Harvard Library Bulletin, 1-41. https://dash.harvard.edu/server/api/core/bitstreams/ c08f7256-e355-4d17-9e14-33b4b028dddb/content

Downloads

Posted

2025-08-03