IT’S hard to say what it will take to shake the state out of its apathy towards polio. There’s not a shadow of doubt that the crippling disease is not just on the upsurge, but rapidly accelerating.

In recent days, almost 20 new cases have been reported across the country — 13 on Sept 16 alone. The number of confirmed cases so far this year has reached 166.

Punjab and Balochistan, earlier thought to be polio-free, have had that myth shattered; and the less that is said about the situation in Khyber Pakhtunkhwa, the better.

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In terms of the tribal areas, the authorities can to some extent hide behind the excuse of the remoteness of the area and the lawlessness that prevails. But what of Karachi, where a shocking number of cases have been confirmed?

What greater indictment could be imagined of a country that has spent over two decades, and millions upon millions of rupees — much of it from global aid and polio-eradication initiatives — on the effort?

Given that Pakistan-specific strains of the virus have been found in several other countries, there is growing fear that this country stands to re-infect the global population at large. Considering this scenario, it could be argued that in merely issuing the advisory for unvaccinated travellers that was issued by the WHO in May, the world has shown a degree of forbearance towards Pakistan and invested confidence in its ability to put its house in order in this regard.

But Pakistan has simply failed to make enough of a push. Consider, for example, the government’s decision that individuals would be required to produce vaccination certificates before travelling: in reality, such screening is being done sporadically, if at all. Then, there’s the problem of those who refuse to let the vaccinations be administered.

With a WHO review meeting due on Sept 30 regarding the travel advisory, it may well be time to start mulling mechanisms that penalise the refusal to vaccinate; at the very least, we need to seriously step up the vaccination effort.

Published in Dawn, September 22nd, 2014