Islamabad, Pakistan – Continuing and sustained polio vaccination efforts in Pakistan and Afghanistan in 2022 are likely to determine whether the world can entirely eradicate the debilitating virus, billionaire philanthropist Bill Gates has said on his first visit to Pakistan, one of the two countries where the disease remains endemic.
Gates spoke to reporters at the end of a daylong visit to the Pakistani capital Islamabad on Thursday, during which he met Pakistani Prime Minister Imran Khan, top health official Dr Faisal Sultan, and other leaders.
Gates, a US-based billionaire who made his name as the co-founder of tech giant Microsoft, is also the co-founder of the Bill and Melinda Gates Foundation, which is a key funder of worldwide polio eradication efforts, as well as supporting Pakistan’s Ehsaas cash grant scheme for low-income families and the country’s new Raast digital payments system.
“I think that the steps taken in Pakistan during 2022 will probably set us up to finish polio eradication,” Gates said.
“Afghanistan is a little bit of a question mark, because that’s a more complex situation, but the quality of health work in Pakistan, the improvements that various parties coming together, and the current data suggest it’s really the work that we do in the next year or two years that will bring us to zero.”
Last year, Pakistan reported just one case of the wild polio virus, and the country has now gone 12 months without a new case being reported for the first time since data on the virus has been recorded.
In Afghanistan, four cases of polio were reported in 2021, with the country’s first case in 2022 reported last week in Paktika province, according to the Global Polio Eradication Initiative (GPEI).
The two South Asian countries are the last countries where polio remains endemic, after worldwide eradication efforts in recent decades that involved a sustained campaign of oral and injected vaccines targeting children below five, who are at risk of contracting the debilitating, highly infectious disease that can lead to paralysis and death.
Since 1988, worldwide cases of the virus have dropped by 99 percent, from more than 350,000 to just five cases in Afghanistan and Pakistan last year, according to the GPEI’s data.
In August, the Taliban armed group forcibly took control of the Afghan capital Kabul, overthrowing the government of US-backed President Ashraf Ghani.
Since then, the Taliban has taken over governance across the country, and has called for increased foreign aid to stave off a looming humanitarian crisis in a country that has seen its economy collapse at the end of the war.
Gates said while his foundation was working with other partners on helping Afghanistan’s vaccination efforts, “we don’t have any direct connection there”.
Sultan, the Pakistani prime minister’s special assistant on health and the country’s de facto health minister, said his government was in direct contact with the Taliban leaders on the issue.
“[We] have directly engaged with them and have ongoing conversations to make sure that a synchronised campaign for eradication of polio can continue,” he said. “Because we look at our two countries, adjacent to each other, as epidemiologically speaking tightly linked to the eradication of polio.”
Dr Anita Zaidi, the Bill and Melinda Gates Foundation’s president of gender equality and director of vaccine development and surveillance, said the Taliban would have to involve women in vaccination efforts if they intended to succeed in a full countrywide polio vaccination campaign.
“If they do change their strategy to [go] house to house, then they need women,” she said. “Without women, you can’t succeed.”
In Pakistan, vaccination efforts since 2019 have been hampered by an increase in vaccine boycotts, as opposed to refusals based on ideological opposition to the vaccines, with citizens in the less developed districts demanding specific governance outcomes in order to agree to give their children the vaccine.
Addressing that issue, Sultan said while “one cannot exactly just pivot or base your vaccination campaign on this kind of a transaction”, the Pakistani government was working to increase citizens’ sense of ownership in these areas.
“When the ordinary citizen sees that it’s not just for polio vaccination that somebody is knocking on their door, but they are empowered through an intervention of the government, that indirectly does work out into building that trust and having that confidence,” he said.
Asad Hashim is Al Jazeera’s digital correspondent in Pakistan. He tweets @AsadHashim