Achieving the end game: employing "vaccine diplomacy" to eradicate polio in Pakistan

Public Health Surveillance of Pediatric Polio in Pakistan: A Cohort Study

Background and objective Polio continues to be endemic in Pakistan despite substantial international efforts to combat it, which presents a serious public health concern. Strategies for eradicating polio depend on understanding the dynamics of pediatric polio transmission and the efficacy of surveillance. This research study aimed to critically evaluate the public health surveillance system for pediatric polio in Pakistan and propose recommendations for improvement. Methodology This study was conducted from June 2020 to July 2023 in three well-known hospitals in different areas of Pakistan and involved 26 patients. Reviews of medical records, interviews, and surveillance report analysis were all part of the data collection process. Descriptive statistics, chi-square tests, and logistic regression analysis were performed using SPSS Statistics version 27.0 (IBM Corp., Armonk, NY) with the statistical significance set at p<0.05. Results The highest incidence of polio was observed in children aged 13-24 months (nine patients, 34.62%), with males accounting for 14 cases (53.85%) and urban residents 16 cases (61.54%). Vaccination status significantly influences disease incidence (p<0.001), with two patients (7.69%) unvaccinated, 10 patients (38.46%) partially vaccinated, and 14 patients (53.85%) fully vaccinated. Paralysis was the predominant symptom in 16 patients (61.54%). Recovery outcomes varied, with eight patients (31%) fully recovering, 12 patients (46%) showing partial improvement, and six patients (23%) experiencing chronic motor impairments. Effective surveillance depends on timely reporting [odds ratio (OR): 2.15, p<0.001] and healthcare worker training (OR: 1.67, p<0.001), highlighting crucial aspects of polio management strategies. Conclusions Based on our findings, vaccination status significantly impacts polio occurrence, with a notable proportion found in partially vaccinated or unvaccinated children. Paralysis remains the primary symptom, with varied recovery outcomes, including chronic motor impairments in some cases. This study underscores Pakistan's ongoing challenges with pediatric polio, highlighting the crucial need for improved vaccination, surveillance, and rehabilitation efforts.

Vaccine diplomacy: nation branding and China’s COVID-19 soft power play

As a global crisis, COVID-19 has altered how nation-states project influence. Public health has risen to the top of every agenda as individuals, societies, and nation-states focus on a common goal. With the advent of COVID-19 vaccines, home-grown national vaccines when distributed all over the world can play an integral role in nation branding as a technique for projecting soft power. This paper applies the theoretical lenses of nation branding and soft power to examine China’s bilateral vaccine diplomacy efforts, specifically the motivations and outcomes. The findings suggest that Chinese vaccines are used not only for image repair and for expanding Beijing’s great power ambitions, but also to reinforce and leverage existing soft power programs, and to capitalize on new economic and geopolitical opportunities. Vaccine diplomacy is a natural extension of Chinese soft power including prior engagement in health diplomacy. Sentiment analyses of social media and international media coverage suggest that where vaccines go, influence may follow. Although international sentiments are not all positive—with concerns over Chinese vaccines’ efficacy, safety, and data availability, Beijing reaped substantial soft power dividends through its ability to project influence in scientific prowess and civic virtue by providing the vaccines as International Public Goods through aid and gifts to countries left behind by the vaccine inequity.

Bargaining and gendered authority: a framework to understand household decision-making about childhood vaccines in the Philippines

Introduction

Targeted vaccination promotion efforts aimed at building vaccine confidence require an in-depth understanding of how and by whom decisions about vaccinating children are made. While several studies have highlighted how parents interact with other stakeholders when discussing childhood vaccination, less is known about the way in which vaccination uptake is negotiated within households.

Methods

We conducted 44 in-depth interviews with caregivers of children under five in the Philippines who had delayed or refused vaccination. Interviews were conducted between August 2020 and March 2021 and were audio-recorded, transcribed verbatim and translated into English. Notions of intra-household vaccination bargaining emerged early during systematic debriefings and were probed more pointedly throughout data collection.

Results

Parents as well as paternal and maternal families proved to be dominant stakeholders in intra-household bargaining for childhood vaccination. Although bargaining among these stakeholders was based on engrained, gender-based power imbalances, disadvantaged stakeholders could draw on a range of interrelated sources of bargaining power to nevertheless shape decision-making. Sources of bargaining power included, in descending order of their relevance for vaccination, (1) physical presence at the household (at the time of vaccination decision-making), (2) interest in the topic of vaccination and conviction of one’s own position, (3) previous vaccination and caregiving experience, and (4) access to household resources (including finances). The degree to which each household member could draw on these sources of bargaining power varied considerably over time and across households.

Conclusion

Our findings highlight how bargaining due to intra-household disagreement coins decisions regarding childhood vaccination. Considering the risks for public health associated with vaccine hesitancy globally, we advocate for acknowledging intra-household dynamics in research and practice, such as by purposefully targeting household members with decision-making capacity in vaccination promotion efforts, aligning promotion efforts with available bargaining capacity or further empowering those convinced of vaccination.

China’s Vaccine Diplomacy and Its Implications for Global Health Governance

The COVID-19 pandemic has wreaked havoc on global economy and human communities. Promoting the accessibility and affordability of vaccine via diplomacy is the key to mitigating the pandemic crisis. China has been accused of seeking geopolitical objectives by launching vaccine diplomacy. The definition of vaccine diplomacy is neutral by nature. China’s vaccine diplomacy is based on its holistic approach to national security and the importance China attaches to the “Belt and Road” Initiative. With a whole-of-government approach on both the bilateral and multilateral levels and marketization of vaccines, China’s vaccine diplomacy has immense implications for global health governance, in that it helps to narrow the global immunization vaccination gap and to promote human-right-based approach to global health governance. However, the sustainability of China’s vaccine diplomacy is questionable because of the Sino-American geopolitical competition and doubts over the efficacy of China’s vaccines. The escalation of power rivalry between China and the U.S. and the concerns over the efficacy of China’s vaccines forebode the gloomy future of China’s vaccine diplomacy.

Reimagining diaspora diplomacy during the COVID-19 crisis in India

Diasporas are organized groups motivated by common cultural, ideological, political and religious values and common concerns for their countries of origin. Diaspora diplomacy has gained prominence worldwide, particularly in India, spurred by harrowing images of deaths and devastation due to the COVID-19 pandemic. A new generation of diaspora professionals modeled as social entrepreneurs uses collaborative and non-profit models to establish relationships with their counterparts to facilitate medical services and research. Teleradiology and telepsychiatry facilitate communication between diaspora members and their counterparts. We propose a common telehealth platform to standardize advice given by the Indian diaspora in the Global North as protocols change rapidly in acute pandemics. Consideration should be given to the well-known digital divide in India and other low- and middle-income countries. We advocate for diaspora members to train themselves in the art of global health diplomacy, to promote transparency and accountability in the collection of funds and a mandatory provision of outcome measurement by independent monitors rather than through social media. In the long run, Indian-Americans should play an active role in strengthening the domain of public health, which has historically been neglected in India, by focusing on the country's long-term infrastructure needs. The lessons learned from various diaspora efforts should be independently evaluated and recorded as best practice for future pandemics and humanitarian crises.

Polio Amidst COVID-19 in Pakistan: What are the Efforts Being Made and Challenges at Hand?

Poliomyelitis, a crippling viral disease, has been affecting many children in Pakistan despite the numerous efforts that have been taken to curb its spread. The COVID-19 pandemic has halted mass polio vaccination campaigns globally, including Pakistan, resulting in a resurgence of new cases. Pakistan managed to flatten the COVID-19 curve from July to October that made three immunization drives possible, but the COVID-19 cases are on the rise again which can again complicate the polio situation in the country if left unmonitored. The efforts of Pakistan have been effective with no significant rise in polio cases in 2020 as compared with 2019. We discuss the numerous challenges faced by the polio eradication program in Pakistan. To help eliminate polio, Pakistan needs to enhance its efforts in the struggle against polio with the same zeal and stringency used to flatten the curve of COVID-19 in these challenging times.