Dr Mohsin Khurshid

A Talk with Dr. Mohsin Khurshid on Polio eradication in Pakistan

The low immunization coverage and several socioeconomic factors, such as poverty, illiteracy, and lack of access to immunization and community health services, contribute much towards polio campaign failure.

Dr. Mohsin Khurshid is working as an Assistant professor at the Department of Microbiology, Government College University, Faisalabad, Pakistan. He has completed his Ph.D. (Microbiology) research related to Antimicrobial Resistance at the Department of Microbiology, Government College University, Faisalabad, Pakistan, and Institute of Antibiotics, Fudan University, Shanghai, China. He has obtained his MPhil Microbiology from Quaid-i-Azam University Faisalabad and MSc Microbiology from the University of Karachi, Pakistan. He completed his BSc (Medical Laboratory Technology) from the University of the Punjab, Lahore, Pakistan, with “Clinical Microbiology” as a major subject. Previously he has served as Lecturer in College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.

Dr. Khursheed’s research interest includes the bacterial Pathogenesis, antibiotic resistance mechanisms among bacteria, and the potential role of bacteria in cancer diagnosis and management. Dr. Mohsin Khurshid is actively involved in research work related to Antimicrobial Resistance, Probiotics, and the role of the microbiome in health and disease and has made high impact publications in international journals.  

Interview Dr. Mohsin Khurshid
Dr. Mohsin Khurshid

Here are some excerpts of his recent conversation with our Editor-in-Chief, Saadeqa khan;

Saadeqa: Can you give an overview of the poliovirus? And why do children more susceptible to it?

Dr. Khurshid: Polio, or poliomyelitis, is a disabling and life-threatening disease caused by the poliovirus. Most people who get infected with poliovirus will not do not have any visible symptoms. Around 25 percent of people will have flu-like symptoms like Sore throat, Tiredness, Fever, Headache, Nausea, and Stomach pain, and usually, these symptoms last for only 2 to 5 days and go away without any therapy. Few people infected with poliovirus develop severe symptoms affecting the brain and spinal cord that includes the following

  • Feeling of pins or needles in the legs known as Paresthesia.
  • Inflammation of the covering of the brain and or spinal cord is known as meningitis, which occurs in around 1/25 polio virus-infected individuals.
  • The weakness of the arms and or legs or paralysis occurs in about 1/200 people infected with poliovirus. Paralysis is the severest symptom of the poliovirus infections that can lead to disability or death. 

The children who recover completely from this infection can develop muscle weakness, pain, or paralysis 15 to 40 years later in life known as post-polio syndrome. It is essential to understand that Polio or “poliomyelitis” is defined as “the paralytic disease”; therefore, only those individuals having the paralysis are considered to have the disease “poliomyelitis.”

Polio can affect at any age, but it mainly affects children less than five years old in parts of Asia and Africa. Poliovirus is transmitted through person-to-person contact. The infected individuals shed the virus into the environment through the feces. If the hygiene and sanitation conditions are poor, the Virus can spread through the community. In case, enough number of people are fully immunized in any community against Polio, the poliovirus does not find any susceptible host to infect and ultimately dies out. As younger children are not much toilet-trained, they can be a source of transmission. The older children, as well as adults, are generally more hygienic compared to the younger children, they do not contribute much towards the transmission of poliovirus.  

Saadeqa: What are the primary reasons behind the fact that Pakistan couldn’t eradicate poliovirus until now? Though Polio widely considers extinct around the globe?

Dr. Khurshid: There are multiple reasons which contribute to the country’s failure to eradicate Polio. In Pakistan, the low immunization coverage and several socioeconomic factors, such as poverty, illiteracy, and lack of access to immunization and community health services, contribute much towards this failure. All these challenges, together with diverse geography, which encompasses the mountain range, glaciers, deserts, and the harsh terrains, contribute to poor delivery of public health services. Furthermore, the huge differences in population density also make it difficult to expertly complete the polio vaccination campaigns, with densely-populated metropolitans, for instance, Karachi and Lahore offering a higher risk of fecal-oral spread compared with the less populated and mountainous regions such AS Balochistan and Gilgit Baltistan. 

There are also significant inequalities in the availability of resources and immunization coverage among the provincial and district levels with better coverage in Punjab and inferior coverage in Balochistan and FATA. Moreover, the implementation of vaccination campaigns is quite variable with reports of false compliance, lack of vaccination registration records, vaccinator satisfaction towards the financial incentives, or delays in salaries or payments. The power interruption and lack of equipment made it tough to maintain the cold chain necessary for OPV efficacy. 

Vaccine hesitancy is another factor that is influenced by illiteracy, socioeconomic, cultural, and religious factors. Parental refusal is a significant hindrance to the vaccination campaign due to fallacies regarding the intensions of immunization, such as the common misconception that vaccines can sterilize children or contain derived pig products that are forbidden in Islam. 

The number of polio cases has decreased by more than 90 % since 1994, even with the multiple challenges that the polio eradication campaign has faced in Pakistan. Such as Taliban insurgency FATA and KPK, displacement of millions of people, and negative propaganda against vaccination. 

Saadeqa: What are the reasons behind OPV failure? And why IPV prefer over OPV?

Dr. Khurshid with his Chinese colleagues
Dr. Khurshid with his Chinese colleagues

Dr. Khurshid: IPV is not added due to the OPV failure. The choice of inactivated polio vaccine (IPV) or oral polio vaccine (OPV) depends on where and when you were born. For example, the people born in the USA after 2000 received an injection of the IPV, but the people born before 2000, have received the OPV administered by mouth in the form of drops.

World Health Organization (WHO) recommended using both vaccines, particularly among the children born in polio-affected countries, although the debate among the scientists reflects that both vaccines (OPV and IPV) have different strengths and weaknesses. The IPV results in higher levels of antibodies in the blood compared to the OPV. Moreover, it poses no risk of reversion to a virulent form as it does not reproduce. However, it confers a low level of the immune response in the intestine and mucous membranes when administered solely. Therefore, it is less effective in preventing viral replication in the intestine.

Further, IPV is more challenging to administrate (because of injection) and more expensive compared to OPV. On the other hand, the OPV provides better mucosal immunity (Intestine and mucous membranes) than IPV. However, OPV contains a live virus. Therefore there is a chance that it can replicate and revert to a virulent form. 

The WHO, therefore, suggests using both vaccines to put a stop on the transmission chains for a polio-free world. Upon the WHO recommendations, the IPV started in the winters of 2015 by adding a dose of IPV at 14 weeks to the three doses of OPV already being used for routine immunizations. 

Saadeqa: In Pakistan, the polio immunization campaign is controversial for a long; what do you think is the primary reason behind?

Dr. Khrushid: The primary reason behind the polio immunization complaints illiteracy and the proclivity of people toward the negative propaganda. The militants operating in Pakistan and few religious clerics have spread a myth linking the vaccination program to a western conspiracy to sterilize Muslims and have painted the vaccinators as US spies. This narrative got strength especially after the news that a fake hepatitis B vaccination campaign was funded by US CIA to trace Osama bin Laden in Abbottabad, which led to a profound distrust of the polio vaccination campaign, particularly in rural KPK and FATA having the highest rates of vaccine refusal and the most poliomyelitis cases.

These hurdles are being managed by the Government of Pakistan by involving religious leaders and social mobilizers and by deployment the police for smoothly running the vaccination programs. The tendency of the public to avoid the vaccination due to a lack of awareness is far more dangerous in the eradication of Polio than handling the few people involved in anti-polio vaccination propaganda. Notably, the emergence of polio cases in the past few years necessitate further rigorous measures in the future. 

Saadeqa: We have best Researchers and well-equipped Laboratories in Islamabad and Karachi, so why do not our health experts locally analyze the controversial Polio vaccine?

Dr. Khurshid: Our laboratories are not well-equipped and funded as required to analyze the vaccines in Pakistan that are mainly because we are not producing human vaccines locally. For the Polio vaccine, we do not need much this local testing even as the vaccine manufacturing companies have already gone through it. The vaccines manufacturing also includes a set of well-characterized testing for any potential contamination that requires exceptional quality control and quality assurance systems. Therefore the manufacturers are responsible for quality, efficacy, and safety. Even if we establish the vaccine quality control testing locally and start the trial, this is nothing to deal with illiteracy and misconceptions. 

Saadeqa: How can we change the mindset of our layman (parents) towards the Polio vaccine as they are reluctant to use?

Dr. Khurshid: For an effective anti-polio vaccination and changing the mindset, we need to resolve the suspicion of the general public. The explanation by the health officials, especially about the higher number of doses of various vaccines as in Pakistan, the number of doses of various vaccines is more than being given in most countries that cause doubts. Moreover, increasing public awareness with the help of social media and religious leaders about the benefits of vaccination and addressing the misconceptions are of utmost importance.

Saadeqa: We are facing a total lockdown. What do you think the role virologist or microbiologist play in this time of trouble?

Dr. Khurshid: A microbiologist or virologist is specialized in the detection, identification, and containment of the microorganisms that may cause disease. A microbiologist is also involved in developing feasible interventions and solutions to reduce the spread of microorganisms in the community. In this lockdown situation, the microbiologists can help to analyze the samples being collected from the suspected patients for the contagions. Moreover, they can be involved in developing strategies for interventions based on findings. Microbiologists help educate the public regarding this pandemic regarding the safety measures for prevention. 

Saadeqa: Recently it is announced that Pakistani researchers sequenced a genome of Coronavirus, and interestingly it is different in some expects to that of Virus found in Wuhan, China, that indicates a fast mutation rate. What do you think, whether the coming months will be disastrous for Pakistan or we could manage safely?

Dr. Khurshid: Two different groups of Pakistani researchers from NUST and the University of Karachi have carried out the whole genome sequence of Coronavirus (SARS-CoV-2). It would be quite early to anticipate the outcomes of this pandemic, especially in Pakistan, as COVID-19 is a deadly pandemic sweeping the world. Pakistan would have to increase the COVID-19 testing capacity in the coming few days. There are two main reasons for testing people; to diagnose the individuals and to see how much COVID-19 has spread in the country. This information will be helpful for social distancing procedures. Let’s say, if few people are infected, the lockdown must be continued, and if the Virus has already been spread to large numbers of people, then further lockdown will be less useful.

Saadeqa: Students around Pakistan are continuously demanding a semester break due to severe technical problems in Online classes. What would you suggest to students and teachers to better cope with this situation?

Dr.Khurshid: I think that the students are right in this matter. Although the higher education commission has directed the universities to engage the students through online classes or assignments that will be beneficial for the students, however, this must not be a substitute for regular lectures. The main benefit of online courses is the flexibility to the student in terms of molding the class timing according to the student’s schedule by selecting a time that works best for him or her. The on-campus educations have many advantages, especially learning discipline and motivation and face-to-face interactions with the teachers. In our system, the online system may not be successful due to the lack of internet facilities, particularly in rural areas. Therefore, on-campus education is still likely the better option. 

Also read: A teachers take on getting the most out of online classes

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1 thought on “A Talk with Dr. Mohsin Khurshid on Polio eradication in Pakistan

  1. Dr Mohsin described scenario on Polio Eradication very well and tell us the true reasons behind its failures.

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