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IN 2009, India reported 741 polio cases, more than any other country worldwide. Last week, it marked three years since the last polio case was documented, putting the country on track to be declared polio-free by the World Health Organisation (WHO) in March.
Meanwhile, Pakistan became the only polio-endemic country where the number of polio cases increased between 2012 and 2013, from 58 to 91. WHO has termed Peshawar the largest reservoir of endemic poliovirus in the world: 83 out of the 91 cases detected last year are linked to the poliovirus circulating in the city, as are 12 out of 13 cases reported in Afghanistan in 2013. Cases have been detected from Karachi to Rawalpindi as well.
Comparing the polio situation in India and Pakistan is not merely a form of self-flagellation — it is a useful exercise that highlights the fact that the spread of polio in Pakistan is the result of serious governance failings. India and Pakistan face the same challenges in terms of tackling polio: poverty, poor sanitation, population density, internal migration, and weak public health systems.
Admittedly, India did not have to face militants who outlaw polio vaccinations in areas under their control and mercilessly kill polio workers. But to pretend that Pakistan’s polio crisis is exclusively a security matter, rather than a governance challenge, is both deceptive and counterproductive.
To tackle its polio problem, India deployed 2.5 million doctors, health workers, and community mobilisers to carry out a vaccination campaign. The effort was well coordinated between government departments, Rotary clubs, WHO, Unicef and local administrators.
The campaign was also data-driven, strategic and holistic: data helped identify vulnerable communities, including migrants; strategies focused on reaching these marginalised groups and developing awareness programmes, for example, among Muslim communities suspicious of vaccination; workers took holistic approaches, for instance, by emphasising sanitation and hydration in cases where the polio vaccination became ineffective because children were suffering from diarrhoea.
Monitoring was also a crucial element of the initiative: in vulnerable states such as Uttar Pradesh and Bihar, vaccinators visited 60 million households multiple times each year. Such a comprehensive and coordinated approach is lacking in Pakistan, and exacerbating the situation. For example, the number of families in Khyber Pakhtunkhwa that refused polio vaccination nearly doubled between 2012 and 2013, from 74,000 to 154,918. According to news reports, this may be the result of poor coordination between the provincial health department and a company hired by Unicef to develop a communications strategy to spread awareness about polio vaccination.
Sadly, such governance shortcomings occur at the highest levels. Under the National Emergency Action Plan, the previous government made some headway towards polio eradication. This was achieved by establishing a prime minister’s task force, empowering district commissioners to manage vaccination campaigns, and establishing accountability committees at all government tiers.
But momentum under the action plan has been lost since May 2013. The caretaker government dismantled the prime minister’s polio monitoring cell, and the post of focal person for polio eradication lay vacant between May and the end of November 2013. It remains unclear whether national-level oversight of the polio campaign is motivated and committed.
Rather than acknowledge and address these governance failings, the government portrays soaring polio cases as a consequence of the Taliban’s vicious campaign against polio workers. But isn’t it the government’s job to provide security for polio workers? Don’t the security challenges of carrying out polio vaccinations simply demand an even more coordinated and well-governed effort?
A government that took its mandate seriously would make every effort to counter militants’ efforts to undermine its authority. Too often, militants’ opposition to polio vaccination is excused as an ideological or ignorant position, when it is a strategic one.
Bans against polio vaccinations allow militant groups to enforce their writ over an area while further eroding the state’s legitimacy — think, for example, of Hafiz Gul Bahadur’s decision to make polio vaccinations in North Waziristan contingent on the cessation of US drone strikes.
It’s time the government considered the consequences of failing to robustly tackle the polio challenge: increasing costs of public health programmes as polio patients require surgery and long-term rehabilitation; growing inter-provincial resentment as certain parts of the country remain worse-hit than others; travel bans that further isolate Pakistanis from the global economy (a requirement that Pakistanis travelling to India should be vaccinated against polio takes effect at the end of this month).
In many countries, successful polio campaigns have paved the way for successful immunisation drives. These are key to ensuring healthier — and so more economically productive — young populations.
It seems harsh to reduce the suffering and disabilities of polio patients in Pakistan to economic considerations. But as long as we see the rise in polio cases as a tragedy of circumstance, rather than the result of governance shortfalls, the situation will deteriorate.
The writer is a freelance journalist.
Twitter: @humayusuf
